**1. Introduction**

Fetal anemia is a rare condition that can cause fetal hydrops, fetal distress, and eventually fetal death if left untreated. Fetal anemia has many causes. However, the leading cause is an alloimmune disease, and the incidence has been rapidly decreasing owing to the use of immunoglobulins [1]. Nonimmune-related causes include parvovirus B19 infection, fetomaternal hemorrhage, monochorionic pregnancy complications, and other rare diseases [2]. Intrauterine transfusion (IUT) effectively treats fetal alloimmune anemia and nonimmune-related diseases [3]. However, to date, few reports have been published regarding the outcomes of rare diseases that cause fetal anemia. Herein, we report an extremely rare case of fetal anemia associated with Pearson syndrome. Although there was a limit to prenatal diagnosis, this rare mitochondrial disease can cause fetal anemia [4]. This is the first report on fetal anemia caused by mitochondrial disease managed with IUT.
