Pregnancy is a state of physiological hypercoagulability, with an increase in fibrinogen and decrease in fibrinolytic activity, with increasing gestational age.7 8 An expansion in plasma volume results in a physiological decrease in platelets, haematocrit and Hb during pregnancy,7 although the prothrombin time remains largely stable.7 9 10 While the haemostatic changes in normal pregnancy are well described, there have been few investigations of the relationship and potential clinical implications of coagulation abnormalities in association with severe anaemia in pregnant women. This evidence concerns the gene GSTM1 and anemia.