Introduction: Abnormal uterine bleeding (AUB) frequently causes iron deficiency anemia; however, coexistence with thrombocytopenia and uterine anomaly is unusual.

Case Report: A 30-year-old nulligravida presented with severe AUB and marfanoid features. Laboratory evaluation showed iron-deficiency anemia and thrombocytopenia refractory to transfusion. Imaging and intraoperative findings confirmed a bicornuate unicollis uterus with adenomyosis. Total abdominal hysterectomy resulted in normalization of platelet count postoperatively.

Conclusion: Severe AUB out of proportion to typical presentation should raise suspicion of Müllerian anomaly. Definitive surgical management can reverse hematologic abnormalities in select cases.

Keywords: AUB, bicornuate uterus, thrombocytopenia, iron-deficiency anemia, adenomyosis.

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