Background: Complications of Sickle beta thalassemia in pregnancy are underreported. Due to paucity of well controlled studies there are no clear guidelines for management especially with respect to blood transfusion. Here we describe a successful management of sickle beta thalassemia and discuss competing opinions and relevant recommendations.

Case summary: A 28 years old primigravida with previously undiagnosed sickle beta thalassemia had severe anemia and suffered from a crisis episode. She was given blood transfusions after worsening of anaemia and during painful crisis. Her pregnancy was completed successfully till term.

Conclusion: Underutilisation of antenatal services is a problem in India due to which such cases remain undiagnosed. In absence of clear guidelines, obstetricians are faced with the dilemma of selective vs. prophylactic transfusion.