title: Intrauterine transfusion combined with partial exchange transfusion for twin anemia polycythemia sequence: modeling a novel technique.
abstract: BACKGROUND
  Twin anemia-polycythemia sequence (TAPS) is a newly described disease in monochorionic twin pregnancies, characterized by large inter-twin hemoglobin differences. Optimal management for TAPS is not clear. One of the possible treatment modalities is intrauterine blood transfusion (IUT) in the donor with or without combination of partial exchange transfusion (PET) in the recipient.
  
  
  METHODS
  We applied a computational model simulation to illustrate the mechanism of IUT with and without PET in TAPS occurring after laser surgery for twin-twin transfusion syndrome (TTTS). Model simulations were performed with the representative anastomotic pattern as observed during laser intervention, and after placental dye injection.
  
  
  RESULTS
  The model was tested against different cases where IUT was combined with PET for the treatment of post-laser TAPS. Model simulations using the observed anastomotic pattern showed a significant reduction of hyperviscosity in the recipient after IUT/PET compared to IUT without PET.
  
  
  CONCLUSIONS
  In this model simulation we show that the addition of PET to IUT reduces the severity of polycythemia in the recipient. PET may thus be important to prevent complications of hyperviscosity.
  
  
  CONCLUSIONS
  This model simulation shows the beneficial effect of PET for the recipient in TAPS cases treated with IUT.
authors.affiliation: Division of Fetal Medicine, Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: f.slaghekke@lumc.nl.
authors.forename: F
authors.initials: F
authors.lastname: Slaghekke
authors.affiliation: Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: J P H M
authors.initials: JP
authors.lastname: van den Wijngaard
authors.affiliation: Division of Fetal Medicine, Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Akkermans
authors.affiliation: Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: M J C
authors.initials: MJ
authors.lastname: van Gemert
authors.affiliation: Division of Fetal Medicine, Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: J M
authors.initials: JM
authors.lastname: Middeldorp
authors.affiliation: Division of Fetal Medicine, Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: F J
authors.initials: FJ
authors.lastname: Klumper
authors.affiliation: Division of Fetal Medicine, Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: D
authors.initials: D
authors.lastname: Oepkes
authors.affiliation: Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: E
authors.initials: E
authors.lastname: Lopriore
mesh_terms: D001805:Blood Transfusion, Intrauterine; D003198:Computer Simulation; D005260:Female; D005315:Fetal Diseases / Q000628:therapy*; D005330:Fetofetal Transfusion / Q000628:therapy*; D006801:Humans; D008962:Models, Theoretical; D011247:Pregnancy; D059285:Pregnancy, Twin
keywords: Intrauterine transfusion; Mathematical model; Partial exchange transfusion; Twin anemia polycythemia sequence