Obstetric emergency in a patient with Bombay blood group: A case report of ruptured ectopic pregnancy and transfusion challenge

The Bombay (Oh/hh) phenotype lacks the H antigen and is incompatible with all conventional ABO blood groups, making obstetric hemorrhage a major transfusion challenge. We report a case of ruptured ectopic pregnancy in a patient with Bombay blood group to highlight urgent management steps and transfusion logistics. Clinical details, imaging, operative findings, diagnostic blood-group evaluation, and the transfusion course are described for a 26-year-old female who presented with massive hemoperitoneum and profound anemia. Blood grouping and compatibility testing were performed in the transfusion medicine department using standard forward and reverse ABO typing. The patient demonstrated absence of agglutination with anti-H lectin and incompatibility with routine O-group blood units, confirming the Bombay (Oh/hh) phenotype through extended serological evaluation and cross-matching procedures. Emergency laparotomy with right salpingectomy evacuated ~2500 mL hemoperitoneum. Initial compatible donor units were unavailable locally; the patient was stabilized and transferred to a tertiary center where compatible Bombay units were mobilized through rare-donor channels and non-governmental organizations. She received packed red blood cells and plasma, was weaned from vasopressors and ventilatory support, and was discharged stable. Management of obstetric hemorrhage in Bombay phenotype requires immediate surgical control, aggressive resuscitation, early involvement of transfusion medicine, and activation of rare-donor registries/networks. Strengthening rare-donor registries and promoting antenatal identification are key to improving outcomes.