Intravenous Imferon masquerading as an acute hemolytic transfusion reaction

The case of a 74-year-old woman with a history of chronic iron deficiency anemia requiring transfusion is reported. Shortly after receiving intravenous iron-dextran, the patient was transfused with two units of crossmatch compatible packed red blood cells and subsequently experienced severe racking chills associated with mild elevation of temperature. In the evaluation of this febrile reaction, her serum exhibited a distinct red-brown discoloration which was interpreted as free hemoglobin. Laboratory studies performed to evaluate the possibility of acute intravascular hemolysis were all within normal limits. Subsequent investigation revealed that the color of the recipients serum was due to iron-dextran. Caution is urged in the evaluation of patients for hemolytic transfusion reactions who have been administered intravenous iron-dextran, since the drug imparts a red-brown tinge to the plasma which may be misinterpreted as free hemoglobin.