Abstract
A 49-year-old woman with type 2 diabetes mellitus presented to the emergency department. Her examination showed marked pallor, exhaustion, lethargy, yellowish eyes, anorexia, nausea and vomiting. Laboratory analysis revealed: Hemoglobin (Hb) 4.8 g/dl, MCV 91fl, platelet count 233 × 106 /L, Total bilirubin 7.0 mg/dl, Glucose 316 mg/dl, hematuria and normal G6PD. Hemolytic panel was unswerving with hemolysis. IV fluids and 2 units of packed cell were transfused. Despite transfusion, during the first 4 days of hospitalization the hemolysis continued so that immune hemolysis was suspected in spite of negative coomb's test. After 3 weeks of the patient refer to the hospital, she was discharged home with stable vital signs and Hb10 g/dl. Blood transfusion along with corticosteroids, IVIG and rituximab saved the life of this patient. We concluded in cases that presented with a severe drop in hemoglobin, even if there is a negative direct antiglobulin test (DAT) pay special attention to the immune mediated hemolysis and do not be misled with a negative coomb's test.