A 25-year-old male presented with a history of anemia since childhood. Examination found pallor and hepatosplenomegaly. Investigations revealed microcytic hypochromic anemia and bone marrow aspiration showed erythroid hyperplasia consistent with thalassemia intermedia. Patients with thalassemia intermedia have variable clinical presentations between thalassemia major and minor, and may require lifelong monitoring and chelation therapy to manage iron overload from ineffective erythropoiesis.