Sideroblastic anemia recurring during two pregnancies

A 25-year-old lady presented with a severe normocytic anemia (Hb 5.3 g/dl) and a sideroblastic marrow at the end of her first pregnancy. Six months into the puerperium, after the transfusion of a total of 8 units of red cells, there was apparent spontaneous improvement and then she was lost to follow-up. After a second pregnancy without clinical problems, she presented during a third pregnancy, at the age of 30 years, with similar hematological findings. Twenty-two months later she was well with a normal blood count. One possible reason for relapse in pregnancy is the increased demand for pyridoxine that occurs, but only one other case of sideroblastic anemia relapsing during pregnancies has been reported.