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ISSN 3061-8142 (Electronic)

2026, Number 2

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Rev Mex Anest 2026; 49 (2)

Scheduled cesarean delivery in a pregnant woman with irregular antibodies: hematologic optimization and combined neuroaxial anesthesia. Case report

Ángeles-Martínez VA, Santiago-Basurto VS, Aguilar-Silva F

Language: Spanish
References: 28
Page: 121-125
PDF size: 441.54 Kb.


ABSTRACT

The presence of red blood cell antibodies against high-frequency antigens in obstetric patients represents a clinical challenge, particularly anesthetic, due to the difficulty in obtaining compatible blood, the risk of hemolytic complications, and the need to minimize blood loss during surgery. We present the case of a 32-year-old pregnant woman with a history of cesarean section complicated by hemorrhage and transfusion, normoevolutive with normal evolution of pregnancy, and preoperative detection of irregular IgG antibodies against a high-frequency antigen, with no compatible units available. A multidisciplinary approach was implemented, including optimization of erythropoiesis (intravenous iron and vitamin B12), planning of autologous transfusion, identification of a compatible donor, prophylactic hemostatic measures, and an anesthetic plan based on Patient Blood Management (PBM). Combined neuroaxial anesthesia was used with prophylaxis against hypotension (continuous phenylephrine infusion), tranexamic acid (1 g before and 1 g after incision), a cell-saver, and intraoperative viscoelastic monitoring. A favorable maternal-fetal outcome was achieved, with hemodynamic stability, a postoperative pain score of 1/10, and no need for immediate transfusion or hemolytic events. The comprehensive approach enabled a safe outcome in a complex transfusion context, highlighting the key role of anesthesiology in perioperative strategy.


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