Pelvic extramedullary hematopoiesis with life-threatening hemorrhage: a case report

Thalassemia is an inherited blood disorder characterized by defective hemoglobin production, leading to chronic anemia and the necessity for lifelong blood transfusions. Extramedullary hematopoiesis is a compensatory mechanism in which blood-producing tissue forms outside the bone marrow. The occurrence of extramedullary hematopoiesis as a pelvic mass is rare.

We report the case of a 44-year-old woman with β-thalassemia major who was found to have a pelvic fat-containing mass incidentally on imaging. A diagnostic laparotomy revealed a highly vascular mass. Complete resection was not feasible due to significant hemorrhage, necessitating postoperative embolization for hemostasis. Histopathological examination confirmed the diagnosis of extramedullary hematopoiesis. Postoperatively, the patient developed severe anemia, requiring frequent transfusions. To reduce transfusion dependency, splenic artery embolization was performed.  CONCLUSION: This case underscores the rare presentation of extramedullary hematopoiesis as a pelvic mass. Accurate diagnosis is critical, as surgical removal can result in severe hemorrhage and worsening anemia. Splenic artery embolization provides a valuable therapeutic approach to managing transfusion burden in such cases.