Tehran University of Medical Sciences International Journal of Hematology-Oncology and Stem Cell Research 2008-2207 19 3 2025 07 21 307 309 EN Soniya Abraham Department of Medicine, Division of Hospital Medicine, University of Texas Health Science Center at San Antonio, San Antonio, USA Sana Sultana Department of Medicine, Ramaiah Medical College, Bangalore, India Jay Parekh Department of Medicine, Division of Hematology Oncology, University of Texas Health Science Center at San Antonio, San Antonio, USA 2024 06 13 2025 05 17 Autoimmune hemolytic anemia (AIHA) is the immune mediated destruction of red blood cells leading to anemia. It is a well-known paraneoplastic syndrome in hematological malignancies, particularly lymphoproliferative disorders but rarely reported in solid tumors. In this report, we describe the case of a 79-year-old gentleman who presented with mixed AIHA, initially treated with methylprednisolone and rituximab with improvement in labs.  CT abdomen and pelvis showed a 3.6 cm pancreatic tail mass concerning for neoplasm with splenic vein thrombosis and carcinomatosis. The biopsy revealed pancreatic adenocarcinoma. Methylprednisolone was changed to prednisone and his hemoglobin remained stable throughout the hospital course. This case presents an extremely rare association between AIHA and pancreatic adenocarcinoma.  https://ijhoscr.tums.ac.ir/index.php/ijhoscr/article/view/2263 https://ijhoscr.tums.ac.ir/index.php/ijhoscr/article/download/2263/1097