Baby A's First (and Hopefully Last) Blood Transfusion

Yesterday was the big day for Baby A to get her blood transfusion. I'll spare you the details of the logistics of the whole day, but basically, from noon until 1:30ish, I was prepped, ultrasounded, and brought to the OR where they do C-sections and the other more minor OB surgeries. I had the same nurse as I had for my laser surgery, which was so awesome! Right before we were brought to the OR, my amazing surgeon said that she would be totally fine with Nate coming in with us. I wish I had gotten a picture, but he got to wear a sexy white jumpsuit along with a head covering, mask, and shoe covers. It was quite the sight!

I was given local anesthetic and lots (and lots) of conscious sedation. For my nurse friends, I received 4mg of versed and 300 mcg of fentanyl (which I did not find out until after the procedure.) It was a bit much, and I ended up losing my dinner in the car on the way home, even after receiving 8 mg of zofran and some phenergan. I will be sure to let the next anesthesiologist I see know to take it easy on me! Either way, I felt nice and loopy during the procedure and, even though it took two hours, it seemed like an hour at the most to me.

Prior to surgery, the doctors had seen on ultrasound that there was a spot that they could easily use to enter the umbilical cord by going behind the placenta (and therefore not have to poke a hole through the amniotic membrane). Apparently, during the procedure, they entered the umbilical cord through this route three different times, but they were unable to get the blood transfusion to advance toward baby A, so they had to try a different approach. They ended up poking again (this time through the membrane) and giving the baby 18 mL of packed red blood cells right into her peritoneal cavity (abdomen).

Another thing they did during the procedure was to take blood samples from the baby's cord to determine just how anemic she really was. There were a couple people from the lab stationed in the OR during my procedure. They could test the blood right there so they knew what they were working with... then the doctors could do calculations to determine how much blood they needed to give to get the blood counts back in normal range. They took a couple of different readings... one of them showed that the baby's hematocrit (the percentage of her whole blood that is taken up by red blood cells) was 2% and one of them showed it was 7%. Yikes. I remember hearing this during the procedure and thinking that I must have heard them wrong. To give a little perspective, an adult is somewhere around 40% and a fetus should be somewhere around 50%. Our surgeon explained that babies can handle a low hematocrit for longer than adults, but eventually they go into heart failure just like adults would. There was NO evidence of heart failure for Baby A. Basically, thank God this procedure was done emergently, and we pray that it was done before any serious damage occurred.

Once we got to recovery around 4pm, Nate promptly began his search for the Reese's Peanut Butter Cups that he had promised to get me after the procedure. (Because of the nausea, I didn't end up eating them until after midnight, but oh well.) Our doc came by around 6pm to scan us again, I think just to ease our minds more than anything. The first things she showed us (as always) were their two beating hearts. When looking at Baby A's abdomen, we could see all the extra blood from the blood transfusion. This will be absorbed slowly into her bloodstream, which is why we probably won't see any major changes for a while. We plan to go back Monday for another ultrasound. If the procedure was successful, we would expect that the bloodflow numbers will have improved, but not necessarily that they will be in normal range yet. We will be happy with any improvement we see!

We know that sometimes for babies with TAPS, a blood transfusion is all they need to "reset" the amount of blood that flows in either direction from the placenta. While we are more than willing to do more transfusions or a repeat laser procedure if we need to, we are hoping and praying that this is just what our babies needed to finally BOTH receive the right amount of blood. Thank you again for all your prayers for us and our babies. We love you all!

Nate, Sara, and Babies A and B