Suspected twin anemia polycythemia sequence in a dichorionic, diamniotic twin pregnancy: a case report

Tania Jeyaseelan; Panicos Shangaris; Athina Efthymiou; Linzi Martin; Lisa Story; Surabhi Nanda; Neelam Gupta; Mudher Al-Adnani; Andreas Marnerides; Kypros H Nicolaides; Srividhya Sankaran

doi:10.1186/s13256-023-03766-8

Suspected twin anemia polycythemia sequence in a dichorionic, diamniotic twin pregnancy: a case report

Tania Jeyaseelan, Panicos Shangaris, Athina Efthymiou, Linzi Martin, Lisa Story, Surabhi Nanda, Neelam Gupta, Mudher Al-Adnani, Andreas Marnerides, Kypros H Nicolaides, Srividhya Sankaran

Research output: Contribution to journal › Article › peer-review

9 Downloads (Pure)

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.

Original language	English
Article number	28
Number of pages	4
Journal	Journal of medical case reports
Volume	17
Issue number	1
Early online date	29 Jan 2023
DOIs	https://doi.org/10.1186/s13256-023-03766-8
Publication status	E-pub ahead of print - 29 Jan 2023

Keywords

TAPS
Fetal therapy
Dichorionic twins
Fetal blood transfusion

Access to Document

10.1186/s13256-023-03766-8Licence: CC BY

Suspected twin anemia polycythemia sequence in a dichorionic, diamniotic twin pregnancy: a case reportFinal published version, 877 KBLicence: CC BY

Cite this

@article{e8d4490dbd5246c4b8001df5c642e561,

title = "Suspected twin anemia polycythemia sequence in a dichorionic, diamniotic twin pregnancy: a case report",

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.",

keywords = "TAPS, Fetal therapy, Dichorionic twins, Fetal blood transfusion",

author = "Tania Jeyaseelan and Panicos Shangaris and Athina Efthymiou and Linzi Martin and Lisa Story and Surabhi Nanda and Neelam Gupta and Mudher Al-Adnani and Andreas Marnerides and Nicolaides, {Kypros H} and Srividhya Sankaran",

note = "Funding Information: We would like to thank the rest of the team at Guy's and St Thomas{\textquoteright} NHS Trust and King{\textquoteright}s College Hospital who cared for this patient. Funding Information: PS is funded by an NIHR Clinical Lectureship (CL-2018-17-002) an Academy of Medical Sciences Starter Grant for Clinical Lecturers (SGL023\1023) and grants from the Fetal Medicine Foundation. KHN and AE are funded by the Fetal Medicine Foundation (registered charity 1037116). The views expressed in this article are those of the authors and not necessarily those of the National Health Service, the NIHR, or the Department of Health. Publisher Copyright: {\textcopyright} 2023, The Author(s).",

year = "2023",

month = jan,

day = "29",

doi = "10.1186/s13256-023-03766-8",

language = "English",

volume = "17",

journal = "Journal of medical case reports",

issn = "1752-1947",

publisher = "BioMed Central",

number = "1",

}

TY - JOUR

T1 - Suspected twin anemia polycythemia sequence in a dichorionic, diamniotic twin pregnancy: a case report

AU - Jeyaseelan, Tania

AU - Shangaris, Panicos

AU - Efthymiou, Athina

AU - Martin, Linzi

AU - Story, Lisa

AU - Nanda, Surabhi

AU - Gupta, Neelam

AU - Al-Adnani, Mudher

AU - Marnerides, Andreas

AU - Nicolaides, Kypros H

AU - Sankaran, Srividhya

N1 - Funding Information: We would like to thank the rest of the team at Guy's and St Thomas’ NHS Trust and King’s College Hospital who cared for this patient. Funding Information: PS is funded by an NIHR Clinical Lectureship (CL-2018-17-002) an Academy of Medical Sciences Starter Grant for Clinical Lecturers (SGL023\1023) and grants from the Fetal Medicine Foundation. KHN and AE are funded by the Fetal Medicine Foundation (registered charity 1037116). The views expressed in this article are those of the authors and not necessarily those of the National Health Service, the NIHR, or the Department of Health. Publisher Copyright: © 2023, The Author(s).

PY - 2023/1/29

Y1 - 2023/1/29

N2 - 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.

AB - 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.

KW - TAPS

KW - Fetal therapy

KW - Dichorionic twins

KW - Fetal blood transfusion

UR - http://www.scopus.com/inward/record.url?scp=85146933455&partnerID=8YFLogxK

U2 - 10.1186/s13256-023-03766-8

DO - 10.1186/s13256-023-03766-8

M3 - Article

C2 - 36709312

SN - 1752-1947

VL - 17

JO - Journal of medical case reports

JF - Journal of medical case reports

IS - 1

M1 - 28

ER -

Suspected twin anemia polycythemia sequence in a dichorionic, diamniotic twin pregnancy: a case report

Abstract

Keywords

Access to Document

Other files and links

Fingerprint

Cite this