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Twins to mom with hereditary spherocytosis


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We have a patient with hereditary spherocytosis who is pregnant with twins who are due in a few weeks.  We have been notified that the babies could require exchange transfusions due to hyperbilirubinemia from the spherocytosis if they inherit it.  Does anyone have any experience with such a case?  Besides small volume or exchange transfusions of one or more babies, mom is starting with a chronic anemia so will be in more trouble if she bleeds much.  It will be a busy time if everyone needs transfusion, but I wanted to see if there are any concerns I haven't thought of. Fortunately, no antibodies and mom is A pos.

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