Ravulizumab, the first long‐acting C5 inhibitor, provides immediate, complete, and sustained C5 inhibition for 8 weeks and prevents IVH and thrombosis.2–5 Surgery can exacerbate complement activation[6] and trigger severe IVH and thrombosis in patients with PNH during the perioperative period. Here, C5 is linked to paroxysmal nocturnal hemoglobinuria.