title: A challenging case of pregnancy with placenta accreta and very rare irregular antibodies versus Cromer blood group system: a case report.
abstract: BACKGROUND
  This report describes the challenges of treating a pregnant woman who had a rare case of critical placenta accreta with concurrent Cromer system anti-Tc(a) and anti-Kidd A alloantibodies. No previous case of such alloimmunization in a patient with placenta accreta has been reported.
  
  
  METHODS
  A 28-year-old African woman with anti-Cromer Tc(a) antibodies, anti-Kidd A antibodies and placenta accreta was admitted to the obstetric emergency department at our university hospital with persistent vaginal bleeding. Her rare Cromer blood group system antibodies had been diagnosed 1 month earlier; no compatible blood had been found despite a worldwide search. We performed a cesarean section after placement of Fogarty balloons in her uterine arteries with preoperative endovascular interventional radiology. Other therapeutic interventions included preoperative iron administration to raise hemoglobin and the scheduled predeposit of autologous blood. Intraoperative therapeutic management was aimed at preventing coagulopathy and massive bleeding. With the use of alternative medical techniques determined during perioperative planning, her intraoperative blood loss was only 1000 mL, despite the placenta accreta. She was discharged from the hospital 4 days after cesarean section.
  
  
  CONCLUSIONS
  To the best of our knowledge, this is the first report of an alloimmunized patient with two different alloantibodies and concurrent high risk of bleeding because of placenta accreta. The close collaboration among obstetricians, anesthesiologists, interventional radiologists, blood bank pathologists and intensive care doctors prevented serious consequences in this patient. The exceptional feature of this case is the patient's double risk: the placenta accreta and the inability to transfuse compatible blood. These two extreme situations challenged the multidisciplinary medical team.
authors.affiliation: Cattedra e Servizio di Anestesia e Rianimazione 1, Azienda Ospedaliera Universitaria Policlinico di Modena, Modena, Italy. stefanobusani7@gmail.com.
authors.forename: Stefano
authors.initials: S
authors.lastname: Busani
authors.affiliation: Cattedra e Servizio di Anestesia e Rianimazione 1, Azienda Ospedaliera Universitaria Policlinico di Modena, Modena, Italy. ghirardiniam@virgilio.it.
authors.forename: Annamaria
authors.initials: A
authors.lastname: Ghirardini
authors.affiliation: Reparto di Ostetricia e Ginecologia, Azienda Ospedaliera Universitaria Policlinico di Modena, Modena, Italy. petrella.elisabetta@gmail.com.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Petrella
authors.affiliation: Reparto di Ostetricia e Ginecologia, Azienda Ospedaliera Universitaria Policlinico di Modena, Modena, Italy. neri.isabella@unimore.it.
authors.forename: Isabella
authors.initials: I
authors.lastname: Neri
authors.affiliation: Servizio di Radiologia 1, Azienda Ospedaliera Universitaria Policlinico di Modena, Modena, Italy. federico.casari@me.com.
authors.forename: Federico
authors.initials: F
authors.lastname: Casari
authors.affiliation: Servizio Immunotrasfusionale, Azienda Ospedaliera Universitaria Policlinico di Modena, Modena, Italy. venturelli.donatella@policlinico.mo.it.
authors.forename: Donatella
authors.initials: D
authors.lastname: Venturelli
authors.affiliation: Servizio di Radiologia 1, Azienda Ospedaliera Universitaria Policlinico di Modena, Modena, Italy. desantis.mario@policlinico.mo.it.
authors.forename: Mario
authors.initials: M
authors.lastname: De Santis
authors.affiliation: Servizio Immunotrasfusionale, Azienda Ospedaliera Universitaria Policlinico di Modena, Modena, Italy. montagnani.giuliano@policlinico.mo.it.
authors.forename: Giuliano
authors.initials: G
authors.lastname: Montagnani
authors.affiliation: Reparto di Ostetricia e Ginecologia, Azienda Ospedaliera Universitaria Policlinico di Modena, Modena, Italy. facchinetti.fabio@unimore.it.
authors.forename: Fabio
authors.initials: F
authors.lastname: Facchinetti
authors.affiliation: Cattedra e Servizio di Anestesia e Rianimazione 1, Azienda Ospedaliera Universitaria Policlinico di Modena, Modena, Italy. girardis.massimo@unimore.it.
authors.forename: Massimo
authors.initials: M
authors.lastname: Girardis
mesh_terms: D000328:Adult; D001789:Blood Group Antigens / Q000276:immunology*; D001804:Blood Transfusion, Autologous; D002585:Cesarean Section / Q000379:methods; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D010921:Placenta Accreta / Q000276:immunology*; D011247:Pregnancy; D015641:Radiography, Interventional
chemical_list: D001789:Blood Group Antigens