Kawano Michiko, Okamoto Mamiko, Yano Mitsutake, Kawano Yasushi
Department of Obstetrics and Gynecology, Faculty of Medicine, Oita University, Yufu, Oita 879-5593, Japan.
Exp Ther Med. 2022 Sep 12;24(5):669. doi: 10.3892/etm.2022.11605. eCollection 2022 Nov.
Uterine fibroids are associated with heavy menstrual bleeding, abdominal discomfort, subfertility and a reduced quality of life. The present study reported a case series of life-threatening anemia with hemoglobin levels <2.0 g/dl caused by uterine fibroids and genital bleeding. Case 1 was of a 34-year-old woman who was transported to the emergency department of the Department of Obstetrics and Gynecology, Faculty of Medicine, Oita University because of a decline in consciousness level. She had been experiencing excessive and prolonged menstruation for many years but had not sought medical help. A 5-cm uterine submucosal leiomyoma was detected and the patient underwent hysteroscopic myomectomy. Case 2 was of a 36-year-old woman with a history of blood transfusions owing to severe anemia who was presented with progressive dyspnea. Although it was repeatedly explained her that her condition was life threatening, she refused to be hospitalized. Her hemoglobin level was 1.7 g/dl. Multiple uterine fibroids and adenomyosis were detected and total hysterectomy was performed. Case 3 was of a 49-year-old woman who was transported to the emergency department of the Department of Obstetrics and Gynecology, Faculty of Medicine, Oita University due to abdominal pain and severe anemia. Blood testing revealed a hemoglobin level of 1.9 g/dl. Multiple uterine fibroids with a maximum diameter of 8.5 cm were detected. However, the patient insisted on discharge because of lack of disease awareness. Total hysterectomy was performed. The present study is the largest case series showing a detailed clinical course of patients with life-threatening anemia with hemoglobin levels <2.0 g/dl. Additionally, Case 1 of the present series exhibited the lowest hemoglobin level (1.1 g/dl) reported to date. The present cases and a review of the literature suggested that the most important risk factors of life-threatening anemia are the patient's mental, social and personal factors, rather than the organic and functional abnormalities of the uterus.
子宫肌瘤与月经过多、腹部不适、生育力低下及生活质量下降有关。本研究报告了一系列因子宫肌瘤和生殖器出血导致血红蛋白水平<2.0 g/dl的危及生命的贫血病例。病例1为一名34岁女性，因意识水平下降被送往大分大学医学部妇产科急诊室。她多年来一直经历月经量过多和经期延长，但未寻求医疗帮助。检查发现一个5厘米的子宫黏膜下平滑肌瘤，患者接受了宫腔镜子宫肌瘤切除术。病例2为一名36岁女性，因严重贫血有输血史，出现进行性呼吸困难。尽管反复向她解释其病情危及生命，但她拒绝住院。她的血红蛋白水平为1.7 g/dl。检查发现多发性子宫肌瘤和子宫腺肌病，遂行全子宫切除术。病例3为一名49岁女性，因腹痛和严重贫血被送往大分大学医学部妇产科急诊室。血液检查显示血红蛋白水平为1.9 g/dl。检查发现多个最大直径为8.5厘米的子宫肌瘤。然而，由于缺乏疾病意识，患者坚持出院。随后为其进行了全子宫切除术。本研究是最大的病例系列，展示了血红蛋白水平<2.0 g/dl的危及生命的贫血患者的详细临床过程。此外，本系列病例1的血红蛋白水平（1.1 g/dl）是迄今为止报告的最低水平。本病例及文献回顾表明，危及生命的贫血最重要的危险因素是患者的心理、社会和个人因素，而非子宫的器质性和功能性异常。
