Background: Bombay phenotype is rare and case reports of antenatal care in these patients are scarce. We present an even rarer case of a Bombay female pregnant with twins and detail her multidisciplinary management and outcome.

Aims: In conjunction with a literature review of all published cases, we hope this assists other clinicians with their decision making in the antenatal management of this uniquely challenging scenario.

Methods: We describe a case report of a Bombay female pregnant with dichorionic diamniotic twins. We summarise the literature to date to better inform decision making and patient blood management in the antenatal care of Bombay patients.  

Results: Haematinics were optimised to ensure an optimise haemoglobin. Anti-H titres were tracked throughout pregnancy and were 1:256 at both 28 weeks and 36 weeks gestation. Regular middle cerebral artery dopplers were performed to assess for fetal anaemia. There was constant communication with obstetrics and anaesthetics throughout the antenatal period. Both autologous frozen and directly donated fresh red cells were available as part of a clear detailed transfusion plan for the patient (Figure 1). Transfusion was not required and neither child was affected by haemolytic disease of the foetus and newborn. The neonates were blood group O, DAT negative, and blood group A, DAT positive. Maternal anti-A was detected in the neonatal eluate.

Detailed Haemostasis / Transfusion Plan for our twin delivery with Bombay blood group

Conclusions: Bombay phenotype poses unique challenges during pregnancy, particularly when postpartum haemorrhage risk is increased such as twin pregnancy. Through employing patient blood management strategies, engaging a collaborative multidisciplinary approach involving anaesthetics and high risk obstetrics, and a clear detailed delivery plan, these challenges can be surmounted.

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/bombay-phenotype-and-twin-pregnancy-case-report-and-literature-review/