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The Bombay blood group is a rare blood type discovered in India about fifty years ago, characterized by the absence of the H antigen and the presence of anti-H, anti-A, and anti-B antibodies. It can be mistakenly identified as blood group O, which poses risks for fatal transfusion reactions and hemolytic disease in both, mother and the fetus. This case report describes a young woman with Bombay blood group who presented with acute hemolytic transfusion reaction and intrauterine death of the fetus. She was also suffering from severe preeclampsia which further confounded her clinical findings. She was delivered by Cesarean section and shifted to maternal ICU. Patient developed acute kidney injury and received dialysis for the same. She was discharged in a satisfactory condition and is on regular follow up with nephrology. The above case highlights the importance of recognizing the Bombay blood group, especially in pregnancy, labor, and delivery, emphasizing the need for access to anti-H blood to prevent complications for both mother and child.