Severe Iron Deficiency Anemia in a Jehovah's Witness diagnosed with Peutz-Jeghers Syndrome

A 29-year-old woman presented with abdominal pain, nausea, vomiting, and non-bloody diarrhea and was found to have profound microcytic iron deficiency anemia (hemoglobin 4.8 g/dL). Endoscopy and colonoscopy revealed numerous colonic, rectal, and gastric polyps. CT enterography showed multiple large jejunal polyps and a short-segment intussusception without obstruction. Histopathology confirmed hamartomatous polyps, and genetic testing identified a heterozygous pathogenic Serine/threonine kinase 11 (STK11/LKB1) variant, confirming Peutz-Jeghers syndrome. As a Jehovah's Witness, she declined allogenic blood products. A comprehensive transfusion-free anemia management protocol, including intravenous iron dextran, erythropoiesis-stimulating agents, vitamin supplementation, and minimization of iatrogenic blood loss, resulted in hemoglobin to improve to 10.9 g/dL at 4 weeks and 14.0 g/dL at 4 months, enabling elective robotic-assisted jejunal polypectomy. This case highlights Peutz-Jeghers syndrome as an uncommon cause of severe iron deficiency anemia and illustrates a multidisciplinary, ethically sensitive, transfusion-sparing approach to managing life-threatening anemia in a Jehovah's Witness patient.