Pancytopenia in pregnancy

A woman in her 30s presented to the obstetric emergency department with fatigue and light headedness in her third pregnancy at 35 weeks’ gestation. Previous pregnancies resulted in an uneventful vaginal delivery and spontaneous pregnancy loss in the first trimester. There was no history of breathlessness, palpitations, fever, weight loss, chronic condition, or substance use disorder, or family history of blood disorders or malignancy. She had been prescribed oral iron and folate (cobalamin) supplementation according to local antenatal guidelines but took these irregularly. She had a vegetarian diet.

The patient had severe pallor, pedal oedema, and a body mass index of 19. Her pulse rate was 110 beats/min, blood pressure 118/70 mm Hg, respiratory rate 14 breaths/min, and oxygen saturation 98% on room air. Cardiorespiratory and neurological examinations were normal. There was no hepatosplenomegaly on palpation. On obstetric examination, there …