What is coombs negative hemolytic anemia with large granular lymphocytosis. ?

Multifactoral: Coombs (-) hemolytic anemia means that you have evidence of hemolysis (RBC fragmentation) that is not immune mediated. Potential causes include medications, artificial valves, microangiopathic causes, and disorders involving the RBC membrane, etc. Large granular lymphocytosis may be reactive or represent a leukemia if absolute levels are 2-20,000 and sustained for >6 mo in your peripheral blood.