TITLE OF CASE: A rare coincidence of Hashimoto’s thyroiditis and Evans syndrome presenting as transfusion refractory anaemia

Evans syndrome is a rare autoimmune entity comprising of autoimmune haemolytic anaemia with immune thrombocytopenia. It can be associated with a variety of autoimmune conditions, in such cases, it is classified as secondary Evans syndrome. Its association with Hashimoto's thyroiditis is very rare, and a common immunopathogenic overlap might be present between both the conditions. Here, we are reporting a case of an adolescent girl who presented with fatigue, pallor, and menorrhagia for the last two months. She had received multiple blood transfusions but continued to be severely anaemic suggesting the possibility of an ongoing haemolysis. Her haematological workup revealed autoimmune haemolytic anaemia with a positive direct antiglobulin test along with thrombocytopenia. Further work-up revealed Hashimoto's thyroiditis and associated secondary Evans syndrome. We present first such paediatric case in the Indian context along with an outline of diagnostic evaluation and further management.