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Pre-birth blood transfusion saves anemic infant

POSTED: January 25, 2009 11:53 p.m.
SARA GUEVARA /The Times

When Nancy Perez, 20, was six months pregnant with son Alan Jesus Gomez, who now is 1 month old, tests showed the baby had severe anemia and his heart was failing. The only way to save him was with a blood transfusion, which was performed Sept. 10 for the first time at Northeast Georgia Medical Center.

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When Alan Jesus Gomez was born on Dec. 24, he looked perfectly normal. But to those who know his history, he represents a Christmas miracle.

Three months earlier, the baby was in danger of dying. His life was spared only because of a medical procedure that was performed while he was still in the womb.

His mother, Nancy Perez of Gainesville, went to the Hall County Health Department on Sept. 8 for a routine checkup. She was startled to learn that a large amount of fluid appeared to have accumulated inside the baby’s body.

Perez was only in her 24th week of pregnancy. The baby would have little chance of survival if he were delivered at that stage.

Perez was referred to Dr. Alex Allaire, a Gainesville perinatologist who handles high-risk pregnancies. He suspected that the baby’s fluid buildup was caused by anemia, a shortage of red blood cells.

"In anemia, the blood is thin like water," said Allaire.

The high volume of fluid was overwhelming the baby’s cardiovascular system, sending him into heart failure.

But Allaire believed he knew what the culprit was.

"The most common cause of anemia in a fetus, if the mother is healthy, is parvovirus," he said.

Allaire emphasizes that this is not the same strain of parvovirus that infects dogs. In humans, a type of parvovirus causes "fifth disease," a mild infection often seen in preschoolers. Kids with fifth disease typically have a rash and symptoms similar to the common cold.

"Most people get it when they’re very young and don’t remember having it, but it gives them immunity," said Allaire. "(Perez) just happened to have not gotten it before."

Adults with fifth disease may have no symptoms. But if a woman is exposed to the virus early in pregnancy, it can be dangerous for the fetus. The virus settles in the fetal bone marrow and disrupts production of red blood cells.

Allaire tested Perez’s amniotic fluid, confirming that she had been exposed to parvovirus.

Later, he inserted a needle into the umbilical vein to sample the baby’s blood. If the test indicated anemia, the baby would need a blood transfusion in order to survive.

Allaire has performed many fetal blood transfusions during his career, but the procedure never had been done before at Northeast Georgia Medical Center.

"All of us were exposed to this (procedure) during our training, but we never had the opportunity to do it ourselves," said Lissa Shirley, the hospital’s blood bank supervisor. "(Allaire) called us several days ahead of time to let us know that he might need to do it. Then we had to borrow a special centrifuge that fit what we needed to do."

Shirley explained that when a fetus is transfused, the blood must be "washed" to get all the plasma out.

"You only want red cells," she said. "You have to make the blood as concentrated as possible because the baby can’t handle much volume."

Spinning the blood in a centrifuge causes red cells to settle to the bottom, where they can be separated from the plasma.

Once that had been done, Allaire used ultrasound guidance to infuse the blood into the baby’s umbilical vein.

"We gave about 40 cc, which was almost half of the baby’s blood volume," he said. "Most of the time, this is enough to allow the bone marrow to regenerate."

By comparison, the pint of blood typically given during an adult transfusion contains about 250 cc.

Allaire said it was lucky that Perez’s pregnancy had reached 24 weeks.

"It’s technically impossible to do this procedure before 18 weeks," he said. "The vein is too small."

Thanks to using the umbilical vein as a handy access point, there was no need to cut into Perez’s abdomen to treat the baby’s condition.

Allaire said there are a handful of hospitals in the U.S. that perform fetal surgery under extreme circumstances. For example, if the developing baby is being suffocated by a large tumor, surgeons may attempt to slice open the uterus, pull the fetus partially out, remove the tumor, and put the baby back inside the womb.

Such procedures still are rare and risky. Allaire said no one in Georgia currently is performing prenatal surgery.

Fortunately, fetal anemia can be treated without an operation.

"Most of the life-threatening things we see prenatally, we can’t do anything about," said Allaire. "This is one of the few that we can."

Almost as soon as he performed the transfusion on Sept. 10, Allaire could tell that it was working and that the baby’s chances of survival had increased tenfold.

"I was very happy to hear that he was going to be all right," said Perez. "I had been very worried because I didn’t know what was going to happen."

The rest of her pregnancy was uneventful.

"She had a normal, natural delivery," Allaire said.

Alan Jesus Gomez came into the world at 1 p.m. on Christmas Eve, weighing 7 pounds, 9 ounces.

A first-time mom, Perez has enjoyed bonding with her new son. To look at the baby, one never would guess that he had been seriously ill.

"He has no health problems at all," said Perez.



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