Pure red cell aplasia (PRCA) is characterized by near absence of red blood cell precursors in the bone marrow with associated anemia and reticulocytopenia. Megakaryocytes and white blood cell precursors remain intact. Acute self-limited PRCA is the most common form. Acquired chronic PRCA is often idiopathic but can be associated with underlying disorders such as thymoma or autoimmune diseases. Congenital PRCA is associated with physical abnormalities. Pure red blood cell aplasia should always be included in the differential diagnosis of chronic unexplained anemia. We report a case of idiopathic pure red blood cell aplasia in an elderly male who has had a chronic anemia with recurrent blood transfusions for about 30 years.