Embolization to treat Uterine Fibroids with Bleeding and sev
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Mannat Kaur Bhatia
Embolization to treat Uterine Fibroids with Bleeding and severe Anemia
A 45-year old female 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.

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 LH and 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.

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.
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Dr. C●●●●●●●t K●●r
Dr. C●●●●●●●t K●●r Obstetrics and Gynaecology
Dr Mannat, how were the issues of DVT and pulmonary emboli addressed. And why was she not built up with packed cell transfusions ?
Aug 2, 2017Like
M●●●●t K●●r B●●●●a
M●●●●t K●●r B●●●●a General Medicine
DVT associated with uterine fibroids can rarely be the cause of PE so a pre-hysterectomy IVC filter is placed to reduce risk of post operative pulmonary embolism. Giving anticoagulants for DVT when she had menorrhagia would have resulted in increased vaginal bleeding, which would need stabilisation by packed cell infusions. If her Hb wasn' t so low then immediate anticoagulation followed by UAE and then hysterectomy would have been the ideal course which wasn' t so in this case. This is my opinion on this case, any new insight would be appreciated.... Read more
Aug 3, 2017Like