Multimodality Approach in Salvaging an Anemic Precious Twin Pregnancy Complicated with Multiple Red Cell Alloantibodies and Delayed Hemolytic Transfusion Reaction: A Case Report

A BSTRACT Multi-transfused patients and multiparous patients have a high chance of developing irregular antibodies. This can lead to multiple complications, including delayed hemolytic transfusion reaction (DHTR) jeopardizing the life of both mother and fetus. We report a case of a post in vitro fertilization (IVF) pregnant patient with precious twin pregnancy with symptomatic anemia. Evaluations revealed that the case was complicated by multiple red cell alloantibodies and DHTR, which required a multimodality approach to salvage both the mother and the fetus. The presence of multiple alloantibodies had resulted in such a complex situation that out of 372 O Rh D + packed red blood cell (PRBC) units, only two were found to be antigen-negative and crossmatch compatible. Management also required a course of intravenous immunoglobulin (IVIg), pulse steroid therapy and multiple erythropoietin injections, which supported pregnancy till 30 weeks period of gestation (POG), at which she delivered healthy twins by lower section cesarean section (LSCS).