A 75-year-old woman, who had been on maintenance hemodialysis (HD) from 2000, was receiving erythro- poiesis stimulating agent (ESA) for renal anemia. In November 2013, although still continuing ESA, she was admitted to our hospital due to worsening anemia. Since blood tests suggested the possibility of hemolytic anemia, we consulted,with hematologists, and she was transferred to another hospital. Differential diagnosis for anemia revealed that she had newly developed Evans syndrome, which is the complication of autoimmune hemolytic ane- mia (AIHA) and idiopathic thrombocytopenic purpura(ITP). She was successfully treated for AIHA with blood transfusion and administration of steroids, and for ITP by eradicating Melicobacter pylort. Anemia is commonly seen in HD patients, and the majority of anemia cases are diagnosed as renal anemia; however, hemolytic anemia should be considered in order to make a differential diagnosis. There are few reports of Evans syndrome in HD, and the pathogenesis of Evans syndrome is largely unknown. Further accumulation of clinical reports is needed to clarify its etiology.
