Understanding Life Threatening Anemia Caused by Abnormal Uterine Bleeding A Case Report

Introduction

Abnormal uterine bleeding (AUB) is often dismissed as a common gynecological issue, but in certain cases, it can lead to severe, life-threatening anemia. A recently documented case highlights the urgent need for a multidisciplinary approach in diagnosing and treating such conditions.
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Case Summary

A 40-year-old woman presented with symptoms of malaise, weakness, and tachycardia. She had been experiencing heavy menstrual bleeding for 14 consecutive days. Upon examination:

• Uterine bleeding was confirmed.
• No other pathological findings were identified via transvaginal ultrasound.
• Laboratory tests showed critical anemia:
  • Hemoglobin: 24 g/L
  • Hematocrit: 7.4%
  • RBC count: 0.75 x 10¹²/L

Immediate intervention involved:

• Six units of red blood cell transfusion.
• Administration of tranexamic acid and fresh frozen plasma.
• Surgical curettage.

Histopathology revealed a proliferative endometrium, and post-treatment, the patient’s hemoglobin level improved significantly to 90 g/L.

Read the full study at https://doi.org/10.29328/journal.cjog.1001115.

Broader Implications: The Liver’s Role in Coagulopathy

Interestingly, the patient’s abdominal CT scan revealed alcohol-related liver disease (ARLD), linking her bleeding disorder to impaired liver function.
The American Liver Foundation (ALF) emphasizes that the liver is crucial in producing clotting factors, and damage to the liver increases the risk of coagulopathy.

• Liver dysfunction impacts primary and secondary hemostasis.
• Anemia in this context must be treated through a multidisciplinary approach involving gastroenterologists, anesthesiologists, and hepatologists.

A detailed analysis can be found in our main journal article.

Treatment Strategies for Severe AUB

When managing severe AUB with life-threatening anemia:

• Medical Management:
  • Tranexamic acid, despite concerns over thrombosis risk, remains a first-line agent.
  • Hormonal therapy options include combined oral contraceptives and levonorgestrel-releasing intrauterine devices (LNG-IUDs).
• Surgical Management:
  • Indicated for patients unresponsive to medical treatment or clinically unstable.
• Importantly, treating underlying causes like coagulopathy significantly improves outcomes.

Key Takeaways

• Always investigate for coagulopathy when encountering severe AUB.
• Alcohol abuse can exacerbate bleeding risks through liver dysfunction.
• A multidisciplinary treatment plan ensures better patient outcomes.
• Early intervention with blood transfusions and surgical measures can be lifesaving.

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Conclusion

This case underscores the importance of viewing AUB not merely as a gynecological issue but as a potential systemic emergency requiring collaborative care. Early recognition and tailored interventions save lives.

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