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An 84-year-old women had repeated gastrointestinal bleeding from a Dieulafoy lesion, i.e. a gastric or duodenal ulcer containing an aberrant artery. Her blood group was AB-D negative; her Rhesus phenotype was CCdee. In addition, antibody screening revealed anti-c alloantibodies as the result of a previous transfusion. Donors negative for D and c are very rare in Caucasian populations. Compatible red cell concentrates are available only from the European Bank of Frozen Blood of the Council of Europe, located at Sanquin in Amsterdam, Tthe Netherlands. The patient could be saved by requesting compatible erythrocyte concentrate from this blood bank. Severe blood loss poses a serious challenge in patients who are positive for alloantibodies against blood group antigens with a high frequency in the population, and in patients who are themselves negative for such antigens. The presence of alloantibodies is often the result of previous blood transfusions. In view of the large number of antigens on erythrocytes, one should therefore be conservative as to blood transfusion in order to prevent alloantibody formation.

A 45-year-old woman underwent a Caesarean section at a gestational age of over 32 weeks. Screening for irregular erythrocyte antibodies in the transfusion laboratory yielded a positive result. It appeared that the patient had for several years been known to have antibodies against At(a), a high-frequency antigen that may cause severe transfusion reactions when incompatible packed cells are administered. No autologous donated blood was available and the only compatible At(a)-negative unit of packed cells in the Blood Bank of the Council of Europe was damaged during the thawing process. A cell saver was therefore used during the Caesarean section, and family members were summoned for donation. This case report illustrates the necessity of a transfusion plan for pregnant women with (rare) irregular antibodies.