The current focus of perioperative management of anaemia has shifted from allogeneic transfusion to optimising and conserving the patient’s blood through the implementation of patient blood management (PBM) strategies. We here- by report a case to illustrate the success of applying PBM strategies in managing a surgical patient with an extremely rare red blood cells (RBC) phenotype. An 80-year-old Malay man was planned for urgent major abdominal surgery following diagnosis of intestinal obstruction secondary to an advanced rectosigmoid tumour. A request of two units packed RBC was made given anticipated blood loss intraoperatively. His pre-operative haemoglobin was 135 g/L. His previous immunohaematological record showed that he had an extremely rare P k (P1-, P-, Pk+) phenotype with clinically significant anti-P, anti-PX2, and anti-P1. The elements of PBM strategies were explored and applied. Even- tually, the patient successfully underwent a surgical operation without any allogeneic RBC transfusion.