Successful Management of Twin Anemia/Polycythemia Sequence by Syngeneic Partial Exchange Transfusion

Abstract

Twin anemia/polycythemia sequence (TAPS) is characterized by large intertwin hemoglobin (Hb) differences without signs of twin oligopolyhydramnios. The spontaneous form complicates approximately 3-5% of monochorionic twin pregnancies. TAPS placentas are characterized by the presence of only very few and small unidirectional arteriovenous anastomoses, which allow a slow transfusion of blood from the donor to the recipient, gradually leading to highly discordant Hb levels. Neonatal morbidity in TAPS appears to be mainly limited to hematological problems at birth. Donor twins may be severely anemic and require blood transfusions, whereas recipient twins may be severely polycythemic and require partial exchange transfusion (PET). We herein report monochorionic twins with TAPS: the anemic twin was transfused with the blood concomitantly obtained from the polycythemic co-twin during PET. To our knowledge this is the first therapeutic approach using a recipient twin's whole blood as a donor source instead of a foreign blood donor. In this case, we have approached this recently (un)known form of chronic fetofetal transfusion from a different aspect. In our opinion, this will lead to new postnatal therapeutic approaches for optimal TAPS management.

Twin Anemia Polycythemia Sequence: Current Views on Pathogenesis, Diagnostic Criteria, Perinatal Management, and Outcome

“…Since TAPS twins share their blood circulation and therefore have exactly the same blood cell characteristics, it may be of additional value to transfuse the anemic twin with the recipient's whole blood as a donor source instead of foreign donor blood. Recently, Yarci et al (2014) reported a case of TAPS in which the anemic donor was successfully transfused after delivery with blood obtained from the polycythemic co-twin during PET. The main advantage of this new therapeutic method is avoidance of donor exposure and of the risk of blood product infections (Yarci et al, 2014).…”

“…Recently, Yarci et al (2014) reported a case of TAPS in which the anemic donor was successfully transfused after delivery with blood obtained from the polycythemic co-twin during PET. The main advantage of this new therapeutic method is avoidance of donor exposure and of the risk of blood product infections (Yarci et al, 2014). Whether this new approach may lead to decreased morbidity in TAPS pregnancies requires further investigation.…”

Re-Thinking Elective Single Embryo Transfer: Increased Risk of Monochorionic Twinning - A Systematic Review

“…This condition occurs in approximately 5% of MCDA pregnancies spontaneously. It is seen even more frequently (12%) after fetoscopic laser treatment for TTTS [75][76][77][78][79][80] Poor neurodevelopmental outcomes including isolated cognitive delay, motor delay and cerebral palsy rates range greatly be- 86 tween 2 and 20% in both the donor and recipient twins who are affected by TAPS [81] .…”

Perinatal outcome of pregnancy complicated by twin anemia–polycythemia sequence: systematic review and meta‐analysis

“…The search identified 265 articles, of which 122 were assessed with respect to their eligibility for inclusion and 40 were included in the systematic review 8,16,23–25,28–62 (Table 1, Figure S1). Thirty‐eight studies reported outcomes according to the type of TAPS in 502 pregnancies (306 (61.0%) with spontaneous TAPS and 196 (39.0%) with postlaser TAPS) and 21 studies reported outcomes according to management in 417 pregnancies with TAPS diagnosed prenatally.…”