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Autoimmune hemolytic anemia (AIHA) has been rarely reported worldwide or from India as the underlying cause of anemia in malaria. We hereby present a case of complicated Plasmodium falciparum malaria with concomitant warm AIHA in a 31-year-old male. Direct Antiglobulin Test (DAT) was positive and elution studies showed pan-agglutination reaction. Clinico-hematological and serological follow-up of the patient was done post artesunate treatment until day 9. We suggest that it is important to establish the immune basis of anemia in malaria patients for guiding the treatment plan for the clinicians and providing packed red blood cell transfusion if required.

Aplastic Anaemia (AA) is an immune mediated, primary haematopoietic disorder characterised by pancytopenia with significant morbidity and mortality. Allogeneic Haematopoietic Stem Cell Transplant (HSCT) is the treatment of choice in younger patients whenever Human Leucocyte Antigen (HLA) matched donor is available. For older patients and those in whom matched donor is not available, immunosuppressive therapy is the frontline treatment. With the long survivals of AA patients, clonal evolution into Myelodysplastic Syndrome (MDS) and clinically evident Paraoxysmal Nocturnal Haemoglobinuria (PNH) is frequently seen over a period of 5-10 years. The prognosis and overall survival of post AA, MDS is poor and the only treatment of choice is Allogeneic HSCT. The overall survival of post AA, MDS is however comparable to de novo MDS post-transplant. The authors hereby discuss a case of 26-year-old male patient, known case of AA who evolved into MDS with Excess Blasts 1 (MDS-EB-1) and type III PNH clone over a period of six years.