We present a 35-year-old previously healthy primigravida who presented at 26(4/7) weeks of gestation with pancytopenia and hepatosplenomegaly. She received 10 transfusions and delivered at 34(4/7) weeks of gestation by cesarean section. Two months later following splenectomy, she was diagnosed with malaria. Physicians should have a high index of suspicion for malaria in the context of splenomegaly and pancytopenia in pregnancy even in the absence of fever.