“…[2] AHTR can present as hypotension, tachycardia, increase in temperature, perspiration, flushing, rashes, bronchospasm, nausea, breathlessness, and palpitation, but in an anesthetized patient, it may present as hypotension, increase in airway pressure, hematuria, and diffuse bleeding due to disseminated intravascular coagulation (DIC) either in combination or alone. [25] In this case, the presence of hematuria was the only clue that led to the suspicion of mismatch transfusion and further evaluation in that direction. Intravascular hemolysis leads to release of Hb which is bound by haptoglobin, hemopexin, and albumin; when the binding capacity of free Hb is exhausted, it will be secreted and reabsorbed in glomeruli; when the absorptive capacity by the glomeruli is exceeded, hemoglobinuria ensues.…”