PreprintArticleVersion 1Preserved in Portico This version is not peer-reviewed
Treatment of Twin Anemia Polycythemia Sequence with Donor Transfusion and Partial Recipient Exchange Transfusion: Procedural Considerations and Outcomes
Version 1
: Received: 27 June 2024 / Approved: 27 June 2024 / Online: 27 June 2024 (16:55:41 CEST)
How to cite:
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. Preprints2024, 2024061982. https://doi.org/10.20944/preprints202406.1982.v1
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. Preprints 2024, 2024061982. https://doi.org/10.20944/preprints202406.1982.v1
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. Preprints2024, 2024061982. https://doi.org/10.20944/preprints202406.1982.v1
APA Style
Shantz, C. F., Rosner, M., Kush, M. L., Miller, J. L., & Baschat, A. A. (2024). Treatment of Twin Anemia Polycythemia Sequence with Donor Transfusion and Partial Recipient Exchange Transfusion: Procedural Considerations and Outcomes. Preprints. https://doi.org/10.20944/preprints202406.1982.v1
Chicago/Turabian Style
Shantz, C. F., 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" Preprints. https://doi.org/10.20944/preprints202406.1982.v1
Abstract
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 sought to give 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 set up. Procedure characteristics and outcomes as well as 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 for fetal decelerations. Patients delivered at 33.0 weeks [IQR 31.9-33.3] with two survivors and no neonatal transfusion requirements. IUT volumes were 48 ml [IQR 39-63 ml] and pET volumes 32 ml [IQR 20-50] utilizing aliquots of 5 – 20 mls for the latter (p=0.021). For IUTs, assumption of a fetal blood volume below 150 ml/kg underestimated required transfusion volume. For pETs, all formulas required adjustment of 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.
Medicine and Pharmacology, Obstetrics and Gynaecology
Copyright:
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
