Treatment of Twin Anemia Polycythemia Sequence with Donor Transfusion and Partial Recipient Exchange Transfusion: Procedural Considerations and Outcomes.
Camille F ShantzMara RosnerMichelle L KushJena L MillerAhmet Alexander BaschatPublished in: Journal of clinical medicine (2024)
Background: Intrauterine transfusion (IUT) of the donor and partial exchange (pET) of the recipient is a temporizing treatment for pregnancies with Twin Anemia Polycythemia Sequence (TAPS). We aimed to provide a detailed description of the procedural approach and outcomes for sequential donor IUT and recipient pET in TAPS. Methods: Retrospective study of spontaneous TAPS referred to the Johns Hopkins Center for Fetal Therapy treated with donor IUT followed by recipient pET utilizing a double-syringe setup. Procedural characteristics and outcomes as well as the accuracy of existing transfusion formulas were analyzed and compared with the literature. Results: 5 of 78 patients with spontaneous TAPS underwent a total of 19 combined IUT/pET procedures (median first procedure to delivery interval 5.6 weeks [interquartile range IQR 1.9-6.0]). One pET was stopped due to fetal deceleration. The patients were delivered at 33.0 weeks [IQR 31.9-33.3] with two survivors and no neonatal transfusion requirements. The IUT volume was 48 mL [IQR 39-63 mL] and the pET volume was 32 mL [IQR 20-50], utilizing aliquots of 5-20 mL for the latter ( p = 0.021). For the IUTs, the assumption of a fetal blood volume below 150 mL/kg underestimated the required transfusion volume. For the pETs, all formulas required adjustment of the dilution volume based on bedside testing ( p < 0.05 for all). Conclusions: Donor transfusion followed by partial exchange in the recipient can prolong pregnancy in spontaneous TAPS and obviate the need for neonatal transfusion. A double-syringe setup facilitates efficient saline exchange. Because the accuracy of volume formulas is limited, bedside testing is recommended to achieve the target hemoglobin.
Keyphrases
- cardiac surgery
- pet ct
- computed tomography
- sickle cell disease
- positron emission tomography
- chronic kidney disease
- end stage renal disease
- pet imaging
- acute kidney injury
- newly diagnosed
- type diabetes
- ejection fraction
- bone marrow
- young adults
- minimally invasive
- insulin resistance
- mesenchymal stem cells
- weight loss
- skeletal muscle
- iron deficiency
- liquid chromatography