Flight Fitness Assessment in a Hajj Pilgrim with Symptomatic Iron-Deficiency Anemia Secondary to Uterine Leiomyoma: A Case Report and Clinical Decision-Making Perspective

Determining flight fitness in Hajj pilgrims with anemia remains challenging because current recommendations largely rely on hemoglobin thresholds while providing limited guidance for integrating laboratory findings with clinical judgement during predeparture screening. Evidence on real-world decision-making in mass gathering medicine remains limited. Case Presentation: A 46-year-old Indonesian woman undergoing final Hajj predeparture screening presented with fatigue, dizziness, pallor, and active menstrual bleeding secondary to uterine leiomyoma. Her hemoglobin decreased from 8.2 g/dL to 7.9 g/dL following intravenous crystalloid administration, likely because of hemodilution. Despite stable hemodynamic status, persistent symptoms, ongoing blood loss, and reduced physiological reserve led to temporary flight deferral and referral for definitive management. Discussion: This case highlights that flight fitness assessment should integrate hemoglobin values with symptom severity, physiological compensation, functional capacity, and travel demands. It also reveals limitations in current screening protocols, including reliance on laboratory thresholds and the lack of standardized clinical decision-support tools. Conclusion: An integrated, patient-centered approach to flight fitness assessment may improve clinical decision-making, patient safety, and Hajj predeparture screening while providing practical insights for travel medicine and mass gathering health.