Antoinette Williams of Jamaica was 29 weeks into her fifth pregnancy when her baby became dangerously anemic from Rh disease, a fairly common condition that is highly preventable in the United States and is caused by an incompatibility of blood between the mother and baby.
Without a fetal blood transfusion, however, the baby had only a 50 percent chance of survival.
With each pregnancy, the mother’s body attacks the baby’s red blood cells more aggressively, which commonly makes each subsequent fetus more anemic earlier in the pregnancy. Rh disease doesn’t affect the mother, so it is nearly undetectable without regular checkups.
Only a handful of doctors are trained to perform a fetal blood transfusion, so it’s not uncommon for mothers to travel beyond state boundaries for the procedure. The Neonatal Intensive Care Unit at the Victoria Jubilee Hospital in Jamaica didn’t have the resources to reverse the anemia. Such a procedure had never been done in Jamaica before.
Kelly had spent a month in 2016 in the United States learning more about fetal therapy from Paek and then returned to Jamaica. As a doctor who loves to teach, Paek eagerly jumped in, searching for solutions to ensure Williams would get the procedure.
“It’s a great procedure because you can see tangible, immediate results.”
“We looked into the cost of bringing her out here (to Kirkland), but as a noninsured patient, she’d have to pay with cash, and it was cost-prohibitive,” she said. “We talked to doctors in the U.S. and they could have flown down there, but it would have been expensive. I decided I would just do it right then. What they needed was someone like me who could show them how to do the actual procedure and to show them what they would need.”
The NICU had almost all the required equipment and the team in Jamaica prepped everything for Paek’s arrival. She flew down on a Tuesday in June and met with the Williams family and did the procedure the next day. A fetal blood transfusion requires extensive skill and experience, but other than an ultrasound machine, it doesn’t require advanced equipment, Paek said. The procedure was first performed in the 1950s, when the baby was given blood into the abdomen. With the help of better ultrasound machines, doctors can now check blood flow in an unborn baby’s brain to detect anemia, and the transfusion can be given directly into a tiny vein in the umbilical cord.
“You can imagine a bowl of Jell-O with a spaghetti noodle suspended in it,” Paek said. “So you’re trying to go through the bowl of Jell-O and get to the spaghetti.”
From start to finish, the procedure took only about 15 minutes, she said, and the baby’s blood flow went back to normal immediately. Williams was kept in the hospital overnight for observation, and the transfusion was enough to keep the baby healthy until she was delivered seven weeks later. Paek said most fetuses with Rh disease need a transfusion every three weeks, and the most she’s done in one pregnancy is seven.
Within her two-day trip, Paek likely saved the baby and became the first to perform a fetal blood transfusion in Jamaica.
“I won’t lie; it was pretty cool,” she said of the accomplishment. “It’s a great procedure because you can see tangible, immediate results … it’s such a fixable thing that for someone who does procedures, it feels very gratifying to do. And I was able to teach outreach. It’s just awesome.”
Paek said she’d be willing to fly back to Jamaica to teach the medical team how to do the transfusion and would like to be there to back them up during their next case.
“They have such a good setup,” she said. “They have well-trained doctors; they just need some training. I think they’ll be able to do it in the future.”