A case of severe macrocytic anaemia caused by cobalamin and folic acid deficiency in a 32 year-old gemellipregnant woman in gestational week 32 +2 is described. Her symptoms and the laboratory data were initially interpreted as HELLP-syndrome (haemolysis, elevated liver enzymes and low platelet count), and caesarean section was performed. None of the persons involved in her earlier prophylactic controls suspected anaemia, and no specific dietary advice were given. If she had received dietary advice early in the pregnancy, anaemia could have been avoided. This emphasizes the need for dietary advice early in pregnancy.