Today Philip and I had our first appointment with our High Risk OB Dr. Howard at UT. Some of my friends have asked why I'm having to go to a high risk OB, so here is a short (and long) explanation.
Immunology lesson (I'm a nerd)
This lesson may not be necessary, but it will be helpful to understand the rest of the story.
All the cells in your body are covered in many antigens. Some of these antigens do nothing but identify the cells as "self". Antigens are molecules that stick out of the cell membranes that can be detected by immune system cells like white blood cells. Just picture all of your cells waving flags that proclaim to be "you". This way when bacteria invade your body and they don't have any "self" flags they can be targeted for destruction.
Any foreign cells are targeted for destruction by using antibodies. Antibodies can be thought of as little "flags" that our body makes to identify something as foreign, or needing to be destroyed. When your immune cells see another cell with antibodies on them they know to kill it immediately. There are several different types of antibodies (called immunogobulins) and they each play a role in our ability to fight off foreign cells or substances. Allergies are just an immune response to a particle that is not "self"(some of us see dog hair and dandruff as a threat while others do not).
Two and a half years ago the day after Ethan made his dramatic entrance (emergency C-section due to a prolapsed cord) to the world the pediatrician noticed that his little body was covered in petechiae. After being admitted to the NICU we had a consultation with their hemotologist and we were informed that Ethan had neonatal alloimmune thrombocytopenia. All that really means is that my body made antibodies against little Ethan's platelets because we had a different type and once he was born he was in great danger of spontaneous bleeding because all of his platelets were being destroyed. The hemotologist also told us that it was a miracle that he was born via C-section because that saved him from having bleeding in his brain. You can read Philip's testament of Ethan's second day of life and how God truly blessed us here.
Two years ago Philip and I got our platelets "typed" to make sure that this was the issue, and to see what are chances were of having issues with future pregnancies. Well, Philip is homozygous dominant (1a1a) and I am homozygous recessive (1b1b). If you'll remember your high school biology for a moment and do a quick Punnent square all our our babies will be 1a1b. This means that all of our babies will have platelets that my body sees as foreign or "not self". This is bad because my body will make anti-bodies against the baby's platelets while in utero and the baby could possible have inter-cranial bleeding before he or she is even born.
After Ethan was born he was given treatments of IVIg (Intravenous Immunogobulin G) that helped his platelet count return to normal as fast as possible. It was explained to me that these extra antibodies would attach themselves to the my antibodies in his little body and stop them from marking his platelets for destruction. Our doctor today said that really doctors don't know how IVIg helps this issue, they just know that it does.
Here is our plan of action as outlined by Dr. Howard today:
- Beginning at 18 weeks of gestation (end of January) I will begin weekly IVIg treatments to lower the baby's chance of having low platelets and/or bleeding on the brain.
- We will have extra ultrasounds through out the pregnancy to check to make sure that the baby's brain is not bleeding. Even if this is the case there is not much we can do, but to increase the amount of IVIg I am taking or to add steroids to my drug regiment. Without IVIg treatment bleeding only occurs in 10% of patients and the numbers are not available for patients with treatment because this is such a rare problem, but Dr. Howard seemed optimistic that IVIg "takes care of the problem".
- At 32 weeks we will probably test the baby's platelet count by taking a sample of blood from the umbilical cord. If the platelets are really low the baby can actually be given a transfusion (although that only helps out for a couple of days) and again we will change my drug amounts and/or types.
- The weekly IVIg treatments take about an hour unless I have a reaction to them and I'll try to schedule them while Ethan is in Preschool (which will work until May or so).
- The baby (when born) will have to have his/her platelet count monitored and may have to be admitted to the NICU, but this time we are delivering in a hospital that has one down the hall instead of having our little one across town. UT even has "room-in" NICU rooms where parents can stay with their babies for long periods of time. I don't know if we would be eligible to stay in such a room, but they are available.