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Anaphylactic reactions are excluded by the presence of red plasma or urine, discordant pretransfusion and posttransfusion ABO blood types, or a positive direct antiglobulin (Coombs) test result. Demonstration of anti-IgA in a pretransfusion sample of the recipient's serum or plasma establishes the diagnosis.
Routine urinalysis can confirm the presence of red blood cells in the urine. The urine can also be tested for infection by sending a sample for culture. Blood tests may be done to check kidney function. If the source of the blood is unclear, a CT scan of the ureters and kidneys may be performed to rule out any stones or structural abnormalities responsible for the blood.