PT - JOURNAL ARTICLE AU - Shelly Fay Haferkamp AU - Sundar Venkata Cherukuri AU - Sri Laxmi Valasareddi AU - Amith Skandhan TI - Acute on chronic anaemia with a haemoglobin of 18 g/L (1.8 g/dL) and haematocrit of 7.2% AID - 10.1136/bcr-2018-226000 DP - 2018 Nov 01 TA - BMJ Case Reports PG - e226000 VI - 11 IP - 1 4099 - http://casereports.bmj.com/content/11/1/e226000.short 4100 - http://casereports.bmj.com/content/11/1/e226000.full SO - BMJ Case Reports2018 Nov 01; 11 AB - 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 g/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 cm uterine fibroid in addition to a 5.9×5.4 cm 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.