A 31-year-old primigravida at 33 weeks of gestation with precious twin pregnancy was referred from a peripheral hospital with jaundice, malaise and hypoglycaemia. A clinical diagnosis of acute fatty liver of pregnancy progressing to coagulopathy was made. Emergency Caesarean section was performed and obstetric hysterectomy had to be done to control the bleeding. Timely management by obstetrician, anaesthetist and prompt component therapy by transfusion medicine specialist resulted in a successful outcome. The most advocated ratio of transfusing blood products in massive transfusion is 1:1:1 (packed red cells: fresh frozen plasma: platelets).