Neonatal hemochromatosis in monochorionic twins

Abstract

Neonatal hemochromatosis (NH) is a form of neonatal liver failure caused by maternal-fetal alloimmune injury to hepatocytes. The etiology of neonatal hemochromatosis is not exactly understood. However, according to one theory neonatal hemochromatosis is believed to be an alloimmune disorder causing liver injury in the fetus. In order to diagnose neonatal hemochromatosis there are some criteria that should be taken into account, such as positive family history, high serum ferritin levels, high serum alpha-fetoprotein levels and siderosis demonstrated by histology or with magnetic resonance.We present a case of a monochorionic newborn twin who applied to our hospital with sepsis clinical symptoms like clinics, was diagnosed with NH and immediately treated with antioxidant therapy while the other twin with same clinical symptoms did not respond to therapy and passed away. NH should be considered in the differential diagnosis of cases with sepsis-like clinical symptoms that do not respond to antibiotics; early antioxidant therapy in these cases is lifesaving.

Heterogeneous Presentation of Neonatal Hemochromatosis in Dichorionic Twins

“…Table 1 summarizes the clinical characteristics of published cases of twins pregnancy affected by NH in the literature. 7 8 9 10 11 …”

Disparate clinical findings in monochorionic twins with neonatal hemochromatosis

“…1 We know of only four previously reported sets of twins with NH. [2][3][4] Herein we report on monochorionic twins with NH showing disparate clinical and laboratory findings. The present patients were Japanese monochorionic twin boys born by caesarean section at the 37th gestational week to a healthy mother with a healthy sibling and who had no previous affected offspring.…”

“…immunoglobulin (IVIG) with or without exchange transfusion . We know of only four previously reported sets of twins with NH . Herein we report on monochorionic twins with NH showing disparate clinical and laboratory findings.…”

“…Only four sets of twins with NH have been reported previously (two monochorionic, two dichorionic) . In each monochorionic case, one twin survived and the other died.…”

“…Only four sets of twins with NH have been reported previously (two monochorionic, two dichorionic). [2][3][4] In each monochorionic case, one twin survived and the other died. The dichorionic twins had disparate clinical and laboratory findings, but had good outcomes without liver dysfunction.…”