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.

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.