This 23-year-old black female delivered went to her doctor because of chronic fatigue, bone pain, and easy bruising and frequent nose bleeds. Physical exam demonstrated hepatomegaly and splenomegaly and lab results demonstrated anemia and thrombocytopenia. Biopsy and further workup led to a stillborn infant by Caesarean section, following which she experienced excessive uterine bleeding including the passage diagnosis of blood clotsGaucher disease. Further study revealed an enlarged spleen  Despite appropriate therapy the anemia and thrombocytopenia (platelet count 58,000)persisted as well as the severe splenomegaly. A splenectomy was performed with an uneventful postoperative course other than persistent pain in her right leg (the right hip had been fractured 2 years earlier). Subsequently she developed aseptic necrosis The surface of the left femoral head requiring a prosthetic replacementspleen was pale and roughly granular. Microscopic evaluation of the bone removed at the time of surgery The cut surface revealed Gaucher cells in the marrow spacesame pale appearance.