{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,21]],"date-time":"2025-08-21T17:46:19Z","timestamp":1755798379030,"version":"3.44.0"},"reference-count":15,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,7,14]],"date-time":"2025-07-14T00:00:00Z","timestamp":1752451200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Transfusion Medicine"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Individuals with Bombay and para\u2010Bombay red blood cell (RBC) phenotypes produce anti\u2010H antibodies associated with acute haemolytic transfusion reactions. The rarity of compatible donor units creates unique logistical challenges, especially during pregnancy as the onset of labour and fetal distress can occur without warning.<\/jats:p><\/jats:sec><jats:sec><jats:title>Case Report<\/jats:title><jats:p>A 24\u2010year\u2010old female at 38\u2009weeks gestation presented with breech fetal position and reported anti\u2010H antibodies. Critically, the in\u2010house antibody screen was negative by automated solid\u2010phase red cell adherence (SPRCA), while manual testing subsequently demonstrated anti\u2010H antibodies. Forward typing with Ulex europaeus lectin confirmed the absence of H\u2010antigen on RBCs, while Lewis phenotyping and saliva neutralisation revealed H\u2010antigen in secretions, consistent with the para\u2010Bombay phenotype. Three frozen Bombay RBC units were obtained from a nationwide search, and four cross\u2010match compatible non\u2010Bombay (O\u2010positive) units were also prepared. An external cephalic version (ECV) was originally planned since vaginal delivery carries lower bleeding risk than caesarean section (CS). However, acknowledging the unpredictability of ECV, the challenge of timing thawed units, and the possibilities of massive haemorrhage versus wasting rare donor blood, an elective CS was ultimately preferred. Delivery was uneventful without transfusion needs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This case highlights key considerations regarding serologic identification, blood product management, and interdisciplinary clinical decision\u2010making for patients with Bombay and para\u2010Bombay phenotypes. First, automated SPRCA testing may provide false negative results for anti\u2010H antibodies. Second, backup transfusion strategies for para\u2010Bombay patients may include non\u2010Bombay RBCs. Finally, the procurement, preparation, and use of rare blood products requires thoughtful deliberation between multiple care providers.<\/jats:p><\/jats:sec>","DOI":"10.1111\/tme.70000","type":"journal-article","created":{"date-parts":[[2025,7,14]],"date-time":"2025-07-14T12:43:31Z","timestamp":1752497011000},"page":"399-402","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Serologic investigation and management of an antibody screen negative para\u2010Bombay phenotype during pregnancy"],"prefix":"10.1111","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-0565-1682","authenticated-orcid":false,"given":"Yaseen Ali","family":"Jamal","sequence":"first","affiliation":[{"name":"Department of Pathology Stanford University School of Medicine  Stanford California 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