Background: Pancytopenia characterized by a decrease in all three blood cell lines-erythrocytes, leukocytes, and platelets-presents significant challenges during pregnancy.This condition often arises due to nutritional deficiencies, especially vitamin B12 and folate, associated with low socioeconomic status and poor antenatal care (ANC).This case series highlights the pregnancy management challenges and fetomaternal outcome associated with pancytopenia in pregnancy.Case presentation: Six pregnant women between 19 and 39 years of age presented with pancytopenia were managed at a tertiary care center over 4 months.The cause of nutritional megaloblastic anemia was confirmed via bone marrow aspiration (BMA) in most cases.All the pregnant women had low serum vitamin B12 levels and were vegetarians.Common maternal complications included severe anemia hemoglobin (Hb) 3.1-6.4gm/dL, postpartum hemorrhage, preeclampsia, sepsis, and two cases of maternal mortality.Obstetric management involved timely blood transfusions, parenteral vitamin supplementation, and ICU support in four cases.Fetal complications included intrauterine growth restriction, low birth weight (LBW), neonatal intensive care unit (NICU) admission, and two neonatal deaths.Discussion: This case series reinforces the strong association between vitamin B12 deficiency and pancytopenia in pregnant women with inadequate antenatal care and poor nutritional intake.The clinical spectrum ranged from severe anemia to life-threatening hemorrhagic complications.Early diagnosis, multidisciplinary management, and improved antenatal surveillance are crucial to prevent adverse outcomes.Conclusion: Pancytopenia in pregnancy, though uncommon, is a serious condition often linked to nutritional deficiencies.Regular antenatal screening, including complete hemogram, dietary counseling, and early referral to tertiary care centers, can reduce morbidity and mortality.
Sethi et al. (Fri,) studied this question.