‘Get me out now!’ : Why we are calling James our ‘miracle man’
Most of you are probably aware that we keep calling James our miracle. It’s not purely because of our fertility struggle or even his birth story – there’s more! This blog will describe why James needed to be born when he did, and why he may not have survived just a week longer in the womb. We like to think he paved his own path and essentially saved his own life.
On day one when we visited James in the Neonatal Intensive Care Unit (NICU), the doctors explained he was born with a platelet level of 11. Platelets are a component of the blood essential for clotting, and normal levels are between 140 and 450. Low platelet levels obviously cause bleeding into tissues and subsequent bruising, with severe cases causing uncontrollable haemorrhage. James was born extremely swollen and bruised, mostly around his head and bottom (both of which were ‘stuck’ in my small uterus – his head was up the top and his bum was down in my cervix). He also had petechial (red/purple) spots which are caused by broken capillary blood vessels. The medical staff were describing how each contraction I had would have been like a punch to our poor little man in the womb.
James had immediately received a platelet transfusion overnight but he had not responded – his platelets only rose to 26. The doctors then began questioning whether James had a condition called ‘Neonatal Alloimmune Thrombocytopaenia (NAIT)’. I’m still trying to get my head around this myself, but I’ll have a go at describing it for you with the help of google! James would have inherited platelet antigens from both Scott and myself. James’ specific antigens which were inherited from Scott were recognised by my body as foreign, and I made reactive antibodies which crossed the placenta and subsequently ‘attacked’ James’ platelets. Do not get this confused with RhD (rhesus) negative blood types – this is completely different and relates to platelets rather than red blood cells. NAIT is a relatively uncommon condition which is not routinely tested or screened in pregnancy. When platelet levels fall below 50K it is classified as severe – levels this low generally cause irreversible intracranial haemorrhage (bleeding on the brain), resulting in long-term disability or death. This is where it truly started to sink in just how lucky we were – even the most knowledgeable doctors who really have ‘seen it all’ were calling this a miracle!
The doctors requested Scott and I have our blood tested immediately in order to determine if this was definitely what had caused James’ low platelet levels. In the meantime, they found specific platelets from a donor in Melbourne and had them sent over on ice immediately. They divided this one donor bag into three and gave James a transfusion as soon as they arrived, and his platelet levels began to rise, increasing the likelihood of NAIT. In the meantime, Scott and my blood results confirmed what the doctors had expected – our platelet types were the ‘typical’ setup of NAIT, hence why James required specific platelets the same as mine (which didn’t have the causative antigen) in order to increase his levels. James received the three transfusions which were enough to initially raise his platelets to a ‘normal’ level, but this also meant they had used the supply if they needed to transfuse again. Despite my offering, the doctors were very reluctant to take and use my platelets unless absolutely necessary, as I had just had major surgery and my levels were also depleted due to bleeding. They instead found a donor on the registry in Sydney and contacted her asking her to kindly donate that day in case they were required, and they were again sent over on ice immediately. This is my not so subtle hint to please donate blood if you don’t already – James’ only hope were those specific rare platelets, and we will forever be in debt to those two kind-hearted selfless people who took their time to save a life – and this time it was our little man’s life.
While the transfusions were doing their job, James wasn’t completely out of the woods. The primary injury caused by NAIT is intracranial haemorrhage (bleeding on the brain), so you can imagine our fear considering his head was so bruised and swollen when he was born. All the staff kept reassuring me James was too well, he was acting appropriately and his observations were perfect which largely reduced the chance he had internal bleeding. As a nurse I knew all of this, and as much as I wanted to believe them, it was hard to feel reassured until I had the final all clear. Two days after James was born, an ultrasound of his head was performed, which confirmed our little fighter didn’t have internal bleeding – he was the luckiest little boy in the world. James only required the three initial transfusions, and his platelet levels are now rising as he is slowly producing his own.
Back on that first day in NICU, my favourite doctor and James’ biggest fan (let’s just call him Doctor Awesome) explained to us that James’ early arrival into this world was a blessing in disguise and if he had stayed inside just a little longer his platelets may have depleted completely and caused irreversible (if not fatal) internal bleeding...not to mention that he probably wouldn't have survived a vaginal delivery – even now this news is inconceivable. My case has since been the talk of the nursery. I have had medical students reviewing our case, and the doctors are all unbelievably impressed by our little miracle and how he has held his own. James needed to come early, and we love him for having the courage and strength to do so. He certainly did it in style.
