Busani Stefano, Ghirardini Annamaria, Petrella Elisabetta, Neri Isabella, Casari Federico, Venturelli Donatella, De Santis Mario, Montagnani Giuliano, Facchinetti Fabio, Girardis Massimo
Cattedra e Servizio di Anestesia e Rianimazione 1, Azienda Ospedaliera Universitaria Policlinico di Modena, Modena, Italy.
Reparto di Ostetricia e Ginecologia, Azienda Ospedaliera Universitaria Policlinico di Modena, Modena, Italy.
J Med Case Rep. 2015 May 15;9:112. doi: 10.1186/s13256-015-0607-7.
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.
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.
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.
本报告描述了治疗一名患有罕见的凶险性胎盘植入并同时伴有克罗马系统抗-Tc(a)和抗基德A同种抗体的孕妇所面临的挑战。此前未见有胎盘植入患者发生此类同种免疫的病例报道。
一名28岁的非洲女性，携带抗克罗马Tc(a)抗体、抗基德A抗体及胎盘植入，因持续性阴道出血入住我校医院产科急诊。她罕见的克罗马血型系统抗体在1个月前已被诊断出；尽管在全球范围内进行了搜索，但仍未找到相容的血液。我们在术前进行血管内介入放射治疗，在其子宫动脉中放置福格蒂球囊后进行了剖宫产。其他治疗干预措施包括术前给予铁剂以提高血红蛋白水平以及计划预存自体血。术中治疗管理旨在预防凝血功能障碍和大量出血。通过采用围手术期规划中确定的替代医疗技术，尽管存在胎盘植入，她术中失血量仅为1000毫升。剖宫产术后4天她出院了。
据我们所知，这是首例具有两种不同同种抗体且因胎盘植入而同时存在高出血风险的同种免疫患者的报告。产科医生、麻醉医生、介入放射科医生、血库病理学家和重症监护医生之间的密切合作避免了该患者出现严重后果。该病例的特殊之处在于患者面临双重风险：胎盘植入和无法输注相容血液。这两种极端情况给多学科医疗团队带来了挑战。
