Management of a rare red cell antibody in pregnancy

Abstract

Vel is a clinically significant, high incidence blood group antigen. Alloimmunisation of the rare Vel-negative individual (1:4000) with Vel-positive red cells results in the development of anti-Vel antibodies that are associated with severe haemolytic transfusion reactions on re-exposure to Vel-positive blood, necessitating transfusion with exceedingly limited supplies of Vel-negative red cells. We describe a case of patient blood management in a 35-year-old pregnant woman with anti-Vel antibodies and risk for post-partum haemorrhage (PPH). Confirmatory testing for anti-Vel was performed by Lifeblood. There was only one known compatible donor identified in Australia with a very limited inventory of cryopreserved red cells. As the patient was pregnant, autologous collection was not possible. Due to these limitations in supply of Vel-negative red cells, a multifaceted alternative care plan was developed, including: (1) Patient optimisation for delivery, including replacement of haematinic factors; (2) Early anaesthetic and obstetrics involvement was sought in planning delivery; (3) In the event of PPH, a clearly documented prescription of haemostatic products was suggested including upfront cryoprecipitate, platelets, FFP, tranexamic acid, and recombinant Factor VIIa. Fortunately, the patient had an uncomplicated delivery. This case demonstrates the importance of a comprehensive transfusion plan for patients with rare blood groups.