A 27-year-old woman presented with fatigue, shortness of breath, easy bruising, and a syncopal episode. Laboratory workup revealed hemolytic anemia. A bone marrow biopsy showed hypocellular marrow consistent with aplastic anemia and paroxysmal nocturnal hemoglobinuria (PNH). She was treated with immunosuppression but later developed multiple thromboses. Testing confirmed PNH diagnosis. She received eculizumab therapy which stabilized her hemoglobin levels and reduced transfusion requirements. PNH causes hemolytic anemia due to lack of protective proteins on blood cells, predisposing to complement-mediated destruction and thrombosis.