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Autoimmune hemolytic anemia (AIHA) is characterized by the presence of agglutinins directed against autologous erythrocytes causing their reduced survival. Approximately 20% of AIHA are associated with cold-reactive antibodies. About half of patients are termed idiopathic without any underlying causes. Secondary cases are associated with underlying diseases or with certain drugs. We report herein a case of idiopathic cold autoimmune hemolytic anemia in a 65 year old lady without any underlying cause who presented with grouping discrepancy and responded well to treatment. Blood transfusion was completely avoided by keeping her warm and other conservative management including hematinic. At the time of discharge from the hospital her haematocrit reached 24%. Patient now is being followed as an outpatient and she continues to work daily albeit acro-cyanosis occurs sometimes on exposure to cold water. To our knowledge a careful communication between the transfusion services and clinicians can avoid unnecessary blood transfusions in such cases especially in clinically responding patients.