A 69-year‐old male presented to the hospital emergency department with complaints of fever, dry cough, fatigue and progressive breathlessness for 15 days. He gave history of hypertension but was not on any regular treatment and follow up. On examination he had high blood pressure recording (150/90mm Hg right arm supine) with tachycardia, tachypnoea and was not maintaining oxygen saturation at room air (SpO2 80% on room air). He was febrile (101-degree fahrenheit) and had pallor. Initial laboratory workup on admission showed pancytopenia and deranged serum creatinine of 2.4 mg/dl (findings are summarized in Table 1). It showed total white blood cell count (WBC) 2,100/µL, haemoglobin 2.2gm/dl, platelet count 65,000/µL, urea 46mg/dl, creatinine 2.4mg/dl, total bilirubin 0.8mg/dl, lactate dehydrogenases (LDH) 353IU/L, aspartate aminotransferase (AST) 32U/L and alanine aminotransferase (ALT) 84U/L. His nasopharyngeal swab test for COVID-19 RT-PCR was positive. The chest radiograph showed non homogenous opacities involving left mid and lower zones (Fig. 1). He was diagnosed as a case of severe COVID 19 disease with pancytopenia and was transferred to COVID intensive care unit. He was managed with oxygen therapy, parenteral broad-spectrum antibiotics, packed red blood cell transfusion, injection dexamethasone (6mg IV once a day), antihypertensives, anticoagulant therapy (renal modified dose of injection low molecular weight heparin) and other supportive measures. His inflammatory markers were raised (C‐reaction protein 20.5mg/L, D‐dimer 0.80µg/L, ferritin 900 ng/mL, lactate dehydrogenase 353 IU/L). His iron studies, serum folate and vitamin B12 were within normal range. His coagulation profile was normal. He was evaluated for the possible causes of pancytopenia which included leukaemia, myelodysplastic syndrome, malignancy, bone marrow failure, infections, drug induced bone marrow toxicity, connective tissue diseases and immunosuppressive medications. His serum antinuclear antibody test was negative. Ultrasound of abdomen showed features of bilateral medical renal disease with no organomegaly. Peripheral blood microscopic examination showed pancytopenia and normocytic normochromic anaemia with moderate anisocytosis. No evidence of haemolysis, sepsis or atypia seen (Fig. 2). Bone marrow aspiration and biopsy was done to determine the cause of pancytopenia which showed hypocellular marrow with cellularity less than 20% and increase in fat spaces (Fig. 3). There were focal areas of marrow elements showing trilineage haematopoiesis with markedly diminished myeloid, erythroid and megakaryocytic series. There was no evidence of any leukaemia, myelodysplastic syndrome (MDS), infections or metastatic deposits. Peripheral blood smear and bone marrow microscopic examination was suggestive of pancytopenia with hypocellular bone marrow (Figs. 2 and 3). During the hospital course, three units of packed red blood cells were transfused to the patient. The patient's clinical condition and haematology parameters improved with therapy (Fig. 4). He was discharged on Day 15 with WBC 7,200/ µL, haemoglobin 7gm/dl and platelet count of 1,42,000/ µL. His throat swab for COVID 19 PCR was negative at the time of discharge.