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Case Reports
. 2023 Apr 28:38:e00509.
doi: 10.1016/j.crwh.2023.e00509. eCollection 2023 Jun.

An atypical presentation of endometrial cancer as angina secondary to critically low hemoglobin and iron deficiency associated pancytopenia: A case report

Grace Crawford  1 , Amin Bahabri  1 , Stephanie P'ng  2
Affiliations
Case Reports

An atypical presentation of endometrial cancer as angina secondary to critically low hemoglobin and iron deficiency associated pancytopenia: A case report

Grace Crawford et al. Case Rep Womens Health. .

Abstract

Endometrial cancer is the most common type of gynaecological cancer in high-income countries. Abnormal uterine bleeding (AUB) is the most common symptom of endometrial cancer; however, patients can often present in an atypical fashion. This case is an example of an atypical presentation of endometrial cancer, with angina secondary to severe iron deficiency anemia, and a rare example of pancytopenia secondary to iron deficiency. A 46-year-old nulliparous woman with no past medical history presented to the emergency department with acute chest pain. All her vitals were normal. The ECG showed T-wave inversion with a negative serum troponin. She had obvious pallor but appeared well. She had a critical hemoglobin of 1.9 g/dL and severe iron deficiency with a plasma iron level of <2 μg/L. In the 6 months leading up to her presentation, she had heavy and prolonged menstruation of up to 10 days. She received a total of 6 units of packed red blood cells and an iron infusion. Her chest pain resolved, and her pancytopenia corrected following replenishment of iron stores. She underwent a laparoscopic total hysterectomy, bilateral salpingo-oophorectomy for stage 1b, grade 2 endometroid adenocarcinoma. This is one of the lowest hemoglobin levels recorded in a hemodynamically stable patient with endometrial cancer, and the only case report of iron deficiency induced pancytopenia secondary to abnormal uterine bleeding. This case is a reminder that female patients with angina should have their hemoglobin checked, and patients with anemia should have a thorough review of their gynaecological history.

Keywords: Abnormal uterine bleeding; Angina; Critical anemia; Endometrial cancer; Iron deficiency anemia; Iron deficiency induced pancytopenia.

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Figures

Fig. 1
Fig. 1
ECG at initial presentation showing T-wave inversion.
Fig. 2
Fig. 2
ECG after transfusion, showing resolution of T-wave inversion.
See this image and copyright information in PMC

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