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Fetofetal Transfusion (Twin Transfusion Syndrome)

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Passage of blood from one fetus to another via an arteriovenous communication or other shunt, in a monozygotic twin pregnancy. It results in anemia in one twin and polycythemia in the other. (Lee et al., Wintrobe's Clinical Hematology, 9th ed, p737-8)

Also Known As:

Twin Transfusion Syndrome; Cross Transfusion, Intrauterine; Cross-Transfusions, Intrauterine; Fetofetal Transfusions; Intrauterine Cross Transfusion; Intrauterine Cross-Transfusions; Syndrome, Twin Transfusion; Syndromes, Twin Transfusion; Transfusion Syndrome, Twin; Transfusion Syndromes, Twin; Transfusion, Fetofetal; Transfusion, Twin; Transfusions, Fetofetal; Transfusions, Twin; Twin Transfusion Syndromes; Twin Transfusions; Cross-Transfusion, Intrauterine; Intrauterine Cross-Transfusion; Twin Transfusion

Networked: 68 relevant articles (2 outcomes, 2 trials/studies)

Relationship Network

Disease Context: Research Results

Related Diseases

1.	Hydrops Fetalis (Fetal Edema)
2.	Premature Birth (Birth, Premature)
3.	Polyhydramnios
4.	Anemia
5.	Polycythemia (Erythrocytosis)

Experts

1.	Lopriore, E: 5 articles (01/2013 - 01/2007)
2.	Vandenbussche, F P H A: 4 articles (10/2008 - 01/2007)
3.	Deprest, J: 4 articles (10/2008 - 05/2002)
4.	Johnson, Anthony: 3 articles (08/2013 - 01/2009)
5.	Moise, Kenneth J: 3 articles (08/2013 - 02/2008)
6.	van den Wijngaard, Jeroen P H M: 3 articles (04/2008 - 04/2005)
7.	van Gemert, Martin J C: 3 articles (04/2008 - 04/2005)
8.	Ross, Michael G: 3 articles (04/2007 - 04/2005)
9.	Walther, F J: 2 articles (01/2013 - 01/2007)
10.	Fisk, N M: 2 articles (05/2009 - 09/2002)

Drugs and Biologics

Drugs and Important Biological Agents (IBA) related to Fetofetal Transfusion:

1.	Twin twin transfusion syndromeIBA 05/01/2009 - "Twin-twin transfusion syndrome (TTTS) is a fascinating condition in which fetuses of identical genotype adopt discordant cardiovascular phenotypes, secondary to unbalanced placental inter-twin transfusion. " 02/01/2008 - "The twin-to-twin transfusion syndrome (TTTS) is a severe complication of monochorionic twin pregnancies, caused by a net inter-twin transfusion of blood from one fetus (the donor) towards the other fetus (the recipient) through placental anastomoses. " 11/01/2005 - "To report the initial experience in our country with a new technique for twin to twin transfusion syndrome (TTTS) treatment, using laser to coagulate the placental vessels responsible for the twin transfusion during gestation. " 02/01/1995 - "We hypothesized that this unexpected event was related to reversed acute twin-twin transfusion, and concluded that fetal hydrops remission in twin-twin transfusion syndrome must not be considered as a reassuring prognostic index but as an indication of the need for continuing biophysical monitoring." 09/01/2002 - "In twin-twin transfusion syndrome, recipient fetuses had increased aortic and pulmonary velocities compared with their donor co-twins (mean (SD): 0.73 (0.23) m/s and 0.63 (0.14) m/s), respectively, v 0.53 (0.16) m/s and 0.48 (0.10) m/s in donor twins; p = 0.003 (aortic) and < 0.0001 (pulmonary)), and also in comparison with twin 1 and twin 2. The overall prevalence of congenital heart disease was increased above that in singletons (3.8% v 0.56%; 6.9% in twin-twin transfusion v 2.3% in uncomplicated monochorionic diamniotic twins), with inter-twin discordance for defects. "
2.	Hemoglobins (Hemoglobin)IBA 11/01/2014 - "TAPS is an uncommon form of chronic fetofetal transfusion, characterized by large intertwin hemoglobin (Hb) differences in the absence of amniotic fluid discordances. " 08/01/2014 - "In cases of TAPS following twin-to-twin transfusion, the mean hemoglobin level was higher in donors than in anemic twins with isolated TAPS (P = 0.029) and similar between recipients and polycythemic twins with isolated TAPS (P = 0.135). " 04/07/2008 - "Then, differences between adult hemoglobin concentrations measured during the transfusion and at birth relate not only to the net inter-twin transfusion but also to the finite lifetime of the adult red blood cells. " 09/01/1994 - "However, the diagnosis of twin-to-twin transfusion cannot be made with certainty after birth since virtually all monochorionic gestations have placental anastomoses and there are many causes of growth deficiency and abnormal hemoglobin concentration. " 09/01/1994 - "The discovery of a 'stuck twin' during an ultrasound examination has often been equated with twin-to-twin transfusion based to a great extent on postnatal confirmation of discordant fetal size and hemoglobin concentration. "
3.	Carbon MonoxideIBA 01/01/2013 - "Acute fetal blood loss through the ruptured vessels led to an acute fetofetal transfusion from the co-twin through the placental vascular anastomoses. " 12/01/2009 - "This tribute to Dr Derom is followed by reviews of new research on the pathophysiology of the twin transfusion syndrome and the use of discordant MZ twins (co-twin control) in behavioral research. " 05/15/2009 - "Several putative neurodevelopmental modulators are explored, including death of a co-twin, chorionicity, birth weight discordance, and twin-twin transfusion. " 11/01/1999 - "This fetus had rubella and probable acute twin-twin transfusion following the intrauterine death of the co-twin. " 09/01/2002 - "In twin-twin transfusion syndrome, recipient fetuses had increased aortic and pulmonary velocities compared with their donor co-twins (mean (SD): 0.73 (0.23) m/s and 0.63 (0.14) m/s), respectively, v 0.53 (0.16) m/s and 0.48 (0.10) m/s in donor twins; p = 0.003 (aortic) and < 0.0001 (pulmonary)), and also in comparison with twin 1 and twin 2. The overall prevalence of congenital heart disease was increased above that in singletons (3.8% v 0.56%; 6.9% in twin-twin transfusion v 2.3% in uncomplicated monochorionic diamniotic twins), with inter-twin discordance for defects. "
4.	Messenger RNA (mRNA)IBA 10/01/2012 - "To investigate the effects of chorionicity and severe twin to twin transfusion (TTTS) on maternal circulating cell-free messenger RNA (cf-mRNA). " 09/01/2006 - "Finally, we are using specific disease models (such as congenital diaphragmatic hernia and twin-to-twin transfusion) to understand the effects of gestational age and specific pathology on fetal gene expression by analyzing cell-free mRNA levels in maternal plasma. "
5.	Atrial Natriuretic Factor (ANF)IBA 01/01/1992 - "In 3 cases of severe twin transfusion syndrome we demonstrate that the concentration of atrial natriuretic factor (ANF) in the cord blood of recipient twins is significantly elevated compared to that of donor twins. " 05/01/1989 - "Atriopeptin, a peptide produced by mammalian atria that promotes diuresis, natriuresis, and vascular changes, was in much higher concentration in the recipient twin than in the donor in two cases of severe twin transfusion syndrome. " 05/01/1989 - "Atriopeptin in the twin transfusion syndrome."
6.	Digoxin (Digitek)FDA LinkGeneric 06/01/1985 - "Digoxin therapy is recommended for fetal heart failure from circulatory overload in twin transfusion." 06/01/1985 - "Twin transfusion syndrome: successful in utero treatment with digoxin." 12/01/2005 - "Digoxin reduces the degree of recipient hydrops, but increases arteriovenous fetofetal transfusion. "
7.	TOPSIBA 01/01/2007 - "In conclusion, chronic inter-twin transfusion may lead to an uncommon form of inter-twin transfusion, named TAPS, not associated with TOPS, resulting in severe fetal or neonatal hematological complications. " 04/01/2010 - "TAPS is a newly described form of chronic twin-to-twin transfusion associated with chronic anemia in the donor and polycythemia in the recipient, without twin oligo-polyhydramnios sequence (TOPS). " 01/01/2007 - "We report an uncommon form of chronic inter-twin transfusion, referred to as twin anemia-polycythemia sequence (TAPS), with severe anemia in one twin and polycythemia in the other, without the characteristically associated twin oligo-polyhydramnios sequence (TOPS) seen in the classical twin-to-twin transfusion syndrome (TTTS). "
8.	SteroidsIBA 10/01/2003 - "Concordant and discordant twins were similar in demographics, history of twin-twin transfusion (TTTX), antenatal steroids, chorioamnionitis, pre-eclampsia, cesarean delivery, cord hemoglobin, normal head ultrasounds or I to II intracranial hemorrhage (97 and 99%) and neonatal mortality (4 and 5%), but were different in incidence of preterm labor (83 and 58%), birth weight (1227 and 1509 g) and gestational age (GA) (30 and 32 weeks). "
9.	NeodymiumIBA 01/26/1995 - "This condition can now be treated by endoscopic coagulation of the vascular anastomoses responsible for fetofetal transfusion with a neodymium:yttrium-aluminum-garnet (Nd: YAG) laser. "
10.	IronIBA 01/01/1989 - "These findings support the hypothesis that in chronic twin-to-twin transfusion, depletion of iron stores occurs in the donor while the recipient suffers from iron overload. "

Therapies and Procedures

1.	Laser Therapy (Surgery, Laser) 08/01/2013 - "The benefit of laser therapy for severe twin-twin transfusion: which metaanalysis do you pick?" 02/01/2009 - "Laser therapy for the treatment of severe twin-twin transfusion alone has been the subject of more than 100 peer-reviewed articles in the past 3 years. " 01/01/2009 - "Current controversies in prenatal diagnosis 2: Should laser ablation of placental anastomoses be used in all cases of twin to twin transfusion?" 04/07/2008 - "Currently, the only reliable method to measure the net inter-twin transfusion clinically is when incomplete laser therapy of TTTS occurs and one of the twins becomes anemic and requires an intra-uterine transfusion of adult red blood cells. " 04/01/2007 - "Acute intrapartum twin-to-twin transfusion following successful fetoscopic laser ablation."
2.	Lasers (Laser) 03/01/2013 - "Expanding the gestational age limits for laser treatment for twin-twin transfusion." 11/01/2012 - "PubMed and MEDLINE online databases were searched for articles published between 2000 and August 2011, using combinations of the terms 'twin-twin transfusion', 'TTTS', 'laser', 'recur' and 'outcome'. " 02/01/2001 - "Two infants found to have ileal atresia after birth and who had intrauterine laser treatment to interupt twin to twin transfusion are presented. " 10/01/2015 - "Objective This study aims to determine the clinical outcomes of monochorionic-triamniotic (MT) pregnancies complicated by severe fetofetal transfusion undergoing laser photocoagulation. " 11/01/2005 - "To report the initial experience in our country with a new technique for twin to twin transfusion syndrome (TTTS) treatment, using laser to coagulate the placental vessels responsible for the twin transfusion during gestation. "
3.	Multifetal Pregnancy Reduction 06/01/2001 - "This paper discusses a personal selection of controversial issues, such as multifetal pregnancy reduction of triplets and twins, special cases in multifetal pregnancy reduction, need for invasive genetic studies, management of twin-twin transfusion, discordant fetal conditions, the definition of "term" in multiples, and the controversy about the mode of delivery."
4.	Light Coagulation 10/01/2015 - "Objective This study aims to determine the clinical outcomes of monochorionic-triamniotic (MT) pregnancies complicated by severe fetofetal transfusion undergoing laser photocoagulation. "
5.	Laser Coagulation 07/01/2008 - "Laser coagulation and various volumes and directions of inter-twin transfusion were simulated at 21 weeks. " 05/10/2003 - "For twin transfusion syndrome, laser coagulation of the placental anastomoses is probably superior to serial amnioreduction. " 05/01/2002 - "Forty cases of second-trimester severe twin-twin transfusion underwent fetoscopic laser coagulation of placental anastomoses and were followed up with serial ultrasound up to 14 days after therapy. " 02/01/2002 - "Amnioreduction and laser coagulation are not alternative and equivalent modalities for the treatment of twin-twin transfusion. " 12/01/1999 - "Fetoscopic laser coagulation of the placental vascular anastomoses in severe mid-trimester twin-twin transfusion is a potentially corrective and effective, minimally invasive procedure. "