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An 11-year-old girl with Ollier disease was referred to the emergency department by her pediatrician for evaluation of anemia in the setting of 5 weeks of persistent menstrual bleeding. At 10 years old, she was diagnosed with Ollier disease, a condition characterized by multiple benign cartilage-forming tumors, or enchondromas. At that time, patient had presented with height of 129 cm (fifth percentile), worsening leg-length discrepancy, right anterior knee pain, and unilateral genu valgum (knock knees). Given her age >7 years and unilateral, progressive nature of valgus, pathologic (as opposed to physiologic) valgus was suspected. Radiographs showed multifocal enchondromas at the proximal and distal femur (Figure 1), which confirmed the diagnosis of Ollier disease. She underwent a distal femur hemiepiphysiodesis (arrest of the growth plate on the apical side of the deformity) to correct the angular limb deformity. The patient was in her usual state of health until 5 weeks prior to presentation when she experienced menarche. Since then, she had daily, painless, menstrual bleeding. She reported using 3 to 4 pads/day with quarter-sized blood clots. No associated headache, cramping, or dizziness. For the past 5 days, her mother observed new facial pallor and stated that the patient was “too tired” to participate in routine household chores or neighborhood walks. Due to the prolonged duration of menstrual bleeding and other symptoms, the patient presented to her pediatrician 1 day prior to admission. A laboratory workup was significant for severe anemia (Hgb 6.9 g/dL) for which the patient presented to the emergency department. In the emergency department, the patient reported intermittent fatigue and dizziness, but denied any other constitutional symptoms. Ancillary history revealed no personal or family history of bleeding diathesis. Mother and older sister reached menarche at 11-years-old, and her mother experienced 1 spontaneous abortion, but otherwise no family history of abnormal uterine bleeding or recurrent pregnancy loss. The patient’s initial vital signs were notable for tachycardia with heart rate of 114 beats per minute, but otherwise unremarkable (temperature 37.4°C, respiratory rate of 22 breaths per minute, blood 1101733 CPJXXX10.1177/00099228221101733Clinical PediatricsKaneta et al research-article2022