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Citation:
Campos A, Kogan J, Rasuli B, et al. Twin anemia polycythemia sequence. Reference article, Radiopaedia.org (Accessed on 25 Feb 2025) https://doi.org/10.53347/rID-15453
Twin anemia polycythemia sequence (TAPS) is considered a variant of the twin to twin transfusion syndrome (TTTS) occurring in monochorionic twin pregnancies.
TAPS may occur spontaneously in up to 5% of monochorionic twins and may also develop after incomplete laser treatment in twin-to-twin transfusion syndrome cases 2.
As with twin-to-twin transfusion syndrome, the underlying mechanism is thought to be abnormal placental vascular anastomoses, however, in TAPS the rate of transfusion is slow and therefore results in a gradual discordance of fetal hemoglobin, without the hormonal disbalance and subsequent liquor discordance seen in TTTS. One twin develops anemia and the other polycythemia.
Ultrasound
One of the features suggesting the diagnosis is a discordance in fetal middle cerebral artery peak systolic velocity (MCA-PSV) measurements 4. In contrast to the classic twin-to-twin transfusion syndrome, there is no amniotic fluid discordance (i.e. no-twin oligo-polyhydramnios sequence (TOPS)) 5.
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1. Lopriore E, Slaghekke F, Oepkes D et-al. Clinical outcome in neonates with twin anemia-polycythemia sequence. Am. J. Obstet. Gynecol. 2010;203 (1): 54.e1-5. doi:10.1016/j.ajog.2010.02.032 - Pubmed citation
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2. Slaghekke F, Kist WJ, Oepkes D et-al. Twin anemia-polycythemia sequence: diagnostic criteria, classification, perinatal management and outcome. Fetal. Diagn. Ther. 2010;27 (4): 181-90. doi:10.1159/000304512 - Pubmed citation
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3. Suzuki S. Twin anemia-polycythemia sequence with placental arterio-arterial anastomoses. Placenta. 2010;31 (7): 652. doi:10.1016/j.placenta.2010.04.008 - Pubmed citation
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4. Gucciardo L, Lewi L, Vaast P et-al. Twin anemia polycythemia sequence from a prenatal perspective. Prenat. Diagn. 2010;30 (5): 438-42. doi:10.1002/pd.2491 - Pubmed citation
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5. Weingertner A, Kohler A, Kohler M et al. Clinical and Placental Characteristics in Four New Cases of Twin Anemia-Polycythemia Sequence. Ultrasound Obstet Gynecol. 2010;35(4):490-4. doi:10.1002/uog.7508 - Pubmed
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6. A. Khalil, M. Rodgers, A. Baschat, A. Bhide, E. Gratacos, K. Hecher, M. D. Kilby, L. Lewi, K. H. Nicolaides, D. Oepkes, N. Raine‐Fenning, K. Reed, L. J. Salomon, A. Sotiriadis, B. Thilaganathan, Y. Ville. ISUOG Practice Guidelines: role of ultrasound in twin pregnancy. (2016) Ultrasound in Obstetrics & Gynecology. 47 (2): 247. doi:10.1002/uog.15821 - Pubmed
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7. Beth M. Kline-Fath, Ray Bahado-Singh, Dorothy Bulas. Fundamental and Advanced Fetal Imaging. (2015) ISBN: 9781451175837 - Google Books
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