In The Blood
After a special blood transfusion, one mother is able to battle against a rare antibody to have a healthy pregnancy.
by Jeff Balke
Photography by Charles Ford
Until Christmas Day in 2010, DaVonne Christopher’s first pregnancy had been rather unremarkable. But that evening, during dinner, she went into labor, giving birth to son Eli the following day. Though no complications occurred during the delivery itself, the newborn was quickly whisked away by medical staff; he was severely anemic and in need of additional medical care.
The cause was a rare type of U antibody Christopher carries in her blood, which was only discovered after her son was born. “They told me I had the antibody, but I thought it meant
I was getting a cold,” says the 37-year-old. “A doctor said my son needed to be rushed to a local hospital to get a blood transfusion.”
Did you know?
An extremely rare condition affecting only 0.1 percent of mothers, the U antibody anomoly causes the mother’s blood to attack the red blood cells of her child in utero.
The exceedingly unusual condition causes the mother’s blood to attack the red blood cells of her child in utero. Christopher’s U negative blood type is very rare—it only occurs in 1 in 250 African-Americans and is almost never seen in Caucasians. Although a prior screening test for antibodies had been administered to Christopher early in pregnancy, her results came out negative because the antibody did not present itself until delivery.
“During that pregnancy, some of the red blood cells leaked over from the baby and she developed the U antibody, but doctors don’t conduct a second test if the first is negative,” explains Dr. Kenneth J. Moise, Jr., co-director of The Fetal Center at Children’s Memorial Hermann Hospital, and professor in the department of Obstetrics, Gynecology and Reproductive Sciences at McGovern Medical School at UTHealth.
Fortunately, Eli was quickly treated, recovered and has been healthy ever since. Before trying for a second child, however, Christopher and her husband knew they needed to first consult an expert. “I was very apprehensive about having another child,” she says. “It took a long time for me to be okay with it.”
When she did become pregnant, Christopher was referred to Dr. Moise, who specializes in abnormalities affecting mothers and fetuses. Still, the case was a novelty even for him. “She’s only the second patient in 20 years I’ve taken care of [with this condition],” he says.
Unlike Rh disease, which is similar but much more common, there is no treatment for Christopher’s U antibody anomaly. Furthermore, there is a greater risk of complications with a second pregnancy. To guard against them, Dr. Moise informed her that they would need to have blood on hand for a transfusion, in the event Christopher’s antibodies attacked her baby’s red blood cells before or after birth. “But what blood do you use?” he says. “Everybody’s blood is the wrong blood type.”
The first step was to collect two units of blood from Christopher, one of which was given to her baby while in utero. To prevent any potential harm, however, Dr. Moise and his team first treated the blood with a remarkable technique. “The antibodies are in the liquid part of the blood, the plasma,” he explains, “so we washed that out and kept only the red blood cells—the good cells—and gave just the red blood cells through an intrauterine transfusion. Because it’s her blood, she’s not going to attack it.”
Christopher admits she had a hard time understanding the complexities behind Dr. Moise’s treatment regimen. “I still can’t really explain it,” she says, quickly adding that the physician’s patient and thorough approach was a great aid to understanding. “He broke it down for me on a dry erase board.”
Did you know?
It takes about six weeks for a mother’s antibodies to leave her baby’s system after birth.
There were no further complications after the in-utero transfusion, and Christopher gave birth to a healthy daughter, Lena, last October—a great relief to Christopher and her husband, especially given their rocky first birth. “If it weren’t for [Dr. Moise], I don’t think I would have been at ease with this pregnancy,” Christopher says. “I didn’t have to tell myself to stop worrying, I just automatically stopped worrying.”
Dr. Moise says many times mothers with similar types of blood disorders feel guilty because their bodies, in a way, are rejecting their baby. “I tell them it’s a natural process. If they have the flu virus in them, they would make antibodies to the flu virus,” Dr. Moise adds. “The immune system is doing what’s natural.” Today, thanks to proper diagnosis and treatment of their mother’s condition, both of Christopher’s children are healthy and happy, an outcome Dr. Moise says is normal. “In these cases, the baby is sort of an innocent bystander, he/she just has the wrong blood type,” he explains. “Once the mother’s antibodies leave the baby’s system in about six weeks, the baby has no issue.”
Given the rarity of her condition, Christopher was advised by Dr. Moise to freeze some of her own blood, in case she herself ever needs it in the future. And while both of her pregnancies ended well, fetal blood transfusions are extremely tricky, so Dr. Moise is hoping to find ways to avoid them whenever possible. “We are in the process of working on—and eventually hope to have—a medicine, an antibody against an antibody,” he says. “That’s the future.”
These days, between juggling the demands of a newborn, a 6-yearold and a 14-year-old stepdaughter, Christopher has her hands full. So does Dr. Moise, trying to mitigate the effects of mother-child blood disorders and the risky in utero procedures they often necessitate. “I hope before I retire that we’ll talk about intrauterine transfusions as historical events,” he says.
For more information, visit http://childrens.memorialhermann.org/the-fetal-center/