Background/purpose of the study <p>This study was carried out to explore association of pre-eclampsia (PE) with blood cell parameters like red cell distribution width (RDW), platelet distribution width (PDW), Mean platelet volume (MPV) and Neutrophil–Lymphocyte Ratio (NLR) that have been identified to be associated with endothelial dysfunction, systemic inflammation and coagulation disturbances that are considered as key etiological factors for PE.</p> Methods <p>A total of 80 third trimester pre-eclamptic (cases) and 80 normotensive (controls) pregnant women were enrolled in the study. Age and period of gestation were noted. Blood pressure measurements were done. Blood specimen was obtained and sent for evaluation of blood cell parameters, viz<i>.</i>, RDW, PDW, MPV and NLR. Data were assessed using SPSS 26.0 version. Chi-square and t-test were used.</p> Results <p>Mean age and blood pressure of cases were significantly higher as compared to that of controls (<i>p</i> &lt; 0.001). Mean RDW, PDW, MPV and NLR of cases were 14.36 ± 0.71%, 15.84 ± 0.66%, 9.48 ± 0.46&#xa0;fl and 3.42 ± 0.50, respectively, in cases as compared to 11.93 ± 0.53%, 13.47 ± 0.55%, 8.27 ± 0.24&#xa0;fl and 2.70 ± 0.20, respectively, in controls. All the blood cell parameters were significantly higher in cases as compared to that in controls (<i>p</i> &lt; 0.001). A near strong to strong significant correlation of all these parameters was seen with MAP (<i>ρ</i> = 0.658 to 0.769; <i>p</i> &lt; 0.001).</p> Conclusion <p>Red blood cell parameters showed a significant association with PE and its severity.</p>