{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T15:40:01Z","timestamp":1756309201104,"version":"3.44.0"},"reference-count":10,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2018,11,30]]},"published-print":{"date-parts":[[2018,11]]},"abstract":"<jats:p>Anaemia can present with symptoms of fatigue, shortness of breath, weakness, malaise, tachycardia and skin pallor. If left untreated, this can progress to life-threatening complications such as arrhythmias, cardiac hypertrophy and myocardial infarction. In this report, a 43-year-old woman, who was ambulatory with no exertional dysponea, presented with weakness, fatigue, bilateral lower extremity oedema and intermittent right sided chest pain for several months. This patient was subsequently found to have a haemoglobin of 18 g\/L (1.8\u2009g\/dL) and haematocrit of 7.2%. She was admitted to the hospital and treated with seven units of blood. CT scan showed a 9.6\u2009cm uterine fibroid in addition to a 5.9\u00d75.4\u2009cm mass near the right kidney, which was later diagnosed as metastatic carcinoid tumour. This case deserves attention due to the importance of looking for multiple causes of blood loss and the effects of low haemoglobin levels.<\/jats:p>","DOI":"10.1136\/bcr-2018-226000","type":"journal-article","created":{"date-parts":[[2018,12,22]],"date-time":"2018-12-22T15:05:38Z","timestamp":1545491138000},"page":"e226000","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Acute on chronic anaemia with a haemoglobin of 18 g\/L (1.8 g\/dL) and haematocrit of 7.2%"],"prefix":"10.1136","volume":"11","author":[{"given":"Shelly Fay","family":"Haferkamp","sequence":"first","affiliation":[{"name":"Medical Education, Alabama College of Osteopathic Medicine, Dothan, Alabama, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sundar Venkata","family":"Cherukuri","sequence":"additional","affiliation":[{"name":"Medical Education, Alabama College of Osteopathic Medicine, Dothan, Alabama, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sri Laxmi","family":"Valasareddi","sequence":"additional","affiliation":[{"name":"Hematology and Oncology, Southeast Health, Dothan, Alabama, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amith","family":"Skandhan","sequence":"additional","affiliation":[{"name":"Internal Medicine Residency Program, Southeast Health, Dothan, Alabama, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2018,12,22]]},"reference":[{"key":"2025082708072440000_11.1.e226000.1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2008.791"},{"key":"2025082708072440000_11.1.e226000.2","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1016\/0002-9610(66)90281-9","article-title":"Carcinoid tumor of the small intestine associated with acute gastrointestinal hemorrhage","volume":"111","author":"Schwartz","year":"1966","journal-title":"Am J Surg"},{"key":"2025082708072440000_11.1.e226000.3","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2005.03.038"},{"key":"2025082708072440000_11.1.e226000.4","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1213\/XAA.0000000000000132","article-title":"Recovery from extreme hemodilution (hemoglobin level of 0.6 g\/dl) in cadaveric liver transplantation","volume":"4","author":"Kariya","year":"2015","journal-title":"A A Case Rep"},{"key":"2025082708072440000_11.1.e226000.5","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0b013e3181e668b8"},{"key":"2025082708072440000_11.1.e226000.6","first-page":"527","article-title":"Review of physiologic mechanisms in response to anemia","volume":"156","author":"Hebert","year":"1997","journal-title":"Canadian Medical Association"},{"key":"2025082708072440000_11.1.e226000.7","doi-asserted-by":"crossref","first-page":"1372","DOI":"10.1172\/JCI103014","article-title":"The oxygen dissociation curve in anemia of various types","volume":"33","author":"Kennedy","year":"1954","journal-title":"J Clin Invest"},{"key":"2025082708072440000_11.1.e226000.8","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.2004.040329"},{"key":"2025082708072440000_11.1.e226000.9","doi-asserted-by":"publisher","DOI":"10.1177\/107602960401000412"},{"key":"2025082708072440000_11.1.e226000.10","doi-asserted-by":"crossref","first-page":"2533","DOI":"10.2169\/internalmedicine.53.2620","article-title":"Two cases of acute ischemic stroke associated with iron deficiency anemia due to bleeding from uterine fibroids in middle-aged women","volume":"53","author":"Naito","year":"2014","journal-title":"Intern Med"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2018-226000","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T15:07:32Z","timestamp":1756307252000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2018-226000"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,11]]},"references-count":10,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2018,12,22]]},"published-print":{"date-parts":[[2018,11]]}},"alternative-id":["10.1136\/bcr-2018-226000"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2018-226000","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2018,11]]}}}