Hi! Just wanted some input on this situation..... 58 yr old female presented to the ER on Friday, 3/11 with : hemoglobin of 4.4 g/dL, 12.9% BUN 45 mg/dL Creat 2.30 mg/dL Trpn 0.2 ng/mL Total Bili - 0.5 mg/dL The patient is admitted for chest pain, acute renal failure and anemia. She is typed and screened for 2 units of PRBC's. Screen result is negative, crossmatch is compatible (using gel). Plasma appears to be a light gray color as it is slightly lipemic. First unit is issued around 0700, 3/11. Cardiac collected at 1020, 3/11 shows troponin of 0.8, 1620 - 2.1, 2235 - 3.8. Plasma now appears to be a dark brown/green color. Tech questions serum appearance and calls the nurse to check on the status of the patient and is told she is exhibiting no signs of a transfusion reaction (other than chest pain). Over 2 days, the lab observes the patients labwork and notices her: Total bili increases to 2.1 Indirect bili increases from 0.3 to 1.6 BUN increases to 53 LDH is 1909 (haptoglobin levels are being tested now, will update when I get a result) plasma appears to be getting darker/more brown/red color urine shows 4+ hemoglobin with only 2-5 RBC's per high power field Techs start getting worried that the patient is in fact having a transfusion reaction so they repeat the screen (still negative) and perform a Polyspecific DAT (which is negative). The pathologist is contacted just in case. So...what is your thoughts? Is it possible for something along the lines of compliment and we just can't detect it because of the gel being IgG plus the fact that we use EDTA plasma for testing? I have been reading up where a DAT can be negative during a HTR. Is all this just her renal failure/meds? :confused::confused: