Patient Blood Management for a Transfusion Dilemma Associated With a Rare Blood Group: A Case Report

Patient blood management (PBM) is a patient-centered, evidence-based approach aimed at improving outcomes by optimizing and preserving a patient's own blood, particularly when transfusion support is limited. We report a 76-year-old female with congestive heart failure and severe mitral stenosis presenting with severe iron deficiency anemia. Transfusion was not feasible due to an alloantibody against a high-frequency antigen (HFA), later identified as anti‑Inᵇ in a rare In(b-) phenotype. The patient was managed conservatively using PBM principles, including intravenous iron therapy, minimization of blood loss, and optimization of physiological tolerance to anemia through infection control. Hemoglobin levels improved steadily, and the patient remained stable without requiring a transfusion. This case highlights the importance of transfusion services and multidisciplinary collaboration in safely managing severe anemia in patients with rare blood groups/antibodies to HFAs.