Introduction: Bicytopenia in pregnancy is a rare entity that poses as a diagnostic challenge. It may present as a combination of anemia, leukopenia or thrombocytopenia. Though bone marrow failure is the commonest cause, nutritional deficiencies need to be ruled out. We report a case of Bicytopenia in pregnancy due to Vitamin B12 deficiency. Case report: A 22 year old primigravida with 29 weeks of gestation presented with severe anemia. On evaluation her haemoglobin was 5.1gm/dl and blood picture showed a mixed population of normocytes, hypochromic red blood cells with macrocytes; normal neutrophil count with hypersegmented neutrophils and diminished platelets. Iron studies were normal and her serum Vitamin B12 levels were low. She was given blood transfusions to improve her hemoglobin. Post transfusion, she set into spontaneous labor and delivered a dead female baby of wt 1kg. Treatment with injectable cyanocobalamin followed by oral multivitamin led to a sustained improvement in the haematological parameters. Discussion: This case demonstrates that B12 deficiency could be a rare cause of bicytopenia in pregnancy. Failure to diagnose and treat could lead to fatal maternal and fetal complications. Early diagnosis of B12 deficiency and supplementation is warranted.