Abstract
Twin-twin transfusion syndrome (TTTS) is one of the most serious complications of monochorionic multiple gestations in which the receipient twin becomes plethoric while the donor twin becomes anaemic. We report the case of the 1st of a set of male twins who presented on the 2nd day of life with excessive ruddiness of the whole body noted at birth and yellowness of the eyes and face noted on the 2nd day of life. Given the comparative clinicolaboratory findings, a diagnosis of neonatal polycythemia secondary to twin to twin transfusion syndrome was made. Post partial exchange blood transfusion (PET) recovery was remarkable. This report was made because of its rarity and to raise the index of suspicion for such cases to enable proper evaluation and management.
Highlights
Polycythemia is an abnormally high level of red blood cells
This condition can result from placental red cell transfusion caused by delayed cord clamping, twin to twin transfusion syndrome, others include conditions associated with placental insufficiency viz; small for gestational age infants, pre-eclampsia, post mature infants, maternal diabetes
Vascular anastomosis between the co-twins is common in monochorionic twins, only a percentage ranging from 4 to 7% develop TTT [3]
Summary
Polycythemia is an abnormally high level of red blood cells. It is defined as a venous haematocrit (Hct) greater than 65% and occurs in 0.4-5% of newborn infants [1]. Twin to twin transfusion syndrome (TTTS) occurs following a unidirectional or unbalanced blood flow in the placental vascular anastomosis of a monochorionic mono- or di-amniotic twin pregnancy [2]. Mother is 32 year old woman who booked for ANC at a gestational age of 12 weeks She had routine antenatal investigations with normal findings, 2 doses of tetanus toxoid immunization, and was regular with her antenatal appointments and medications. Based on the observed significant difference in the haemoglobin levels, weight, and appearance of both twins, coupled with the ultrasound report of monochorinic monoamnioitic twinning with polyhydramnios, a diagnosis of neonatal polycythemia secondary to twin to twin transfusion syndrome, with our patient as recipient was substantiated. 43% (Hb=14.3g/dl);significant difference 0.35 kg (14.5%) No difference No significant difference 30 mg/dl No significant difference
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