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Case Study: Obstetrics and Gynecology

Embolization to Treat Uterine Fibroids with Bleeding and Severe Anemia

A 45-year old female Jehovah’s Witness patient with a history of uterine fibroids and severe menorrhagia presented with shortness of breath, fatigue and weakness. She also had a history of deep venous thrombosis (DVT) and pulmonary emboli (PE). She was admitted with iron-deficient anemia for workup and treatment. 

After a Hematology consult, the Coumadin she had been taking for her DVT/PE history was discontinued. Gynecology was consulted and she was diagnosed with multiple large fibroids after a transvaginal ultrasound examination. It was determined that a hysterectomy may be needed, but her 3.8 g/dL hemoglobin level upon admission was too low for surgery. She was started on Lupron (Leuprolide acetate), a long acting (depot) injection medication that suppresses secretion of the gonadotropins luteinizing hormone (LH) and follicle-stimulating hormone (FSH), and is thereby helpful in cessation of hemorrhage from uterine fibroids. She was also started on daily, intravenous 200 mg iron sucrose, and was given darbepoetin alpha 25 mcg intravenously weekly. After 3 weeks her hemoglobin level was 5.5 g/dL and she was sent home on monthly Lupron injections and oral iron supplements. She was also followed in our Hematology clinic.

illustration showing uterine artery embolization

Four months later she was admitted again with shortness of breath, fatigue and weakness, this time with a hemoglobin level of 3.8 g/dL. She had missed one treatment in her Lupron regimen, and had started to bleed again. Her ferritin level was 9 ng/mL (normal level for women being 18-160). On her third hospital day she was taken to interventional radiology for a uterine artery fibroid embolization. Two days later she was discharged with a hemoglobin level of 4.9 on oral iron sulfate, 325 mg twice a day. One month later on a follow up visit in the Hematology Clinic her hemoglobin level was 8.0 and she is now off of Lupron and continuing her oral iron supplements.