Autoimmune hemolytic anemia (AIHA) is a class of disorders of antibody- mediated red blood cell destruction. In rare cases, AIHA presents with concurrent reticulocytopenia, resulting in severe anemia due to inability to replenish hemolyzed erythrocytes. In this case, a 24-year-old woman presented with IgG mediated AIHA and marked reticulocytopenia. She required a rapid transfusion protocol and vasopressor support, immunosuppression with rituximab, vincristine, and intravenous immunoglobulin (IVIG), and stimulation of erythrocyte production with darbepoetin. Due to her reticulocytopenia and her inability to replenish her red cells, she had persistent refractory anemia resulting in end-organ damage, underlining the importance of prompt identification and treatment of this condition.