A 49-year-old previously healthy male was admitted to the hospital with a history of increased dyspnea and fatigue over the course of several weeks. Other history was negative apart from a history of longstanding heartburn that was controlled with proton pump inhibitors and a history of early satiety for the last 1-2 years. There was no family history of malignancy. He was diagnosed with severe anemia (hemoglobin 52 g/L) and his peripheral smear showed schistocytes and polychromasia, as well as nucleated red blood cells (Figure 1). Serum free haptoglobin level was undetectable. Coombs' test was negative, bilirubin and LDH were elevated (73.1 mumol/L [normal < 17.1] and 917 U/L [normal < 225], resp.), and a diagnosis of MAHA was made. In order to rule out an underlying solid tumor, CT scan of the chest, abdomen, and pelvis was performed demonstrating widespread metastatic disease, with thickening of the stomach and a GE junction mass measuring about 6 x 3.2 cm (Figure 2(a)). Gastroscopy was done and confirmed a gastroesophageal junction mass, with the biopsy showing low grade adenocarcinoma.