He handed her the notes.
She sucked her teeth. ‘Are you thinking rhesus haemolytic disease?’
‘Looks like it. Mum’s rhesus negative, the baby’s jaundiced and there was definite hepatosplenomegaly when I examined him.’
‘Better get the cord blood tested for blood group and the Coombs test, plus haemoglobin and bilirubin levels.’
* * *
The first two tests would confirm the diagnosis of rhesus haemolytic disease, and the second two would tell them how serious the condition was. Claire shook her head. ‘How on earth was this missed? Rhesus-negative mums are supposed to be tested for D antibodies at booking, twenty-eight weeks and thirty-four weeks. She could have had anti-D injections and the baby would have been fine.’
‘First baby, and she was a bit slapdash about going to the clinic.’ He coughed. ‘Apparently the dad’s rhesus negative as well.’
Claire frowned. ‘If the mum’s blood group is negative and the baby’s blood group is positive, the dad’s must be positive, too.’ Then she bit her lip. ‘Ah. This might get messy,’ she said softly. ‘Want a hand?’
‘Please. She might tell you a bit more than she told me.’
‘Claire the dragon, scaring her into it, you mean?’ she teased.
‘Claire the woman,’ he said. Then wished he hadn’t when she blushed. Very prettily. Because again it made him want to know what she looked like when she’d just been thoroughly kissed. By him. ‘Girl power,’ he said hastily.
‘Right.’ She didn’t say anything, but he had a nasty feeling she’d been able to read his mind. The problem was, he couldn’t read hers. Claire was unattached—Tilly had told him that much—but why? Was it that she’d concentrated on her career and hadn’t met the right man yet?
Well, he wasn’t the right man for her either. Because he came as a package, the kind of package that very few women would be interested in taking on.
‘Estée, this is Claire Thurman, our senior registrar and acting consultant,’ he said.
‘What’s wrong with Miles?’ Estée asked, her face pinched and drawn.
‘We’re doing some blood tests to find out, but Eliot thinks it’s rhesus haemolytic disease. If he’s right...’ Claire took a swift look at the baby ‘...and I’m pretty sure he is, then we can help Miles and he’ll be fine.’
‘What’s rhesus haemolytic disease?’ Estée asked.
‘People’s blood type is grouped into A, AB, B or O, and then it’s either rhesus positive or negative. When you’re pregnant, some of the baby’s red blood cells leak into your system,’ Claire explained. ‘That’s perfectly normal and doesn’t usually matter at all—but if your blood group is rhesus negative and your baby’s blood group is rhesus positive, the leak of blood into your system makes your body produce antibodies. This won’t affect you at all, but it might affect your baby in any future pregnancies, because if any future baby is rhesus positive, the tiniest leak of blood will make your body produce antibodies, which can cross the placenta and attack the baby’s red blood cells. The baby’s red blood cells change in shape and don’t last for as long as they should do, so the baby can become very anaemic and jaundiced. If the baby’s really badly affected, it might turn into a condition known as hydrops fetalis—meaning that the baby’s tissues are very swollen—and there’s a much greater risk of stillbirth. So that’s why, if we knew you’re rhesus negative, we’d give you an injection of something called anti-D, which stops your body producing these antibodies.’
Estée bit her lip. ‘Right.’
‘It doesn’t usually affect first babies,’ Claire said, ‘unless you’ve had a bit of bleeding during your pregnancy, or a threatened miscarriage, or a test such as an amniocentesis. And your midwife really should have tested your blood when she booked you in, plus twice more in later pregnancy.’
‘I’m not good with needles,’ Estée said. She wrinkled her nose. ‘It’s my fault. She said she needed to do it but I kept saying I’d do it next time.’
Claire sat next to Estée and held her hand. ‘Except then you missed your appointments,’ she said gently. ‘Estée, you took a risk with yourself as well as your baby. Antenatal appointments are a way of letting your midwife check that you’re OK during your pregnancy and not developing any conditions such as pre-eclampsia, which could make you or your baby very ill.’
‘But I was really well—I was hardly even sick! I didn’t show until nearly six months...’ Estée chewed her lip again. ‘He will be all right, won’t he?’
‘We’ll do our best. If it is rhesus haemolytic disease, we can give him a transfusion which will take some of the bilirubin out of his blood—that’s the chemical that’s turning him yellow—and help increase his red blood cells, which will get rid of the anaemia. We can also give him light treatment. That just means putting him under a bank of lights which will help with the jaundice.’
‘So he’s not going to die?’
‘Not if I can help it.’ Claire squeezed her hand. ‘But I do need to know a couple of things, Estée. Things that will stay totally confidential, but that will help us to help Miles.’
Estée thought for a moment. ‘All right.’
‘But before we talk, I need a blood sample. I promise you, you’re not going to feel a thing.’
‘She’s brilliant,’ Eliot said. ‘If she can take blood from tiny, fragile premature babies without hurting them, just think how easy it’ll be for you.’
‘I hate needles,’ Estée said.
‘Then turn and talk to Eliot,’ Claire suggested. ‘Tell him all about the nursery you’ve got planned for Miles.’
Eliot came to sit by the other side of Estée’s bed. ‘This is the bit I like. Holding the hand of the prettiest mums,’ he said. ‘It’s nearly as good as cuddling a new baby.’
‘Oh, men!’ Estée said.
Claire gave Eliot the thumbs-up sign.
‘So, what colours are you using?’
‘Yellow,’ Estée said. ‘With teddy bears. I didn’t know if it was a boy or a girl, so I wimped out and played safe.’
‘Sounds great. Babies love teddies.’ He almost swapped confidences and told her that he’d stencilled Ryan’s room with teddies, but he managed to bite the words back at the last moment.
‘All done,’ Claire said, capping the sample.
Estée stared at her in amazement. ‘But—I didn’t even feel it.’
‘I told you so.’ Eliot winked at her. ‘Claire’s the best.’
‘Can you sort the tests, please, Eliot?’ Claire asked.
He nodded and left the room.
‘OK, Estée. Well done for being brave. I hate needles, too,’ Claire said. ‘So, can you tell me, is Miles your first baby?’
‘Yes.’
‘You haven’t had a miscarriage before?’
‘No.’
‘Any bleeding in this pregnancy?’
‘Just a bit of spotting. My friend said it wasn’t anything to worry about so I didn’t bother telling my midwife.’
‘Right.’ The tiny haemorrhage had probably been enough to start the antibodies; in subsequent pregnancies it could take as little as 0.03 ml of the baby’s blood to make Estée’s body produce the antibodies. ‘Do you know your husband’s blood group?’
‘He’s