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Fetal anemia is a potentially life-threatening condition in pregnancy that requires fast and accurate diagnosis, careful monitoring and appropriately timed action. Clinical presentation depends on several factors among which the most important are the etiology, rate of occurrence and the effectiveness of adaptive mechanisms to reduced tissue supply with oxygen. Through the case presentation, we would like to point out the importance of identifying fetal anemia and explain the underlying pathophysiological mechanisms which are the basis for clinical diagnostic investigation procedures.