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Transfusion of incompatible blood is mostly accidental rather than therapeutic. However, at times, we are faced with challenges wherein we need to transfuse incompatible blood. Once such situation arise in autoimmune hemolytic anemia (AIHA) if it leads to severe anemia. Here, we report a case of AIHA with hypoxia and hemodynamic instability requiring urgent transfusion and later diagnosed to have systemic lupus erythematosus. In AIHA, typing and crossmatching are very difficult. Therefore, one should use the least incompatible blood if transfusion is indicated for the risk of hemolysis.