Iron deficiency anemia presenting as pancytopenia in an adolescent girl

Iron deficiency anemia is commonly associated with thrombocytosis and normal leukocyte count. Thrombocytopenia has occasionally been reported in iron deficiency anemia, but pancytopenia is very rare. We present a case of a young female who presented with iron deficiency anemia associated with pancytopenia that improved with iron replenishment after initial deterioration, the mechanism of which is also discussed in this case report. This case illustrates two uncommon associations of a very common disease: severe iron deficiency can be associated with pancytopenia and can be initially worsened by iron replacement despite normal serum B12 and folic acid levels.