Managing Abnormal Uterine Bleeding in a Patient With Anti-Holley Antibodies and Tranexamic Acid Anaphylaxis: A Case Report

Holley is an antigen of the Dombrock blood group system. Antibodies to Holley antigens, though extremely rare, if present, can result in hemolytic transfusion reactions. This poses a significant clinical challenge for clinicians, especially in patients who are actively bleeding and require blood transfusion. Thus, it is very important for clinicians to be aware of the presence of anti-Holley antibodies and address any management challenges while treating such patients. We report the case of a 47-year-old woman who had anti-Holley antibodies and presented with severe abnormal uterine bleeding (AUB). The patient had critical anemia with active bleeding and needed a blood transfusion, but the presence of anti-Holley antibodies made it challenging to find compatible blood for transfusion. Eventually, the patient underwent an emergency hysterectomy. To make the clinical situation further challenging, the patient developed an anaphylactic reaction to tranexamic acid. The patient was treated for anaphylaxis and subsequently stabilized. The patient was eventually discharged home in a stable condition.