Bombay phenotype (Oh) and high‐titer anti‐H in pregnancy: two case reports and a review of the literature

BACKGROUND Antenatal cases of Bombay‐phenotype (Oh) individuals and hemolytic disease of the fetus and newborn (HDFN) are not well described in the literature. We present two case reports of high‐titer anti‐H in pregnant Oh individuals and their serologic investigation, clinical management, and subs...

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Bibliographic Details
Published in:Transfusion (Philadelphia, Pa.) Pa.), 2018-12, Vol.58 (12), p.2766-2772
Main Authors: Bullock, Tom, Win, Nay, Jackson, Barry, Sivarajan, Sharmila, Penny, James, Mir, Naheed
Format: Article
Language:English
Subjects:
ABO Blood-Group System - blood
Adult
Blood
Case reports
Decision making
Doppler effect
Erythroblastosis, Fetal - blood
Erythroblastosis, Fetal - therapy
Female
Fetuses
Genotype & phenotype
Hemoglobin
Hemolytic disease
Humans
Immunoglobulin G
Isoantibodies - blood
Literature reviews
Management
Phenotypes
Pregnancy
Transfusion
Ultrasound
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Summary:BACKGROUND Antenatal cases of Bombay‐phenotype (Oh) individuals and hemolytic disease of the fetus and newborn (HDFN) are not well described in the literature. We present two case reports of high‐titer anti‐H in pregnant Oh individuals and their serologic investigation, clinical management, and subsequent outcomes. We describe current published cases detailing pregnancy in Oh individuals, to add to the evidence base for clinical decision making and management of pregnancy. STUDY DESIGN AND METHODS We describe two case reports of high‐titer anti‐H in pregnancy in Oh individuals. We summarize published cases to date, to inform clinical decision making and antenatal management in individuals with the Bombay phenotype. RESULTS Of the case reports described, neither were affected by HDFN due to anti‐H. Antibody titers were high in both cases (immunoglobulin G titer scores, 512 and 4000, respectively) and would be expected to cause some degree of HDFN, a surprising finding. Regular mean cerebral artery Doppler ultrasound was normal. Patient blood management (PBM) techniques ensured that the patient's hemoglobin (Hb) levels were monitored and maintained. Transfusion intervention was not required, with minimal blood loss recorded at birth in both cases. CONCLUSION High‐titer anti‐H in Oh pregnancies may, in rare cases, cause HDFN, but evidence suggests that this may not be the case in all pregnancies. We recommend a multidisciplinary approach, with prompt referral to a fetomaternal medicine unit, combined with PBM strategies, and a planned delivery with the provision of rare‐phenotype units (if available and if indicated) on standby.
ISSN:0041-1132
1537-2995
DOI:10.1111/trf.14906