Background: Iron-deficient anemia (IDA) in pregnant women is a significant health issue globally. Oral iron supplementation is the primary treatment for IDA during pregnancy. For women who do not respond to or cannot tolerate oral iron treatment, intravenous (IV) iron preparations may offer a viable therapeutic option in the third trimester of pregnancy. Ferric carboxymaltose (FCM; Ferinject^®) is an IV iron preparation that allows rapid administration of high single doses of iron with a favorable safety profile. This study evaluated the potential impact of FCM therapy on fetal well-being by recording cardiotocography (CTG) before, during, and after iron infusions. Materials and Methods: We examined 105 women with IDA in the third trimester of pregnancy. During the initial evaluation, each patient was assessed for complete blood count, iron metabolism, B12, folates, hemoglobinopathies, CRP, kidney and liver function, and glucose levels. Each subject received intravenous ferric carboxymaltose (FCM), 500 mg. The study focused on the maternal and fetal safety of FCM infusion. The primary endpoint for maternal safety was the observation of adverse effects of iron infusion. For fetal safety, the primary endpoint was the assessment of CTG. Results: We considered 105 women, comprising 101 singleton and 4 twin pregnancies. The median hemoglobin (Hb) at initial observation was 95 g/L and 117 g/L post-therapy. Regarding maternal safety, side effects were observed during or after FCM infusion in four subjects; three cases involved local symptoms, while one case included nausea and skin rash. Concerning fetal safety, 100% of the cardiotocography records were deemed “normal” using the Dawes–Redman criteria. Conclusions: In conclusion, FCM proved effective in treating anemia in this clinically complex population of pregnant women in the third trimester and appeared safe in this cohort, though larger prospective studies are warranted.

Background: Today, in Western countries, patients with allo-antibodies to high-frequency antigens or with complex antibody mixtures represent one of the most significant challenges in transfusion medicine. Another important aspect is the prevention of allo-immunization of patients who lack high-frequency antigens. In these conditions, the availability of a bank of a rare red blood cell group, supported by a database of donors subjected to extensive erythrocyte typing (preferably using erythrogenomic study), can constitute a resource of great value. Materials and Methods: Repeat Caucasian blood donors of group A or O, with selected Rh phenotypes (CCDee, ccDEE, ccdee, ccDee), aged under 52 years, were considered for typing. Moreover, we selected all non-Caucasian repeat blood donors for typing. For extended phenotyping and genotyping we adopted commercial methods supplied by Grfols and Werfen, respectively. For cryopreservation, we selected a high glycerol method in −80 °C electric freezer; blood unit processing was performed using a Haemonetics ACP 215 automated cell processor with close circuit devices. Results: We considered the five patients as follows: PA was massively transfused for a road trauma, developed multiple allo-antibodies (anti-D, anti-k), and required compatible blood units for an elective cardiac surgery; PB was a pregnant woman with anti-Coa (a high frequency antigen) monitored during pregnancy and in which it was necessary to proceed with the transfusion of the newborn; PC was a poly-transfused patient with myelo dysplastic syndrome who developed multiple allo-antibodies (anti-k, anti-CW, anti-Lea) and required continuous supportive therapy, including the procurement of compatible units and the implementation of therapeutic actions in an attempt to reduce the transfusion requirement using luspatercept; PD was a patient with sickle cell disease. They had a Fy (null) genotype, making it very difficult to find compatible units; and PE was interesting for the complexity of the immunohematological and erythrogenomic study performed to characterize a recipient with a rare phenotype and thus allow the transfusion of compatible units, preventing allo-immunization. Discussion: In this report, we have maintained a narrative approach. Starting with five patients representing as many clinical situations as possible, we have illustrated the approach followed for the immune-hematological study and the choices made to try to guarantee effective and safe transfusion therapy.