Blood transfusion is a common clinical practice in the face of more complicated surgical procedures and in management of injured patients. Despite the apparent benefit that can be obtained from transfusions, several problems must be considered when we use massive cold banked blood. Before and during operation we performed massive transfusion to a patient with shock from hemorrhage due to uterine rupture. We observed a diffuse bleeding tendency and pulmonary changes which strongly suggested the acute respiratory distress syndrome with disseminated intravascular coagulation and that may be one of the most serious complications of massive transfusion.