Doctors at Sinai Hospital have performed a series of rare blood transfusion procedures for a patient who wasn’t even born.
It all started when Taneytown resident Stephanie Buckley, who has Rh-negative blood, began searching the internet about her pregnancy. Stephanie had already given birth to two sons who were Rh-positive; the second one had severe jaundice and nearly needed a blood transfusion after birth. That’s when Stephanie learned she was Rh-sensitized, a condition in which her blood had developed antibodies that would attack the red blood cells of any Rh-positive baby she was carrying. Heading into her third pregnancy, her OB/GYN said being Rh-sensitized was a good thing. However Stephanie wasn’t convinced.
“I would Google stuff every night – my husband thought I was nuts – but something just didn’t feel right,” she says.
Because what she was reading online didn’t match what her OB/GYN was telling her, midway through her third pregnancy Stephanie contacted Sinai Hospital’s Institute for Maternal-Fetal Medicine for a second opinion. After reviewing her health history and running some tests, it became apparent that her own blood was fighting her baby’s blood, making the fetus anemic.
According to high risk pregnancy specialist Stephen Contag, M.D., Rh-negative blood is rare, found in only about six percent of pregnant moms. Because Rh-negative blood is so uncommon, it’s usually assumed that the baby is Rh-positive and therefore has blood incompatible with the mother’s. Therefore, Rh-negative moms usually receive shots of Rh immune globulin (RHoGAM) at various points of their pregnancy to prevent their blood from becoming Rh-sensitized. However, without RHoGAM intervention, it’s likely a mother’s blood will develop antibodies that will adversely affect her future pregnancies.
“The public is well-educated about maternal-fetal Rh-incompatibility now,” says Dr. Contag. “All pregnant women get an antibody screen that tells doctors which antibodies are present and at what level.” Armed with this information, if it’s determined that mom is Rh-sensitized, testing to find out if her baby has anemia will begin.
Fetal testing for anemia used to involved amniocentesis, in which a long needle was inserted into the uterus to collect amniotic fluid for examination. Today, there’s a test for fetal anemia that is less invasive and more accurate.
“Using Doppler ultrasound, we can measure the blood flow in a baby’s brain,” explains Dr. Contag. “The faster the blood is flowing, the more watered down the blood is and the fewer red blood cells are present. So when the speed of the blood exceeds a certain rate, we can tell the baby is anemic.” When anemia gets severe enough, a pregnancy can be lost unless medical intervention is taken either through delivery or blood transfusion.
At 28 weeks gestation, it was determined that Stephanie’s baby needed her first transfusion to replace the red blood cells attacked by Stephanie’s Rh-sensitized blood. The transfusion was done in the operating room in case the baby couldn’t tolerate the procedure and an emergency C-section had to be performed.
“We have a well-equipped and prepared team in place because the procedure has to be done in 10 to 15 minutes,” says Dr. Contag.
The fetal blood transfusion procedure started with Stephanie being placed under twilight sedation. She says she didn’t feel anything at all except the initial numbing shot. A sample of 2 ccs of blood was removed from the baby so that her hematocrit, platelets, bilirubin and blood type could be measured. “These measurements allow us to know how much blood we need to give the baby to raise her red blood cells to normal level again,” Dr. Contag says.
Then the transfusion began. Dr. Contag says that a baby’s blood vessels have to be large enough for the needle, which is why fetal blood transfusions can’t be done prior to 22 or 24 weeks gestation or so. Also the blood given to Stephanie’s baby couldn’t be ordinary blood. To be compatible with both mom’s and baby’s blood types, it had to be type O negative – the universal donor blood. It also had to be “washed” to make sure it is free of CNV, a common blood virus, and irradiated to remove all white blood cells to prevent the potential for graft vs. host disease. Finally, it had to be concentrated.
Stephanie’s baby needed fetal blood transfusions every one to two weeks until she was born. After each transfusion, Stephanie had to stay in the hospital for 12 to 24 hours for monitoring. Payton Marie was born healthy, but 5½ weeks early and therefore required time in the NICU. A few weeks after birth, little Payton had another blood transfusion, this time under the guidance of Samuelson Children’s Hospital at Sinai’s pediatric hematologist Yoram Unguru, M.D., who Stephanie describes as “amazing.”
“It feels good knowing I’m here,” says Stephanie. “If it weren’t for Dr. Contag, I probably wouldn’t have been able to sleep at nights. He explained everything, and after seeing how confident he was, so was I.”
- Holly Hosler
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