Objective: To determines the prevalence of red cell antibodies in incompatible cross match cases.Study design: It was a cross-section descriptive study. Method: ABO (forward and reverse) and Rh D grouping of donor and recipient's and serological cross matches are performed using Indirect Antiglobulin test. All incompatible cross match cases are further evaluated in immunohematology. The samples of recipient of incompatible cross match cases are subjected to DAT. Auto control red cell antibody screening and red cell antibody identification panels as required to save the discrepancies in individual cases.Result: Total 37 incompatible cross matches cases performed during the study period. ABO discrepancy was the cause of incompatible cross match in 6 of these cases. The cause of incompatible was autoantibodies in 8, compatible after fresh sample were 9, auto immune hemolytic anemia were 8, and alloantibodies in 14 cases. Conclusion:The IAT cross match is an essential part of compatibility testing before blood transfusion. Antibody screening is not routinely performed on donors or recipients. The cross match incompatible is usually the first indicator of presence of allo/auto antibodies in the recipient serum. The prevalence of 0.105 % of incompatible cross match cases in this study stress the need of IAT cross match before red cell transfusion to avoid the life threating complications. It also signifies the importance of further evaluation of cross match incompatible cases to rule out the presence of significant antibodies.