Albert Wu - Department of Anesthesiology and Reanimation, Faculty of Medicine, Airlangga University - Academic Dr. Soetomo General Hospital, Surabaya, Indonesia
Mariza Fitriati - Department of Anesthesiology and Reanimation, Faculty of Medicine, Airlangga University - Academic Dr. Soetomo General Hospital, Surabaya, Indonesia
Disa Edralyn - Department of Anesthesiology and Reanimation, Faculty of Medicine, Airlangga University - Academic Dr. Soetomo General Hospital, Surabaya, Indonesia
Adriana Jardine - Department of Anesthesiology and Reanimation, Faculty of Medicine, Airlangga University - Academic Dr. Soetomo General Hospital, Surabaya, Indonesia

Objective: Antepartum hemorrhage (APH) is one of the leading causes of maternal and fetalmortality worldwide, complicating ۲–۴% of pregnancies. Considering the probability of bloodtransfusion, blood testing and cross-matching are essential for the anesthesiologist duringperioperative management. Rhesus (Rh) is the second most significant blood group systemafter ABO. Hence, this blood type system needs to be taken into consideration. Furthermore, inIndonesia, Rh-negative blood types are rare.Case Presentation: A ۳۹-year-old woman with Gravida IV, three term pregnancies, no pretermpregnancies, no abortions, and three living children (GIVP۳۰۰۳) and gestational age ۲۶ to ۲۷weeks arrived at the hospital with massive bleeding from the birth canal three hours beforeadmission. The bleeding was fresh red, and the patient had changed diapers twice before arrivingat the hospital. She presented hypovolemic shock, a blood pressure of ۷۱/۳۹ mm Hg, andanemic conjunctivas, with a history of B Rh (-) blood type, ongoing HIV therapy, and completedpulmonary tuberculosis (TB) treatment. The hospital’s and PMI’s (Indonesian Red Cross) bloodbank had no Rh (-) bloodstock. An emergency cesarean section under general anesthesia wasperformed, and a ۹۰۰ g neonate was delivered. The patient received a total of four stored wholeblood (SWB) bags of type B Rh (+) blood products, one SWB bag during surgery, and three SWBbags during recovery in the intensive care unit (ICU).Conclusion: Rh (+) transfusion in patients with Rh (-) should be the last option in an emergency.The transfusion reaction did not occur right away in the initial transfusion. Under promptmanagement, the transfusion response and the life-threatening condition were then successfullymanaged.

Antepartum hemorrhage, Blood transfusion reaction, Emergency, Rhesus negative, Rhesus positive