Our Miracle Baby - Understanding APAS

Photography by Arvin Cruz for Scene Zone e-magazine.

In the baby-making world, it seems like there is nothing as dreaded as the APAS word. Prior to getting pregnant, I had no clue about it, no inkling that such a terminology exists. I have heard some stories of a mother’s blood attacking the fetus or the sperm, and while shocked at first that situations like that actually occur, I would just sadly empathise, murmur a “kawawa naman”, then move on to my next thought agenda for the day, the couple being talked about shelved, the condition noted yet forgotten.

Until I found out that I have APAS too.

Joey and I are very thankful for our OB, Dra. Eileen Manalo. As soon as we stepped into her clinic with our wonderful news of a natural conception, after checking me and confirming that we were indeed 4 weeks and 4 days pregnant, she immediately asked me to undergo immunological blood tests, saying that these were tests usually underwent by those who’ve had miscarriages, but given my history of two failed IUIs, she wanted to have me checked as early as possible for anything we should be prepared for. The prescription she gave was filled with LAT, TSH, IgG/M, and a list of other acronyms I had no clue of. 

I immediately scheduled for tests a few days after. It was a good thing that Joey went with me, as I had no idea that his blood was also actually needed, haha! So there we were at the clinic, sitting for nearly three hours (a glucose test was included), and hoping that everything would be fine.

Six days after our first checkup, we went back to Dra. and showed her the partial results. She referred us to an immunologist, Dr. CJ Gloria, and asked us to see him. We didn’t get to do so because at the time, it seemed like a recommendation more than a necessity.

Blocking Antibodies

On April 25, armed with the complete blood test results, we saw Dra. Manalo again. This time, upon seeing our lymphocyte antibody test, she insisted that we see Dr. Gloria immediately. She explained that I didn’t have “blocking antibodies”, that our baby doesn’t have a “protective helmet”, and while both Joey and I were bewildered by this and wondered what exactly she meant, we scheduled to see Dr. Gloria the week after. She also prescribed aspirin for me.

And I thought the negative results were good, hehe!

On May 4, everything became a bit clearer as Dr. Gloria explained my immunology results. He said that while I didn’t have bad antibodies that can harm the baby, I didn’t have good ones that protect either. He prescribed probiotics for that, 5 billion initially for the first month, then increasing to 30 billion a day. He said I was to take them everyday even up to my next pregnancy, just to ensure that my body would produce good antibodies to protect our current baby, and to prepare for the future one.

Had I known how important probiotics were, I would have taken them in huge doses much, much earlier!!

Blood Too Thick

Seeing my coagulation test report (DRVVT), he said that my blood’s clotting time was too fast, that I had thrombophilia. As per Wikipedia, “thrombophilia (sometimes hypercoagulability or a prothrombotic state) is an abnormality of blood coagulation that increases the risk of thrombosis (blood clots in blood vessels).” Since the nutrients from the mother are transferred to the baby via the blood, you wouldn’t want it to be thick or you’d risk the baby not getting enough nutrition. He said it was good of Dra. Manalo to prescribe aspirin for me early on, which meant she suspected I needed it, but that another blood thinner was needed to work with aspirin. 

This medicine is heparin. I was to inject it on my subcutaneous fat everyday, initial prescription for twenty days. When I went to the drugstore to purchase it, I was astounded by the price - it retailed at P478 per piece! - thereafter I called Joey and told him that we were going to be spending a lot for the next couple of weeks, but hopefully not for my entire pregnancy.

On our subsequent checkup with Dr. Gloria, he advised us to continue with heparin until two weeks before delivery, as a precaution. I’ve been injecting myself initially, which resulted to bruises on my belly, but then discovered that our Manang Klim knows how. She injects into my bum nowadays, but sometimes, I still inject in my belly as I prefer doing it myself. This is a picture of bruising on my tenth week, other women have it worse :(

Natural Killer Cells

The last result that Dr. Gloria pointed out to me were my slightly elevated natural killer cells. (Tunog pa lang, kontrabida na noh? Hehe!) He said that to have high levels of it isn’t good, they might attack the baby. On this he asked me to keep him abreast of all my ultrasound examinations, particularly that of our baby’s heartbeat, because that’s when we’ll know if this was something we had to worry about.  

My NK cells levels were at 22.61%, 1.61% higher than normal.

I left his office feeling slightly overwhelmed yet at the same time assured. Not once did Dr. Gloria mention APAS. Or maybe he did but my preggo brain just didn’t absorb it.

On May 7, our tenth week of pregnancy, I was back in Dra. Manalo’s clinic. She asked me what medicines Dr. Gloria prescribed for me, nodding as she listened. When she checked my womb she saw that I had subchorionic hemorrhage, though there was no external bleeding, and advised me to take it easy. I reported this to Dr. Gloria, and he said to continue with the aspirin and heparin. If the hemorrhage were to persist, I was advised to do a repeat test of my natural killer cells levels.

I asked my Ninang Gloria Liwanag’s opinion (she’s a Lucena-based OB), seeking to understand what caused this hemorrhage and how to help alleviate it. She said that stress is usually a factor in hemorrhages, and that it would naturally go away as long as I’m well-rested. She advised me to go on bedrest just to be sure, and to refrain from going up and down the stairs. And so for two weeks I lived in our second floor bedroom, cancelled all my shows, and K-drama marathoned, hehe.

Two weeks after on May 21st, there was no more hemorrhage (praise God!! No need for another NK cells test!). On June 1st (14th week), we heard our baby’s fast, strong heartbeat for the first time <3 (take that, NK cells!). June 15, I was asked to go on a high-protein diet because our baby is a few days’ short of her supposed gestational age and to keep lying on my left side for optimal circulation. July 15 (20th week), we found out it’s a Lilibubs! July 24 (21st week), I felt her move for the first time (it felt like farting on the inside, haha!) On Aug 6 (23rd week), we went for the mandatory congenital anomaly scan and we thank God over and over because Lilibubs is healthy and everything’s normal and my placenta is finally high-lying and my blood sugar levels are still good! I was asked to continue with my high-protein diet though, because Lilibubs was just in the 16th percentile at the time of the scan. I’ve been having two-three egg whites everyday since then, and feasting on edamame, cheese, meat, and quinoa.

We took advantage of this and asked permission from Dra. Manalo if she’ll allow me to fly to Bacolod. She did, provided I continued to take all my meds (multivitamins, iron, calcium, folic acid, duphaston twice a day, utrogestan, probiotics twice a day, metformin three times a day, aspirin and heparin), and to keep in mind that APAS patients are more prone to miscarriages and/or complications.

There it was again, that word, APAS.

Dense me just never really took it seriously. Whenever Dra. Manalo would say that she was treating me as APAS, I just thought she meant that I was being treated extra carefully. Since our first ultrasound with her we’ve been checking in every two weeks, as opposed to others who went on monthly visits. We didn’t mind because we liked seeing Lilibubs often. 

But as it turns out, I AM an APAS patient, and I DO need to be treated with more caution than usual. It took my joining the APAS group on Facebook to finally realise and understand, lol.

I was added to the group last August 25. In a welcome message containing literature, house rules, success stories, and tips on how to inject heparin, among others, I found out that Joey and I, my blood’s reaction to his, fell under not one, but three of the APAS categories.

First up, WHAT is APAS?

"Antiphospholipid antibody syndrome (APAS) is a group of clinical manifestations associated with the presence of high levels of antiphospholipid antibodies (APA) in the blood of the affected individual. It is associated with recurrent thromboses (formation of blood clots) in the venous or arterial circulation."

Source: https://www.myvmc.com/diseases/antiphospholipid-antibody-syndrome-apas/

Clinical nosebleed right there, haha. Jillianne Castillo, in an article for Smart Parenting last August 9, 2016, put it in much simpler terms:

"APS (or APAS) is an autoimmune disorder.

An autoimmune disorder occurs when the body’s immune system makes abnormal antibodies that attack and damage tissues or cells. Antibodies help defend the body against infection, but in the case of APS, the antibodies attack the body. 

As an autoimmune disorder, APS occurs when the body makes antibodies that mistakenly attack phospholipids, a type of fat that’s found in the blood. This then causes blood clots to form in veins and arteries, which can lead to numerous problems and complications. APS affects three to five times as many women as men. 

It can cause pregnancy complications like miscarriage or stillbirth." 

Source: https://www.smartparenting.com.ph/pregnancy/health-nutrition/pregnancy-and-aps-what-you-need-to-know-a1162-20160809

Savannah Lovis, in a post dated October 18, 2016, summed up the five categories the best:

“There are five categories when a woman undergoes immunological testing. 

Category I is the Leukocyte Antibody Test (LAT). This means that the body of the woman lacks the blocking antibodies needed to stop your own immune system from rejecting your baby. When the DNA of the wife is similar to the DNA of the husband, the body fails to form a protective shield around the fetus, exposing it to the attack of your own immune system. Lymphocyte Immunization Therapy or LIT helps treat this condition by having the husband’s blood plus other donors’ blood injected into the wife. This is why the love, patience, and support of the husband is tremendously important—even more than in normal pregnancies—when a couple has APAS.

For Category II, the proteins in antiphospholipid antibodies glue themselves to the body’s cell membranes. Because this becomes all sticky and forms blood clots, the blood then fails to flow properly, putting the baby at risk. These antibodies attack the placenta and endanger the life of the baby. Most women with Category II often take aspirin or do self-injections of heparin into their bodies as blood thinners or anticoagulants.

Antinuclear Antibodies (ANAs) for Category III concern the nucleus of the cell. They attack the cells inside the womb of the mother and the fertilized egg, hindering implantation and causing a miscarriage. 

As for Category IV, fertilization itself is blocked because the Anti-sperm Antibodies hold off the sperm of the husband from doing what they do best. And when there are no sperm cells that successfully make it to their destination, there is no baby.

Finally, Category V tells of Elevated Natural Killer Cells or NK cells. Even though Natural Killer cells in our white blood cells are highly crucial for our bodies to conquer bad infections and sicknesses like cancer, when these levels are elevated more than normal, they become aggressive and fight off pregnancy as well. All these sound too overwhelming because they are—and more and more women are going through this ordeal every day.”

Source: https://www.facebook.com/groups/allaboutapasandRID/permalink/1505833516097285/?__tn__=K-R

Category 1 - no blocking antibodies. Category 2 - thrombophilia. Category 5 - elevated natural killer cells. 

Three out of five applied to us - bam!

Yet still, even with all these, the Lord granted unto us a child. Walang APAS-APAS sa Kanya! <3 Knowing that I have this condition just impressed on me all the more how much of a miracle our Lilibubs is. 

Joey and I are fortunate in that we found out about these three conditions early, therefore, we got treated early as well. We are lucky that there was no need for us to undergo LIT. We are thankful that until now, Lilibubs is doing well size-wise. And we are grateful for the Lord’s provision that allows us to buy all of these medicines for the whole duration of our pregnancy.

My heart goes out to those who don’t have the means.. who suffer miscarriage after miscarriage, heartbreak after heartbreak.. to those who may have been waiting a long time for a child perhaps not knowing that they have APAS. I wish God had never allowed these immunological disorders to happen, but as with everything in life, we are in no position to question, only to accept and obey, though we may do so with grieving hearts at the beginning..

And to think that:

“Contrary to what many people believe in, APAS is not the only repro-immuno disorder out there. In fact, APAS is only one of the five immune disorders that cause recurrent miscarriages in women.” Balot Del Rosario shares this in her blog, http://callmebalot.com/all-about-apas/apas-fertility-disorders/ . “I think the term was just generalized because the other categories don’t have the acronyms to encapsulate the condition.”

I remember explaining all these to my 63yo mother. I remember her shaking her head and exclaiming, “Ang dami nang ganyan-ganyan ngayon. Dati ‘pag di ka makabuo, baog ka. Yun na yun.”

We are lucky to be living in a modern world that can detect anomalies at the cellular level, and to have medicine that can effectively help prevent miscarriages. At the same time, armed with this knowledge, it is our responsibility to be more considerate of our words and actions. WE NEVER KNOW WHO IS HAVING A HARD TIME AND WHO IS DEALING WITH WHAT. Let us all strive to live more compassionately. Let us LOVE, ladies and gentlemen, fellow human beings, and let us bear with each other.

My heart and prayers go to all my fellow APAS patients. May God bless and protect our babies, and for those who are waiting in between medications, may He grant you His perfect peace as you wait for His will.

“Yet God has made everything beautiful for its own time.” Ecclesiastes 3:11 (NLT)

Blessed be and bossa love,

Sitti

Me and my belly at 24 weeks :)