Gynaecological Disorder with Rare Para-Bombay Phenotype: Challenge in Transfusion Support

Transfusion management in patients with rare blood group phenotypes is a special challenge, especially in surgical cases. We report here the case of a 51-year-old female patient presenting with a huge pseudo-broad ligament fibroid and rare blood group phenotype. Initial serological testing during preoperative workup of the said case revealed BG discrepancies characterized by the O group on cell typing with an extra reaction with pooled 'O' cells on serum typing. A pan-agglutination pattern in antibody screening coupled with a negative direct antiglobulin test and auto-control indicated a Bombay or para-Bombay phenotype. Use of anti-H lectin, saliva secretor study, and antibody screening with cord O cells (Oi) aided in identifying para-Bombay phenotype. Transfusion support in this patient was challenging due to the presence of an anti-IH antibody acting at 37°. One of the major challenges to perioperative care was the unavailability of compatible donor blood units. An autologous transfusion approach was therefore adopted. After the uneventful surgical excision of the fibroid with minimal intraoperative blood loss, one unit of autologous blood was transfused to the patient. This case exemplifies the importance of comprehensive pre-transfusion testing and meticulous planning for patients with rare blood group phenotypes in order to minimize the risk of transfusion reactions and optimize surgical outcomes. Because the rare phenotype of the para-Bombay and transfusion are often problematic, rare donor registries and a heightened degree of clinical awareness will serve to improve patient safety in these instances.