This case report is presenting a girl about two years old that she was admitted to Ali Asghar tertiary pediatric hospital with periorbital edema and petechia and purpura. Her Manifestations were weakness, low appetite, irritability, weight loss, aphasia, from 6 mounts before admission. After evaluation the heart, endocrine, Neurologic system and Genetic consulting it had revealed the exact nature of it. It had diagnosed by a very rare autosomal recessive anemia that is called Thiamin Response Megaloblastic Anemia (TRMA). After 3 years, his brother has been came for similar symptoms and same diagnosis.