OPERATING on a patient who is right in front of you is one thing, but operating on a patient you cannot see with the naked eye or actually handle with your hands is nothing short of phenomenal.
Well, within little more than a two-year span, doctors at Victoria Jubilee Hospital in Kingston have managed to execute another near miracle by performing a much-needed blood transfusion on an unborn child whose mother was facing severe pregnancy-related complications.
The surgical team, which comprised two surgeons, nursing staff, junior doctors, and an anaesthesiologist and team are celebrating a “procedure that went really well” with “almost immediate improvement”.
“At this point, mother and baby remain in stable condition and seem to be doing well. We are just continuing her monitoring with hopes of getting baby to the point where it is more mature and able to tolerate life outside of the womb,” obstetrician and gynaecologist Dr Leroy Campbell, who was one of the surgeons who conducted the operation on Tuesday, told the Jamaica Observer yesterday.
Dr Campbell, who was also part of the team which performed the procedure for the first time in 2017, said the patient who had been identified as having Rhesus (Rh) isoimmunisation — a condition that may occur during pregnancy when there is an incompatibility between the mother’s blood type and the baby’s blood type.
“If a Rh-negative patient has blood cells from a Rh-positive person entering her bloodstream, her immune system will recognise that Rh-positive cell as an invader and will begin to produce antibodies, which will attach to the cells and destroy them,” Dr Campbell explained.
“In this particular case, if the woman is ever pregnant with a baby that is Rh-positive, if any of those blood cells happen to leak into the mother’s circulation, the mother’s immune system will react in the same way and produce antibodies to destroy those cells. These antibodies can actually cross over through the placenta and begin to destroy the baby’s red cells. Once this starts, it can continue until the baby becomes anaemic as, because the red cells are being destroyed, the blood count will fall,” the surgeon explained further.
He said, if the anaemia becomes severe, the baby can develop heart failure, or even die in utero.
“Even if the baby survives the delivery, when it is born it may be born with severe jaundice along with anaemia, and that can lead to irreversible brain damage, or even the death of the baby,” Dr Campbell said.
Faced with this reality, the decision was taken to do the procedure.
“In this particular case, because the baby was quite premature, and the added risk of anaemia along with the, with prematurity, would have reduced the chances of survival significantly if the baby was delivered. We thought it best to offer a transfusion,” the doctor shared.
“Using ultrasound within the operating theatre, we identified one of the blood vessels taking blood to the baby and, with the guidance of the ultrasound, we used a special needle to get to the vessel and withdrew blood from that vessel, tested it to confirm that the baby was indeed anaemic, and then transfused blood specially prepared for this purpose based on the level of the baby’s blood count,” he explained further.
Dr Campbell further noted that “if the procedure had not been done, the likely alternative would have been to deliver, and it was highly likely the baby would have succumbed to the condition of prematurity, severe anaemia, and severe jaundice.
“By doing this procedure it is hoped we can give this baby a few more weeks to mature [before delivery], because even two more weeks [inside the womb] can make a world of difference to a baby with this condition,” he added.
In the meantime, he said the success of the procedure was a “win” for the public health service sector and Victoria Jubilee Hospital.
Yesterday, colleague surgeon Dr Clayon Kelly, who was also part of the 2017 surgical team, said steps are being taken to develop a protocol for the hospital to guide future surgeries of the same type.
“In terms of a protocol, this is something we are looking into. There are protocols available overseas, but it is something we will need to look into specifically for our environment, because, of course, some of the resources might not be available to us,” he said.
A protocol essentially involves documenting the step-by-step approach to the procedure and the equipment and instruments needed.
“We have done it before, so it is pretty much to have it formalised on paper, and it would then be available, so once the procedure is going to be done you hand it to the nursing staff so they would know everything you need,” he added.
He said while the team is now monitoring to ensure that the unborn child and the mother remain stable, it was comforted by the fact that the first child on whom they had performed the procedure is alive and well.
“She is well, we see her every now and again — healthy little girl,” he told the Observer.
The medical doctor said, at last check, the cost to do the procedure overseas would be in excess of US$10,000 or more, depending on the specifics of the case, and other costs such as airfare and additional expenses. The Victoria Jubilee Hospital is a public facility and offered the service free of charge.