A 48-year-old female presented to the emergency department in severe haemorrhagic shock with associated altered mental status. She had suffered severe vaginal blood loss for the past two days. A CT scan did not show any signs of active bleeding, but revealed a large uterine leiomyoma, likely to have caused the severe vaginal blood loss. She was admitted to the intensive care unit for resuscitation with multiple transfusions. The first haemoglobin concentration was 0.9 mmol/l. She developed major cardiac ischaemia and severe acidosis due to the haemorrhagic shock, but survived. Severe anaemia, especially in acute onset due to major haemorrhage, is associated with high mortality and morbidity. In our medical practice to date, we have never encountered such an extreme case of anaemia compatible with life. © 2020, Netherlands Society of Intensive Care. All rights reserved.