Modeling Severely Discordant Hematocrits and Normal Amniotic Fluids After Incomplete Laser Therapy in Twin-To-Twin Transfusion Syndrome

Abstract Our objective was to explain the clinical presentations of sustained arteriovenous anastomotic transfusion of blood after incomplete laser therapy in twin-to-twin transfusion syndrome (TTTS). We extended our mathematical model of TTTS by adding the dynamics of hematocrit, and simulated inco...

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Bibliographic Details
Published in:Placenta (Eastbourne) 2007-07, Vol.28 (7), p.611-615
Main Authors: van den Wijngaard, Jeroen P.H.M, Lewi, Liesbeth, Lopriore, Enrico, Robyr, Romaine, Middeldorp, Johanna M, Vandenbussche, Frank P.H.A, Devlieger, Roland, Deprest, Jan, Ville, Yves, van Gemert, Martin J.C
Format: Article
Language:English
Subjects:
Amniotic Fluid
Anastomoses
Arteriovenous Anastomosis
Biological and medical sciences
Computer Simulation
Embryology: invertebrates and vertebrates. Teratology
Female
Fetofetal Transfusion - therapy
Fundamental and applied biological sciences. Psychology
Hematocrit
Humans
Incomplete laser therapy
Internal Medicine
Low-Level Light Therapy - adverse effects
Mathematical model
Models, Biological
Obstetrics and Gynecology
Pregnancy
Twin-twin transfusion syndrome
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Summary:Abstract Our objective was to explain the clinical presentations of sustained arteriovenous anastomotic transfusion of blood after incomplete laser therapy in twin-to-twin transfusion syndrome (TTTS). We extended our mathematical model of TTTS by adding the dynamics of hematocrit, and simulated incomplete laser therapy, first, by leaving one patent opposite arteriovenous anastomosis from the recipient to the donor and, second, by leaving one patent arteriovenous anastomosis from the donor to the recipient. In both simulations we reproduced the clinical observation of severe hematocrit discordance preceding delayed amniotic fluid imbalance. In conclusion, incomplete laser therapy may cause a severe circulatory imbalance between the twins which presents predominantly as discordant hematocrits rather than discordant amniotic fluid volumes as in primary TTTS. These results imply that the anemia-polycythemia sequence is a sensitive mechanism to identify transfusion reversal after complicated laser therapy, confirming the suggested role of middle cerebral artery peak systolic velocity Doppler measurements as a useful method of follow-up.
ISSN:0143-4004
1532-3102
DOI:10.1016/j.placenta.2006.10.002