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Background: Haematological manifestations are common in SLE, but cytopenias are rarely the only abnormality at diagnosis. Case Summary: We report the case of a 40-year-old woman who was admitted for recurrent anaemia with a 2-month history of constitutional symptoms and no other complaints. Her Full Blood Count (FBC) showed bi-cytopenia, a Haemoglobin level of 4g/dl and a platelet level of 77x103/μl. An Autoimmune serology revealed a positive Antinuclear antibody (ANA) test at 1:2560 and positive SLE antibodies. The diagnosis of SLE was established using the European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) 2019 classification criteria. She was commenced on steroids and Disease Modifying Anti-Rheumatic Drugs (DMARD), and there was a sustained increase in her Haemoglobin and platelet count. She subsequently required no further blood transfusions. Conclusion: SLE can present in a myriad of ways. It is, however, essential to note that haematological features may be the sole manifestation at the time of diagnosis. Early recognition and commencement of appropriate treatment often improve prognosis.