Chronic Abruptio Placentae With Multiple Alloantibodies: An Obstetrician's Challenge.

The current case highlights the management of abruptio placentae in pregnant women with an O Rhesus (Rh)-negative blood group with multiple alloantibodies. We describe a unique case of chronic placental separation in a young primigravida presenting with intrauterine hematoma and intrauterine fetal death (IUFD), who had an O Rhesus-negative blood group with alloimmunization against D, C, and S antigens. The implications in management were the dilemma in diagnosis, the ABO blood grouping discrepancy, multiple alloantibodies including Rh alloimmunization, chronic placental abruption with postpartum hemorrhage, and scope for further pregnancies. Chronic placental separation or abruption can occur silently in some cases. On presentation, they may be mistaken with or for other lesions. In Rh-negative pregnancies, chronic abruption can lead to alloimmunization against Rh and other clinically significant antigens as well. Women with suspicion for chronic abruption must undergo detailed blood group testing as well as immunohematological workup at a nearby transfusion medicine department with a facility for complex immunohematological resolutions.

Antibody screening in multitransfused patients: a prerequisite before each transfusion.

Life-long red blood cell (RBC) transfusions remain the main treatment for severe thalassemia. We hereby report a case of anti S and anti Lu(a) in a ß-thalassemia major patient detected incidentally on antibody screening. The patient was a known case of ß-thalassemia major and was on regular blood transfusion every 3 weeks from the institute from the age of 6 months. Subsequently, on one occasion, patient's crossmatch was compatible despite positive antibody screen using microcolumn gel technique. Autocontrol and direct antiglobulin test were negative on microcolumn gel. Anti S and anti Lu(a) antibodies were identified. Blood unit found compatible was negative for S and Lu(a) antigens. Antibody titers were 1:1 for both anti S and anti Lu(a) in AHG phase using tube technique and antibodies were of IgG type. Blood unit was transfused uneventfully to the patient. Donors were traced back (last three donations) and called for repeat blood sample testing for S and Lu(a) antigen. Two out of three donors were found to be S antigen positive and one out of these two was Lu(a) antigen positive. Anti S and anti Lu(a) antibodies were again identified on patient's subsequent visit for transfusion. The present case re-emphasize the importance of antibody screening at each visit in earlier detection of antibodies in multi transfused patients. Encouraging patients to receive transfusion from one center and dedicating donors could reduce alloimmunization rate but larger studies are required.