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.

Sounds to me like you should only be concerned with the fact that you might be needing 2 exchange transfusions and a bleeding mom to occur at the same time. Busy, but not unmanageable. Maybe make sure you have blood and plasma per your SOP for the exchange in house, and plenty of A pos for mom. Good luck!