Twin anemia – polycythemia sequence (TAPS): postnatal correction of severe anemia in the donor twin by transfusion of blood evacuated from the recipient polycythemic twin
Objective: To correct anemia by postnatal blood transfusion in the (intrauterine) donor twin neonate with blood obtained from the (intrauterine) recipient polycythemic twin.
Methods: The monochorionic twins displayed features of TAPS; concordant intrauterine normal amniotic sacs and fluid volumes, concordant birth weights (2.4kg and 2.2kg) but discordant postnatal haemoglobins (28.3d/dL and 7.3g/dL). Following resuscitation and admission to neonatal intensive care unit, clinical assessment revealed severe polycythemia and severe anemia in the first and second twin respectively. By partial exchange blood transfusion, blood obtained from the first twin was transfused to the second twin.
Results: The babies responded well to neonatal care and anemia was effectively corrected (Hb 18.0d/dL and 11.3g/dL for twin 1 and 2 respectively). One year after birth, the twins are doing well with appropriate developmental milestones.
Conclusions: Homologous transfusion of blood from a sister twin is an uncommon but welcome practice especially in a setting where donated blood is hardly readily available. This practice is strongly recommended in the management of neonatal anemia encountered in cases of TAPS and prenatal successfully managed Twin – Twin Transfusion Syndrome (TTTS).
Key words: Twin, Transfusion, Severe Anemia, Polycythemia
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