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Background: Hemolytic Disease of newborn commonly follows anti- D isoimmunisation. Presence of Inb antibodies is rare and it is challenging to find a matching donor for the mother and baby in such situations. We hereby report a case of combined anti D and Inb isoimmunization in pregnancy. Case history: A 24-year-old third gravida with A negative blood group, presented at 18 weeks gestation with ICT 3+ (1:4 titres). She had previous 2 cesareans, she received both antenatal and postnatal RhDIg prophylaxis as both babies were A positive. Further workup showed DCT negative, ICT pan-reactive 3 and 11 cell panel; with a suspicion of antibody against a high-frequency antigen. Molecular genotyping and antigen workup showed her blood group to be A RhDneg and In(a+b-). Extensive search for compatible donor revealed her brother, who was O negative and In b negative as the only donor available in TN-Puducherry region. She was monitored with weekly anti D and anti Inb titres (1:16 and 1:128 initially), which remained stable; and biweekly USG for MCA PSV and hydrops to look for fetal anemia. At 34weeks, her titres increased to 1:32 and 1:128 respectively, with MCA PSV 1.54 MoM; fetal anemia was suspected. Following a multidisciplinary team discussion, she underwent autologous donation of 300 ml blood prior to Caesarean delivery under maternal and fetal monitoring. She delivered a preterm male baby, weighing 1800gm, by caesarean at 34weeks, without PPH and the blood was transfused in immediate postpartum period. Baby is A Positive, DCT 4 + and received phototherapy and blood transfusion with O Neg blood on PND3. Both mother and baby were doing fine post-operatively and discharged. Conclusion: A close follow up with ICT titres and MCA PSV and watch for fetal hydrops can help in timing delivery in combined Anti D and Anti Inb isoimmunisation.