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The successful application of patient blood management approach in a 48-year-old neurosurgery patient planned for meningioma excision and requiring transfusion is described. The patient had multiple past immunizing events and developed antibody against a high-frequency antigen “e” of the Rh blood group system. With the joint effort from transfusion medicine specialist, anesthesiologist, and surgeon, the patient was successfully managed using the preoperative autologous blood donation program.