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pre womb you take full heart damage in these cases:
getting hit by champion enemies (they're of different colors/sizes)
getting hit by specific enemies, which always deal one full heart of damage (globins are the main ones). explosions also usually deal full heart damage
getting hit under the influence of addicted! pill (the pill makes you take 1 heart of damage for 1 room)
Hmm weird, I definitely had 1 full heart and only got hit by this https://bindingofisaacrebirth.fandom.com/wiki/Maggot
I had no pill used on the room so can't be addicted
Even if it doesn't break from self-damage, do you remember if you've taken damage from another source before entering/leaving one?
That item is the only item from the top of my head that can remove a filled bone heart without outright killing you. Also maybe explains taking massive damage from a non-champion Maggot enemy.