The Big "E"

When my doctor told me I had developed E antibodies, he gave me VERY little information. The more questions I asked, the more he repeated the same answers, in the same vague, difficult to understand way. When I left, I wasn't sure if what I had was a disease, or what, so I was a little panicked. All he told me was that I'd probably have to go to a Maternal Fetal Medicine specialist, and the baby would probably have to be delivered premature.

Naturally, I went home and did my own research. There wasn't much out there. I'll give you a synopsis of what I learned, but I'm not a doctor, so cut me some slack. ;-) If you know of anything I got wrong and have a reputable website online to refer me to, please let me know, and I'll be happy to make needed corrections. Here is what I found out:

Our blood type (A, B, AB, and O) are based on the antigens in our blood. Type A has A antigens in it, type B has B antigens in it, etc. If someone who has A blood is given a transfusion containing type B blood, that person's type A blood will see the B antigens in the new blood as foreign, and therefore will probably rally to fight off these new antigens by producing antibodies to attack them. This is why you need to have a matching blood type given to you in a transfusion.

There are other antigens out there. Basically, these antigens are proteins that are attached to your blood cells. As far as E antigens go (and there are big E and little e antigens, each are different), 98 % of the population have ee, while the rest have either EE or Ee. If a mother is ee, and her husband is ee, there is no problem. But if the father is Ee, there is a 50% chance he will pass on the E antigen to his children. If he is EE, there is a 100% chance he will pass it on to his children.

If an ee mother is pregnant with a baby who has E antigens, and their blood somehow mixes during pregnancy or birth, the mother's blood will detect the E antigens, and create E antibodies to fight off the foreign antigens. This isn't a problem when it happens during a first pregnancy. The problem occurs to subsequent pregnancies. If the mother has another baby with E antigens, the mother's blood will recognize the E antigens, and will make even more antibodies to fight off the antigens. Basically, the mother's blood will try to attack and "kill" the baby's blood. If the level of antibodies gets too high, it can be very dangerous to the baby. The baby could die.

There are two ways to be exposed to these antigens. One, as just described, is to be exposed to it by the father, via the baby. The other is if you get a blood transfusion. They're supposed to check blood for antigens, and the blood can be "cleaned" of the antigens before it is given. But I guess mistakes happen, and you can still be exposed to these antigens through transfused blood. The good thing is, if you get it from a transfusion, you can have your husband's blood tested for a simple antibody screening. If your husband is ee, you are in the clear. Your child will not have the E antigen, and therefore your blood will not fight your baby's. As I mentioned before, if your husband is EE, your child will definitely have the E antigen, and if he is Ee, your child might have the E antigen.

If your baby is suspected to have the E antigen, your blood will be tested at least once a month in the beginning of your pregnancy, and more often if the titer levels go up or as the pregnancy gets further along. If the levels rise past a certain point, they might have to do things such as a cordocentesis or amniocentesis. I believe I also read that a intrauterine blood transfusion for the baby may be necessary. If the situation worsens, the baby will need to be delivered early. My doctor told me that they usually like to deliver the babies at 32-36 weeks. 36 weeks isn't too bad, but 32 weeks is pretty early. He can't give me statistics on how often premature deliveries are done, because usually patients with this condition go to a perinatologist, and he doesn't always get feedback on the outcome.

There are other antigens out there that will cause similar problems. The most common one is antigen D. This is the one that is a problem for moms who are Rh-. It is much more dangerous and can cause more problems. However, there is a solution that usually works for D antibodies. Doctors inject the mother with RhoGam, which are D antibodies but they are too big to cross the placental barrier. It fools the mother's blood into thinking that there is no reason to produce more antibodies, because there are already plenty of antibodies to "do the job". Since the injected antibodies are too big to cross the placental barrier, they don't harm the baby. This usually takes care of the problem. There is no injection for mothers with E antibodies, and I don't think there are for the other problematic antibodies out there, like C, etc. Probably because the others are much more rare, and therefore are not profitable enough to bother researching or manufacturing a treatment.

I will be having my husband's blood tested, although it is likely I got exposed to the antigens from him, via my last baby. The antibodies have never been detected in my blood during previous pregnancies, so either I got them from the last baby, or I got a blood transfusion during the last c-section or my hernia operation. I don't remember getting blood, and my doctor says usually they have you sign something informing you of the risks of transfusion and giving you things to look out for. I always read EVERYTHING I sign, so it's unlikely I had a transfusion. But I'd like my husband to be tested just the same. Since antibody screening is pretty routine during pregnancy blood workups, it is unlikely that I had E antibodies before now. Which probably means my husband is Ee, and didn't pass the antigens on to the first three children.

As annoying and worrisome as this complication is, I know that if my husband has E antigens, then I'm blessed that this hasn't happened sooner. Although you know this is just one more thing that the doctors will try to use against me in the future to coerce me to sterilize myself. Sorry docs, I'm not a cat, and that ain't gonna happen! Of course, the first thing my mother says is "see, I knew something like this would happen...your body just can't take all these pregnancies!" My response was "um, mom, didn't you listen to anything I said? This is something that occurred naturally, and could have happened with the first baby. And it might not even cause any problems. There was no way to prevent it." She acts like I broke myself, lol.

I suppose I could have made my husband submit to several health exams and blood screenings to make sure he was "compatible". I can just see it now... "Sorry dear, I love you and I believe God sent you to me because you are the man that will be a wonderful husband and father and lead me and my future children to Heaven...but God made a mistake and gave you the wrong proteins in your blood, so I'm afraid we'll have to call the whole thing off." ROFL!! I mean, I was picky, but I wasn't THAT picky!

I hope you have enjoyed today's lesson on antigens and antibodies. Hey, you could turn this into a homeschooling lesson! Of course you'll have to come up with your own illustrations. ;-) You could make some E antigen and antibody puppets, and make them have a little puppet fight!