Shantz Camille F, Rosner Mara, Kush Michelle L, Miller Jena L, Baschat Ahmet A
Johns Hopkins Center for Fetal Therapy, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA.
J Clin Med. 2024 Aug 27;13(17):5068. doi: 10.3390/jcm13175068.
Intrauterine transfusion (IUT) of the donor and partial exchange (pET) of the recipient is a temporizing treatment for pregnancies with Twin Anemia Polycythemia Sequence (TAPS). We aimed to provide a detailed description of the procedural approach and outcomes for sequential donor IUT and recipient pET in TAPS. Retrospective study of spontaneous TAPS referred to the Johns Hopkins Center for Fetal Therapy treated with donor IUT followed by recipient pET utilizing a double-syringe setup. Procedural characteristics and outcomes as well as the accuracy of existing transfusion formulas were analyzed and compared with the literature. 5 of 78 patients with spontaneous TAPS underwent a total of 19 combined IUT/pET procedures (median first procedure to delivery interval 5.6 weeks [interquartile range IQR 1.9-6.0]). One pET was stopped due to fetal deceleration. The patients were delivered at 33.0 weeks [IQR 31.9-33.3] with two survivors and no neonatal transfusion requirements. The IUT volume was 48 mL [IQR 39-63 mL] and the pET volume was 32 mL [IQR 20-50], utilizing aliquots of 5-20 mL for the latter ( = 0.021). For the IUTs, the assumption of a fetal blood volume below 150 mL/kg underestimated the required transfusion volume. For the pETs, all formulas required adjustment of the dilution volume based on bedside testing ( < 0.05 for all). Donor transfusion followed by partial exchange in the recipient can prolong pregnancy in spontaneous TAPS and obviate the need for neonatal transfusion. A double-syringe setup facilitates efficient saline exchange. Because the accuracy of volume formulas is limited, bedside testing is recommended to achieve the target hemoglobin.
对供体进行宫内输血（IUT）以及对受血者进行部分换血（pET）是治疗双胎贫血多血序列征（TAPS）妊娠的一种临时治疗方法。我们旨在详细描述TAPS中序贯供体IUT和受血者pET的操作方法及结果。对转诊至约翰霍普金斯胎儿治疗中心、接受供体IUT治疗后再进行受血者pET的自发性TAPS病例进行回顾性研究，采用双注射器装置。分析了操作特征、结果以及现有输血公式的准确性，并与文献进行比较。78例自发性TAPS患者中有5例共接受了19次IUT/pET联合操作（首次操作至分娩间隔的中位数为5.6周[四分位间距IQR 1.9 - 6.0]）。1次pET因胎儿减速而停止。患者在33.0周[IQR 31.9 - 33.3]时分娩，有2名存活者，且无新生儿输血需求。IUT的血量为48 mL[IQR 39 - 63 mL]，pET的血量为32 mL[IQR 20 - 50]，后者采用5 - 20 mL的等分试样（ = 0.021）。对于IUT，假设胎儿血容量低于150 mL/kg会低估所需输血量。对于pET，所有公式都需要根据床边检测调整稀释血量（所有 < 0.05）。供体输血后对受血者进行部分换血可延长自发性TAPS的妊娠期，并避免新生儿输血的需要。双注射器装置有助于高效进行盐水置换。由于血量公式的准确性有限，建议进行床边检测以达到目标血红蛋白水平。
