A Routine Obstetric Management Leading to a Surprising Revelation

Abstract

ABSTRACT The outcome of any obstetric management is often uncertain and sometimes surprises us when least expected. A primigravida at 32 weeks, who reported preterm labor and PROM underwent cesarean section due to non-progress of labor. The per-operative bleeding was more than average. She was transfused with one unit of cross-matched O+ve blood following which there appeared clinical evidence of hematuria. Investigations into this unexpected development revealed that the woman’s blood group was the Bombay group and not O+ve. Bombay blood group is a rare group that is characterized by absent A, B, and H antigens and the presence of anti-A, anti-B, and anti-H antibodies. H antigen acts as a precursor of A and B antigens. During cross-matching, just like O blood group Bombay group will not show any reaction to anti-A and anti-B antibodies. However, when reverse or serum grouping is performed Bombay group will show the presence of anti-H antibody which is not seen in the O group as they have the H antigen. If proper serum grouping/cross-matching is not done for the Bombay group it may lead to serious transfusion reactions.