Intrauterine transfusion combined with partial exchange transfusion for twin anemia polycythemia sequence: Modeling a novel technique

- We applied a model simulation to illustrate IUT with and without PET in TAPS.
- Our model shows polycythemia increases with repeated IUTs without PET.
- Adding PET to IUT reduces the severity of polycythemia in the recipient.
- Adding PET reduces the possible complications due to hyperviscosity.

IntroductionTwin anemia-polycythemia sequence (TAPS) is a newly described disease in monochorionic twin pregnancies, characterized by large inter-twin hemoglobin differences. Optimal management for TAPS is not clear. One of the possible treatment modalities is intrauterine blood transfusion (IUT) in the donor with or without combination of partial exchange transfusion (PET) in the recipient.MethodsWe applied a computational model simulation to illustrate the mechanism of IUT with and without PET in TAPS occurring after laser surgery for twin-twin transfusion syndrome (TTTS). Model simulations were performed with the representative anastomotic pattern as observed during laser intervention, and after placental dye injection.ResultsThe model was tested against different cases where IUT was combined with PET for the treatment of post-laser TAPS. Model simulations using the observed anastomotic pattern showed a significant reduction of hyperviscosity in the recipient after IUT/PET compared to IUT without PET.DiscussionIn this model simulation we show that the addition of PET to IUT reduces the severity of polycythemia in the recipient. PET may thus be important to prevent complications of hyperviscosity.ConclusionThis model simulation shows the beneficial effect of PET for the recipient in TAPS cases treated with IUT.