Often anesthesiologists are experienced to performe the inevitable blood transfusion during massive blood loss. Red blood cells are transfused primarily to increase transport of oxygen to tissues. An increase in the circulating red cell mass produces an increase in oxygen uptake in the lungs and a corresponding probable increase in oxygen delivery to tissues. However, tissue hypoxia may develop from infusion of stored blood due to leftward shift in the oxygen dissociation curve especially massive transfusion. And dilutional thrombocytopenia is probably the most likely cause of a hemorrhagic diathesis in a patient who has received multiple units of bank blood. The deposited fibrin may severely alter the microcirculation and lead to ischemic necrosis in various organs, particulary the kidney, especially derranged hemodynamic conditions are exist. A case ofacute renal failure due to massive blood loss during gastrectomy was reviewed.