Bombay blood and the 'Swab-Lite' method of blood conservation

Bombay blood (hh blood) is a rare blood group (4 per million), with no expression of the H antigen present in blood group O. Bombay blood patients can only receive Bombay blood, with autodonation used for elective surgery. We present a Bombay patient (haemoglobin 12.1 g/dL) who needed urgent coronary artery bypass graft surgery. In order to try and avoid transfusion, we used a multidisciplinary approach as well as the use of 'no swabs' (swab/gauze/sponge), until cardiopulmonary bypass was established. This 'experiment' demonstrates that using fewer swabs may be a simple reproducible action that may reduce the need for transfusion, which is especially useful when dealing with a patient of such a rare blood group.