title: Hypoalbuminemia in donors with twin anemia-polycythemia sequence: a matched case-control study.
abstract: OBJECTIVE
  To determine the differences in albumin levels between donors and recipients with twin anemia-polycythemia sequence (TAPS).
  
  
  METHODS
  We included all consecutive monochorionic twins with TAPS with double survivors. Each twin pair was matched for gestational age at birth with 2 control monochorionic twin pairs unaffected by TAPS or twin-twin transfusion syndrome. We measured levels of albumin, total protein, and hemoglobin on the first day of life in donors and recipients (TAPS group) and the control group.
  
  
  RESULTS
  A total of 25 TAPS twin pairs and 50 control twin pairs were included in the study. The median gestational age at birth was 32 weeks in both groups. In the TAPS group, median levels (IQR) of albumin in donor twins were significantly lower than in recipient twins, i.e. 28.0 g/l (24.0-32.0) versus 32.0 g/l (30.0-34.5) (p = 0.008). Median levels (IQR) of total protein in donor twins were also lower than in recipients, i.e. 44.0 g/l (36.5-49.0) versus 49.0 g/l (46.5-51.0), respectively (p = 0.004). The median (IQR) intertwin albumin difference was significantly higher in the TAPS group than in the control group, i.e. 4.0 g/l (2.5-10.5) versus 2.0 g/l (1.0-4.0) (p = 0.003). The rate of hypoalbuminemia (<20 g/l) and hypoproteinemia (<40 g/l) in donor twins with TAPS was 20% (5/25) and 32% (8/25).
  
  
  CONCLUSIONS
  In addition to lower hemoglobin levels, donor twins with TAPS also have significantly lower albumin and total protein levels compared to recipient twins.
authors.affiliation: Division of Neonatology, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: L
authors.initials: L
authors.lastname: Verbeek
authors.forename: F
authors.initials: F
authors.lastname: Slaghekke
authors.forename: C V
authors.initials: CV
authors.lastname: Hulzebos
authors.forename: D
authors.initials: D
authors.lastname: Oepkes
authors.forename: F J
authors.initials: FJ
authors.lastname: Walther
authors.forename: E
authors.initials: E
authors.lastname: Lopriore
mesh_terms: D000046:Academic Medical Centers; D001724:Birth Weight; D001798:Blood Proteins / Q000032:analysis; D016022:Case-Control Studies; D005260:Female; D005330:Fetofetal Transfusion / Q000097:blood / Q000503:physiopathology*; D005865:Gestational Age; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D034141:Hypoalbuminemia / Q000453:epidemiology / Q000209:etiology*; D007019:Hypoproteinemia / Q000453:epidemiology / Q000209:etiology*; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D011086:Polycythemia / Q000209:etiology*; D011247:Pregnancy; D059285:Pregnancy, Twin; D012189:Retrospective Studies; D012709:Serum Albumin / Q000032:analysis; D000075462:Serum Albumin, Human
chemical_list: C422455:ALB protein, human; D001798:Blood Proteins; D006454:Hemoglobins; D012709:Serum Albumin; D000075462:Serum Albumin, Human