Abstract
Cold agglutinin-induced hemolytic anemia presents diagnostic and management challenges, particularly in resource-limited settings like Pakistan. A 92-year-old male presented with altered consciousness, fever, weakness, and severe asthenia. Laboratory findings revealed severe anemia, elevated mean corpuscular volume, and deranged renal function tests. The diagnosis was confirmed via a positive Direct Coombs test and elevated cold agglutinin titers. Multidisciplinary management led to symptom resolution, including blood transfusions and immunosuppressive therapy. This case report and literature review emphasize the complexities of diagnosing and managing cold agglutinin-induced hemolytic anemia in Pakistan. By enhancing awareness and understanding of this condition, clinicians can optimize patient outcomes through timely intervention and multidisciplinary care.