An 84-year-old female with unresectable, PD-L1–high (combined positive score [CPS] = 55) advanced gastric adenocarcinoma developed a rare case of recurrent immune checkpoint inhibitor associated autoimmune hemolytic anemia and thrombocytopenia after sequential treatment with three ICIs: sintilimab (anti–PD-1), cadonilimab (a bispecific PD-1/CTLA-4 antibody), and ivonescimab (a bispecific PD-1/VEGF antibody). Here, CTLA4 is linked to autoimmune hemolytic anemia.