Iron Deficiency Anemia (H...

A 40-year-old woman was admitted to the intensive care unit for heavy vaginal bleeding lasting four days, associated with lightheadedness, palpitation, weakness, and fatigue. She reported a seven-year history of uterine leomyomas that caused recurrent episodes of menorrhagia. Physical examination disclosed a blood pressure of 110/70 mmHg, a heart rate of 105 bpm, a respiratory rate of 18 breaths/min, and a temperature of 98℉. She appeared pale; no icterus, petechiae, ecchymosis, or purpuric lesions were noted. A cardiac examination revealed a cardiac grade 2/6 to 3/6 systolic flow murmur. The liver span was 9 cm, and non a palpable spleen. Her Hemoglobin level (3.5 g/dL) and platelet count (30,000/mm3). Mean corpuscular volume (56.6 femtolitres) and Red cell distribution width (37.6). Reticulocyte (1.3%.). Iron studies revealed serum iron (27 µg/dL), serum ferritin (7.79 ng/dL), serum transferring (419.9 mg/dL), and percent saturation was 4%. The peripheral blood smear showed marked microcytic hypochromic cells with decreased numbers of platelets. Ultrasound of the pelvis showed an anteverted uterus with heterogeneous parenchyma and calcified anterior myoma and 0.44 cm echo-dense wall thickness with adenomyosis.