Fetal transfusion syndrome

Definition:

Fetal transfusion syndrome is a rare condition that occurs only in identical twins. It involves the transference of blood from one fetus directly to the other in the womb.

Alternative Names:

Twin-to-twin transfusion

Causes, incidence, and risk factors:

In fetal transfusion syndrome, the donor twin is usually born smaller, anemic, and dehydrated while the recipient twin is born larger and polycythemic, with too much blood volume and increased blood pressure.

Both infants may have problems depending on the severity of the transfusion: one from an inadequate blood volume, and the other from too much blood. The donor twin may need a blood transfusion, while the recipient twin may need blood volume reduction.

Because of the increased blood volume, the recipient twin may develop cardiac failure and also require medications to strengthen heart function (such as digitalis).

Symptoms:

unequal size of identical twins (discordant twins)
pallor in the smaller twin and plethora (redness) in the larger twin

Signs and tests:

Both of the twins will receive the following tests:

CBC to check hematocrit
chem-20 to evaluate electrolytes
PT and PTT (clotting studies)
chest X-ray

Treatment:

The goal of treatment is to treat each child's problem.

The donor twin may be anemic enough to need a blood transfusion.

The recipient twin may need to have the volume of fluid reduced (this may involve a reduction transfusion). Medications, such as digoxin - oral (digitalis), may be needed to treat heart failure in this child. A digoxin level will need to be tested at regular intervals if this medication is needed to treat heart failure in the recipient twin.

Expectations (prognosis):

If the twin-to-twin transfusion is mild, full recovery is expected for both babies. However, severe cases can result in the death of a twin.

Calling your health care provider:

This condition is usually diagnosed at or before the time of birth.

Review Date: 7/26/2002
Reviewed By: Elizabeth Hait, M.D., Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH. Review provided by VeriMed Healthcare Network.

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