Treatment of Twin Anemia Polycythemia Sequence with Donor Transfusion and Partial Recipient Exchange Transfusion: Procedural Considerations and Outcomes
Abstract
:1. Introduction
2. Materials and Methods
3. Results
4. Discussion and Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Reference | Stage | Dx GA | GA at 1st Procedure | IUT/pET Procedures | 1st Rx to Delivery Interval (Weeks) | Delivery GA | TAPS Rec BW (g) | TAPS Don BW (g) | TAPS-Related Neonatal Complications |
---|---|---|---|---|---|---|---|---|---|
INDIVIDUAL CASES REPORTED IN THE LITERATURE | |||||||||
Bahtiyar [9] | IV II II | 26.1 27.6 24.6 | 26.3 27.7 24.9 | 1 2 1 * | 1.0 2.7 11.3 | 27.3 30.4 36.2 | NR NR NR | NR NR NR | 2 Partial exchanges 1 Partial exchange - |
Genova [10] | IV+ II+ II+ | 23.6 27.1 27.1 | 23.7 27.3 28.3 | 4 1 * 2 | 4.1 5.4 2.9 | 27.8 32.7 31.2 | 1235 1615 1520 | 980 1664 1759 | Donor cerebral injury, NND Partial exchange - |
Gucciardo [11] | I | 28.9 | 29.0 | 1++ | 5.3 | 34.3 | 1805 | 1525 | - |
Moaddab [12] | IV+ | 25.0 | 25.1 | 1 * | 0.9 | 26 | 1049 | 1145 | Partial exchange, Double NND |
Slaghekke [13] | NR+ | NR | 26.4 | 3 | 5.3 | 31.7 | NR | NR | NR |
CASES REPORTED IN THIS SERIES | |||||||||
Case 1 Case 2 Case 3 Case 4 Case 5 | IV II II II II | 22.9 27.6 29.4 28.9 25.1 | 23.7 28.7 30.0 29.1 27.3 | 7 * 3 3 1 ** 4 | 9.4 5.6 1.9 0.7 6.0 | 33.1 34.3 31.9 29.9 33.3 | 1705 1880 1600 1335 1940 | 1690 1475 1235 910 2050 | - - - - - |
Donor Transfusions (n = 20) | Recipient Partial Exchange (n = 19) | |
---|---|---|
Estimated fetal weight target fetus (g) | 1115 [875–1405] | 1345 [1067–1555] |
Pre-procedure MCA PSV MoM | 1.67 [1.40–1.88] | 0.82 [0.67–1.09] |
Opening hemoglobin value (g/dL) | 7.9 [5.4–9.8] | 19.8 [18.0–20.8] |
Opening Kleihauer–Betke (%) | 50 [26.7–100] | 73.5 [53.1–89.9] |
Hydrops of target fetus | 2 (10) | 0 (0) |
Paralysis of target fetus | 20 (100) | 17 (89.5) |
Intravascular access Intrahepatic Free loop Placenta cord insertion | 2 (10) 3 (15) 15 (75) | 7 (36.8) 3 (15.8) 9 (47.4) |
Procedure time (min) * | 16 [13–21] | 22 [15–30] |
Number of access attempts 1 2 | 17 (85) 3 (15) | 19 (100) 0 (0) |
Number of samples after opening * 1 2 3 4 5 Median (range) | 4 (20) 12 (60) 4 (20) 0 (0) 0 (0) 2 (1–3) | 5 (26.3) 7 (36.8) 4 (21.1) 2 (10.5) 1 (5.3) 2 (1–5) |
First aliquot size 5 10 15 20 | - - - | 3 (15.7) 13 (68.4) 1 (5.3) 2 (10.5) |
Total blood/saline added * | 48 [39–63] | 32 [20–50] |
Total blood removed * | - | 32 [15–50] |
Closing hemoglobin value (g/dL) | 15.3 [14.5–16.0] | 16.8 [16.4–18.4] |
Closing Kleihauer–Betke (%) | 16.8 [14.0–23.1] | 78.2 [47.9–85.0] |
Change in hemoglobin (g/dL) * | +7.2 [5.25–8.27] | −2.5 [−3.0–−1.4] |
Post procedure MCA PSV MoM * | 0.99 [0.83–1.12] | 0.89 [0.82–1.03] |
Last MCA PSV MoM before delivery | 1.15 [1.11–1.18] | 1.02 [0.94–1.12] |
Formula | Reference | Median Difference From Actual Volume | p-Value |
---|---|---|---|
[18] | 15 [13.5–21.5] | 0.002 | |
[8,14,16] | 4.8 [−6.64–10.8] | 0.258 | |
[17] | 2.0 [−11.0–8.4] | 0.470 | |
[15] | 22.3 [12.6–36.03] | <0.001 | |
[19] | 6.2 [5.02–8.12] | 0.001 | |
[8] | −8.5 [−11.6–−6.84] | 0.038 |
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Shantz, C.F.; Rosner, M.; Kush, M.L.; Miller, J.L.; Baschat, A.A. Treatment of Twin Anemia Polycythemia Sequence with Donor Transfusion and Partial Recipient Exchange Transfusion: Procedural Considerations and Outcomes. J. Clin. Med. 2024, 13, 5068. https://doi.org/10.3390/jcm13175068
Shantz CF, Rosner M, Kush ML, Miller JL, Baschat AA. Treatment of Twin Anemia Polycythemia Sequence with Donor Transfusion and Partial Recipient Exchange Transfusion: Procedural Considerations and Outcomes. Journal of Clinical Medicine. 2024; 13(17):5068. https://doi.org/10.3390/jcm13175068
Chicago/Turabian StyleShantz, Camille F., Mara Rosner, Michelle L. Kush, Jena L. Miller, and Ahmet A. Baschat. 2024. "Treatment of Twin Anemia Polycythemia Sequence with Donor Transfusion and Partial Recipient Exchange Transfusion: Procedural Considerations and Outcomes" Journal of Clinical Medicine 13, no. 17: 5068. https://doi.org/10.3390/jcm13175068