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Harada S, Iwatani S, Tamaki S, Yoshida M, Yoshimoto S. Twin anemia polycythemia sequence in discordant dichorionic twins. Pediatr Neonatol 2023; 64:470-471. [PMID: 36732097 DOI: 10.1016/j.pedneo.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/21/2022] [Accepted: 12/30/2022] [Indexed: 01/26/2023] Open
Affiliation(s)
- Shinji Harada
- Department of Neonatology, Hyogo Prefectural Kobe Children's Hospital, 1-6-7 Minatojima-Minamimachi, Chuo-ku, Kobe, Hyogo, 650-0047, Japan
| | - Sota Iwatani
- Department of Neonatology, Hyogo Prefectural Kobe Children's Hospital, 1-6-7 Minatojima-Minamimachi, Chuo-ku, Kobe, Hyogo, 650-0047, Japan.
| | - Shoko Tamaki
- Department of Neonatology, Hyogo Prefectural Kobe Children's Hospital, 1-6-7 Minatojima-Minamimachi, Chuo-ku, Kobe, Hyogo, 650-0047, Japan
| | - Makiko Yoshida
- Department of Pathology, Hyogo Prefectural Kobe Children's Hospital, 1-6-7 Minatojima-Minamimachi, Chuo-ku, Kobe, Hyogo, 650-0047, Japan
| | - Seiji Yoshimoto
- Department of Neonatology, Hyogo Prefectural Kobe Children's Hospital, 1-6-7 Minatojima-Minamimachi, Chuo-ku, Kobe, Hyogo, 650-0047, Japan
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Jeyaseelan T, Shangaris P, Efthymiou A, Martin L, Story L, Nanda S, Gupta N, Al-Adnani M, Marnerides A, Nicolaides KH, Sankaran S. Suspected twin anemia polycythemia sequence in a dichorionic, diamniotic twin pregnancy: a case report. J Med Case Rep 2023; 17:28. [PMID: 36709312 PMCID: PMC9884182 DOI: 10.1186/s13256-023-03766-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 01/06/2023] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Twin anemia polycythemia sequence is a rare complication in monochorionic twin pregnancy. CASE PRESENTATION We describe a case of dichorionic twin pregnancy presenting with suspected twin anemia polycythemia sequence. A 31-year-old White female, on her third pregnancy, had a routine ultrasound scan at 12 weeks gestation, which demonstrated a dichorionic twin pregnancy with one placenta located in the anterior wall and the other in the posterior wall of the uterus. At 21 weeks, a scan demonstrated a 24% growth discordance between the two fetuses with normal Doppler studies and amniotic fluid. At 27 weeks, one twin showed signs of anemia and the other polycythemia; the fetal middle cerebral artery peak systolic velocity was high in the anemic fetus and low in the polycythemic twin (1.8 and 0.5 multiples of the median). An intrauterine blood transfusion was carried out and this increased the fetal hemoglobin concentration in the anemic twin from 3.5 to 12.5 g/dL. At 29 weeks, delivery by cesarean section was carried out because of evidence from middle cerebral artery peak systolic velocity of recurrence of anemia in one twin and worsening polycythemia in the co-twin; at birth the hemoglobin concentrations were 5.6 and 24.9 g/dL, respectively. Histopathological examination confirmed dichorionicity with no communicating vessels between the two placentas. CONCLUSIONS This is the first case of twin anemia polycythemia sequence in a dichorionic, diamniotic twin pregnancy where intrauterine blood transfusion was used to prolong the pregnancy by almost 2 weeks in a "twin anemia polycythemia sequence-like" setting.
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Affiliation(s)
- Tania Jeyaseelan
- grid.425213.3School of Life Course and Population Sciences, Kings College London, St Thomas’ Hospital, 10th Floor North Wing, London, SE1 7EH UK ,grid.420545.20000 0004 0489 3985Department of Women and Children Health, Guy’s and St Thomas’ NHS Foundation Trust, London, SE1 7EH UK
| | - Panicos Shangaris
- grid.425213.3School of Life Course and Population Sciences, Kings College London, St Thomas’ Hospital, 10th Floor North Wing, London, SE1 7EH UK ,grid.420545.20000 0004 0489 3985Department of Women and Children Health, Guy’s and St Thomas’ NHS Foundation Trust, London, SE1 7EH UK ,grid.13097.3c0000 0001 2322 6764Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, SE1 1UL UK
| | - Athina Efthymiou
- grid.425213.3School of Life Course and Population Sciences, Kings College London, St Thomas’ Hospital, 10th Floor North Wing, London, SE1 7EH UK ,grid.46699.340000 0004 0391 9020Harris Birthright Research Centre for Fetal Medicine, King’s College Hospital, London, SE5 8BB UK
| | - Linzi Martin
- grid.420545.20000 0004 0489 3985Department of Women and Children Health, Guy’s and St Thomas’ NHS Foundation Trust, London, SE1 7EH UK
| | - Lisa Story
- grid.425213.3School of Life Course and Population Sciences, Kings College London, St Thomas’ Hospital, 10th Floor North Wing, London, SE1 7EH UK ,grid.420545.20000 0004 0489 3985Department of Women and Children Health, Guy’s and St Thomas’ NHS Foundation Trust, London, SE1 7EH UK
| | - Surabhi Nanda
- grid.425213.3School of Life Course and Population Sciences, Kings College London, St Thomas’ Hospital, 10th Floor North Wing, London, SE1 7EH UK ,grid.420545.20000 0004 0489 3985Department of Women and Children Health, Guy’s and St Thomas’ NHS Foundation Trust, London, SE1 7EH UK
| | - Neelam Gupta
- grid.425213.3School of Life Course and Population Sciences, Kings College London, St Thomas’ Hospital, 10th Floor North Wing, London, SE1 7EH UK ,grid.420545.20000 0004 0489 3985Department of Women and Children Health, Guy’s and St Thomas’ NHS Foundation Trust, London, SE1 7EH UK
| | - Mudher Al-Adnani
- grid.425213.3Department of Histopathology, St Thomas Hospital, Westminster Bridge Road, London, SE17EH UK
| | - Andreas Marnerides
- grid.425213.3Department of Histopathology, St Thomas Hospital, Westminster Bridge Road, London, SE17EH UK
| | - Kypros H. Nicolaides
- grid.425213.3School of Life Course and Population Sciences, Kings College London, St Thomas’ Hospital, 10th Floor North Wing, London, SE1 7EH UK ,grid.46699.340000 0004 0391 9020Harris Birthright Research Centre for Fetal Medicine, King’s College Hospital, London, SE5 8BB UK
| | - Srividhya Sankaran
- grid.425213.3School of Life Course and Population Sciences, Kings College London, St Thomas’ Hospital, 10th Floor North Wing, London, SE1 7EH UK ,grid.420545.20000 0004 0489 3985Department of Women and Children Health, Guy’s and St Thomas’ NHS Foundation Trust, London, SE1 7EH UK
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da Silva Rocha J, Guedes-Martins L, Cunha A. Twin Anemia-Polycythemia Sequence (TAPS): From Basic Research to Clinical Practice. Curr Vasc Pharmacol 2023; 21:91-105. [PMID: 36718965 DOI: 10.2174/1570161121666230131112930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 12/30/2022] [Accepted: 12/30/2022] [Indexed: 02/01/2023]
Abstract
Twin pregnancy is associated with an increased risk of perinatal and maternal complications, and early establishment of the chorionicity type defines this risk. In monochorionic (MC) pregnancies, the fetuses share the same placental mass and exhibit vascular anastomoses crossing the intertwin membrane, and the combination and pattern of anastomoses determine the primary clinical picture and occurrence of future complications. Twin Anemia-Polycythemia Sequence (TAPS) was first described in 2006 after fetoscopic laser surgery in twin-to-twin transfusion syndrome (TTTS) twins, and in 2007, the first spontaneous cases were reported, recognizing TAPS as an individualized vascular identity in fetofetal transfusion syndromes. There are two types of TAPS: spontaneous (3-5%) and iatrogenic or postlaser (2-16%). TAPS consists of small diameter arteriovenous anastomoses (<1 mm) and low-rate, small-caliber AA anastomoses in the absence of amniotic fluid discordances. There are certain antenatal and postnatal diagnostic criteria, which have progressively evolved over time. New, additional secondary markers have been proposed, and their reliability is being studied. The best screening protocol for TAPS in MC twins is still a matter of debate. This review provides a survey of the relevant literature on the epidemiology, vascular pathophysiology, underlying hemodynamic factors that regulate mismatched vascular connections, and diagnostic criteria of this condition. The aim is to increase awareness and knowledge about this recently identified and frequently unrecognized and misdiagnosed pathology.
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Affiliation(s)
- Joana da Silva Rocha
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto 4050-313, Portugal
| | - Luís Guedes-Martins
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto 4050-313, Portugal
- Centro Hospitalar Universitário do Porto EPE, Centro Materno Infantil do Norte, Centro de Medicina Fetal, Serviço de Obstetrícia, Departamento da Mulher e da Medicina Reprodutiva, Largo Prof. Abel Salazar, Porto 4099-001, Portugal
- Unidade de Investigação e Formação - Centro Materno Infantil do Norte, Porto 4099-001, Portugal
- Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-319 Portugal
| | - Ana Cunha
- Centro Hospitalar Universitário do Porto EPE, Centro Materno Infantil do Norte, Centro de Medicina Fetal, Serviço de Obstetrícia, Departamento da Mulher e da Medicina Reprodutiva, Largo Prof. Abel Salazar, Porto 4099-001, Portugal
- Unidade de Investigação e Formação - Centro Materno Infantil do Norte, Porto 4099-001, Portugal
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Lee SY, Bae JY, Hong SY. Twin anemia polycythemia sequence in a dichorionic diamniotic pregnancy. Yeungnam Univ J Med 2021; 39:150-152. [PMID: 34198372 PMCID: PMC8913908 DOI: 10.12701/yujm.2021.01060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/04/2021] [Indexed: 11/04/2022] Open
Abstract
Complications related to the vascular anastomosis of the placental vessels in monochorionic twins are fatal. The clinical syndromes of feto-fetal transfusion include twin anemia polycythemia sequence (TAPS), twin-twin transfusion syndrome, and twin reversed arterial perfusion sequence. We present an extremely rare case of TAPS in a dichorionic diamniotic pregnancy. A 36-year-old woman, gravida 0, para 0, was referred to our hospital with suspected preterm premature membrane rupture. Although her pelvic examination did not reveal specific findings, the non-stress test result showed minimal variability in the first fetus and late deceleration in the second one. An emergency cesarean section was performed. The placenta was fused, and one portion of the placenta was pale, while the other portion was dark red. The hemoglobin level of the first fetus was 7.8 g/dL and that of the second one was 22.2 g/dL.
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Affiliation(s)
- Soo-Young Lee
- Department of Obstetrics and Gynecology, Yeungnam University Hospital, Daegu, Korea
| | - Jin Young Bae
- Department of Obstetrics and Gynecology, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Seong Yeon Hong
- Department of Obstetrics and Gynecology, Daegu Catholic University School of Medicine, Daegu, Korea
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Kanagaretnam D, Nayyar R, Zen M. Twin anemia polycythemia sequence in dichorionic diamniotic twins: A case report and review of the literature. Clin Case Rep 2021; 9:e04184. [PMID: 34026183 PMCID: PMC8123762 DOI: 10.1002/ccr3.4184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 03/02/2021] [Accepted: 04/02/2021] [Indexed: 11/16/2022] Open
Abstract
Although rare, literature demonstrates evidence that vascular anastomoses do occur in dichorionic twins. Therefore, twin anemia polycythemia sequence should be considered as a differential diagnoses in dichorionic twins if there is suspicion on antenatal ultrasound.
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Affiliation(s)
| | - Roshini Nayyar
- Department of Obstetrics and GynaecologyWestmead HospitalWestmeadNSWAustralia
- Westmead Institute for Maternal Fetal MedicineWestmead HospitalWestmeadNSWAustralia
| | - Monica Zen
- Department of Obstetrics and GynaecologyWestmead HospitalWestmeadNSWAustralia
- Westmead Institute for Maternal Fetal MedicineWestmead HospitalWestmeadNSWAustralia
- Westmead Clinical SchoolFaculty of Medicine and HealthWestmead HospitalThe University of SydneyWestmeadNSWAustralia
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Tollenaar LSA, Prins SA, Beuger S, Slaghekke F, Oepkes D, Lopriore E. Twin Anemia Polycythemia Sequence in a Dichorionic Twin Pregnancy Leading to Severe Cerebral Injury in the Recipient. Fetal Diagn Ther 2021; 48:321-326. [PMID: 33774643 DOI: 10.1159/000514408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 11/23/2020] [Indexed: 11/19/2022]
Abstract
Twin anemia polycythemia sequence (TAPS) is a form of chronic imbalanced feto-fetal transfusion through minuscule placental anastomoses leading to anemia in the TAPS donor and polycythemia in the TAPS recipient and has been reported only in monochorionic twins. We report a very unusual case of TAPS which developed in a dichorionic twin pair, born at a gestational age of 33+2. Twin 1 (recipient) was polycythemic and had a hemoglobin value of 22.4 g/dL, whereas twin 2 (donor) was anemic with a hemoglobin value of 9.8 g/dL and an increased reticulocyte count (72‰). Color dye injection of the placenta revealed the presence of a deep-hidden small veno-venous anastomosis. Dichorionicity was confirmed on histologic examination. Aside from respiratory distress syndrome, the donor twin had an uncomplicated neonatal course. The recipient twin developed a post-hemorrhagic ventricular dilatation requiring treatment with a ventriculoperitoneal shunt and Rickham reservoir. This report shows that in dichorionic twins, placental anastomoses can be present, which can lead to the development of TAPS with severe consequences. Therefore, when a pale and plethoric dichorionic twin pair is born, a complete diagnostic work-up is required, including a full blood count with reticulocytes and placental injection, to investigate the presence and nature of potential underlying feto-fetal transfusion. Once the diagnosis of TAPS has been established, cerebral ultrasound, hearing screening, and long-term follow-up are strongly recommended as these twins have increased risk for severe cerebral injury, hearing loss, and long-term neurodevelopmental impairment.
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Affiliation(s)
| | - Sandra A Prins
- Department of Pediatrics, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Sabine Beuger
- Department of Pediatrics, Noordwest Ziekenhuisgroep Den Helder, Den Helder, The Netherlands
| | - Femke Slaghekke
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Dick Oepkes
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Enrico Lopriore
- Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
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