Background Leeches are blood sucking hermaphroditic parasites belonged to the phylum Annelida of the class Hirudinea. Based on the location of leech infestation, the patient may present with anemia and respiratory symptoms. Even though Leech infestation is mentioned as common problem in African countries and the common cause of anemia, especially in children but it is not mentioned as a cause of severe anemia in an infant. Case Presentation In this paper, we are reporting a 10 months old baby presented to Debre Tabor General Hospital with nasal bleeding and blood tingled vomiting of four days duration. With the diagnosis of severe anemia secondary to leech infestation, she was transfused with 360 mL of whole blood and the leech was removed from the oropharynx with McGill forceps. She was followed for 48 hours. There was no ongoing bleeding; the vital signs became stable, and then patient’s parents were advised to boil drinking water before use. Finally, the infant discharged with improvement. Conclusion and Recommendation We concluded that leech infestation should be included as the differential diagnosis of an infant presented with nasal bleeding and blood tingled vomiting who came from rural areas.