Emergency dilatation and curettage in a patient with Bombay blood group

Bombay blood group is a rare autosomal recessive phenotype within the ABO blood group. It represents genetically suppressed A, B and H genes. When considering such patients for transfusion, only blood of identical Bombay type can be safely transfused. We are reporting a patient having Bombay phenotypic blood, underwent emergency dilatation and curettage with active per vaginal bleeding due to retained products of placenta. There are numerous anaesthetic considerations, including emergency surgery with hemodynamic instability due to ongoing blood loss, dilutional coagulopathy as well as presence of Bombay phenotype that severely limit the possibility of red blood cell transfusion. Only four donors were registered with the blood bank of the institution and none was traceable. It becomes a real challenge for the anesthesiologist to manage such type of patients without having units of red packed cell which management is described hereby.