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Comparative Study
. 2020;47(2):123-128.
doi: 10.1159/000500859. Epub 2019 Jul 1.

Leukocyte Counts and Other Hematological Values in Twin-Twin Transfusion Syndrome and Twin Anemia-Polycythemia Sequence

G Laurien Visser  1 , Lisanne S A Tollenaar  2 , Vincent Bekker  1 , Arjan B Te Pas  1 , Arjan C Lankester  3 , Dick Oepkes  2 , Enrico Lopriore  1 , Lianne Verbeek  4
Affiliations
Comparative Study

Leukocyte Counts and Other Hematological Values in Twin-Twin Transfusion Syndrome and Twin Anemia-Polycythemia Sequence

G Laurien Visser et al. Fetal Diagn Ther. 2020.

Abstract

Objective: The aim of this study was to evaluate the differences in leukocyte counts at birth between donors and recipients with twin-twin transfusion syndrome (TTTS) or twin anemia-polycythemia sequence (TAPS).

Methods: We performed a retrospective cohort study in monochorionic twin pairs with TTTS or TAPS. TTTS and TAPS cases treated with fetoscopic laser surgery were excluded. Primary outcome was the difference in leukocyte levels at birth between donor and recipient twins and the presence of leukopenia (defined as leukocyte count <4 × 109/L). Secondary outcomes included early-onset sepsis, necrotizing enterocolitis, use of antibiotics during admission, and neonatal mortality.

Results: We included 99 twins pairs, of which 61 twin pairs were affected by TAPS and 38 twin pairs by TTTS. The mean leukocyte count at birth in donors and recipients was 7.5 × 109/L versus 7.4 × 109/L (p = 0.936), respectively. Leukopenia was significantly more common in donor twins compared to recipient twins (7.1% [7/99] vs. 0% [0/99], p = 0.016). Of the 7 donors with leukopenia, 6 were affected by TAPS and 1 by TTTS. Overall, donors were more often affected by early-onset sepsis than recipients, 23.7% (23/97) versus 13% (13.7/95) (p = 0.049), respectively.

Conclusions: Leukocyte counts at birth in twins with TTTS or TAPS are similar between donors and recipients, but TAPS donors are at an increased risk of leukopenia. Overall, TTTS and TAPS donors seem to be at an increased risk of early-onset neonatal sepsis compared to recipient twins.

Keywords: Leukocyte count; Leukopenia; Monochorionic twins; Twin anemia-polycythemia sequence; Twin-twin transfusion syndrome.

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Conflict of interest statement

The authors have no conflicts of interest to declare. There was no sponsorship or funding arranged for this research.

References

    1. Gucciardo L, Lewi L, Vaast P, Debska M, De Catte L, Van Mieghem T, et al. Twin anemia polycythemia sequence from a prenatal perspective. Prenat Diagn. 2010 May;30((5)):438–42. - PubMed
    1. Verbeek L, Middeldorp JM, Hulzebos CV, Oepkes D, Walther FJ, Lopriore E. Hypoalbuminemia in donors with twin-twin transfusion syndrome. Fetal Diagn Ther. 2013;33((2)):98–102. - PubMed
    1. Verbeek L, Slaghekke F, Sueters M, Middeldorp JM, Klumper FJ, Haak MC, et al. Hematological disorders at birth in complicated monochorionic twins. Expert Rev Hematol. 2017 Jun;10((6)):525–32. - PubMed
    1. Verbeek L, Slaghekke F, Hulzebos CV, Oepkes D, Walther FJ, Lopriore E. Hypoalbuminemia in donors with twin anemia-polycythemia sequence: a matched case-control study. Fetal Diagn Ther. 2013;33((4)):241–5. - PubMed
    1. Koenig JM, Hunter DD, Christensen RD. Neutropenia in donor (anemic) twins involved in the twin-twin transfusion syndrome. J Perinatol. 1991 Dec;11((4)):355–8. - PubMed

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