A 40-year-old male patient presented to the emergency department with complaints of anasarca, mild dyspnea, orthopnea, vomiting, and decreased urine output. A provisional diagnosis of chronic kidney disease was made and planned for hemodialysis. In view of severe anemia, 1 packed red blood cell (PRBC) was requested and after pretransfusion testing one unit of buffy coat-poor, nonleucofiltered, coombs cross-match compatible, fresh (<7-days old) saline-adenine-glucose-mannitol PRBC unit was issued. After transfusion of around 20 ml of red cells patient developed sudden onset of excruciating pain in the lower back and hip joints, tachypnea, and breathlessness with oxygen saturation dropping to 82%. Vitals were normal and patient remained afebrile. After stopping transfusion, supplemental oxygen and opioid analgesic were given. Once the symptoms subsided, transfusion was completed. A complete work-up was done to rule out other adverse reactions. Thus, this patient experienced what is known as an acute pain transfusion reaction.