Twin anemia-polycythemia sequence with suspected cardiac dysfunction.

We present a case of twin anemia-polycythemia sequence diagnosed postnatally with suspected chronic stress on the heart in the donor twin.

A cesarean delivery was performed at 29 weeks' of monochorionic‐diamniotic twin pregnancy because of suspected cardiac dysfunction in twin B due to cardiomegaly and pericardial effusion (Figure 1). The amniotic pockets and appearance of bladders of both twins were normal. Twin A and B were 1246‐ and 1224‐g female infants with normal Apgar scores at 1 and 5 min. The hemoglobin concentration of twin A was 23.9 g/dl (normal: 13–22 g/dl) with reticulocyte counts of 7.2% (normal: <7%), while it was 4.5 g/dl with reticulocyte counts of 29.0% in twin B (Figures 2 and 3). The case was diagnosed as twin anemia‐polycythemia sequence caused by the slow transfusion of red cells through small placental anastomoses. The diagnosis was solidified by the increased reticulocyte level in the donor anemic twin and the placenta with marked color asymmetry (Figure 4). The cardiomegaly with pericardial effusion also indicated the presence of chronic stress on the heart in twin B. Twin A required intravenous infusion of 4.4% human serum albumin for correction of polycythemia, while twin B required a transfusion of red cell concentrate. The case should have been diagnosed and treated during pregnancy; however, fortunately, they had normal development at the 18‐month follow‐up.

FIGURE 1

Ultrasonographic finding showing cardiomegaly and pericardial effusion (yellow arrow)

FIGURE 2

Twin A: a plethoric first twin

FIGURE 3

Twin B: a pallid second twin

FIGURE 4

Placenta having marked color asymmetry

CONFLICT OF INTEREST

All authors declare no conflict of interest relevant to this article.

AUTHOR CONTRIBUTIONS

YS (primary author) analyzed the data and wrote the manuscript. SS involved in formulating the concept of the study, analyzed the data, and drafted the manuscript.

ETHICAL APPROVAL

No ethical objections were observed by the Ethics Committee of the Japanese Red Cross Katsushika Maternity Hospital.

CONSENT

Written informed consent was obtained from the patient.