Discordant Blood Chimerism in Dizygotic Monochorionic Laser-Treated Twin–Twin Transfusion Syndrome

• Published in: Obstetrics and gynecology (New York. 1953) Vol. 116; no. 2, Part 2 Suppl; pp. 483 - 485
• Main Authors: Assaf, Samer A., Randolph, Linda M., Benirschke, Kurt, Wu, Samuel, Samadi, Ramin, Chmait, Ramen H.
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD The American College of Obstetricians and Gynecologists 01.08.2010; Lippincott Williams & Wilkins
• Subjects: Adult; Biological and medical sciences; Blood Group Antigens; Chimerism; Female; Fetofetal Transfusion - physiopathology; Fetofetal Transfusion - surgery; Gynecology. Andrology. Obstetrics; Humans; Laser Therapy; Medical sciences; Pregnancy; Twins; Monochorionic twins; Treatment; Gynecology; Fetofetal transfusion; Dizygotic twin; Laser; Chimerism; Obstetrics; Blood
• ISSN: 0029-7844; 1873-233X
• DOI: 10.1097/AOG.0b013e3181e4bec7

BACKGROUND:Twin–twin transfusion syndrome occurs in 10% of monozygotic monochorionic twin gestations and results from an unbalanced exchange of blood from the donor to the recipient fetus through placental anastomoses. CASE:We present a case of twin–twin transfusion syndrome with differing fetal sex treated with in utero laser surgery. Genetic analyses showed 46,XX/46,XY hematologic chimerism in both twins at birth and at 6 months, with the recipient twin being significantly more chimeric than the donor. Placental pathologic examination confirmed monochorionicity and laser ablation of all anastomoses. CONCLUSION:Despite in utero separation of the fetal circulations remote from delivery, hematologic chimerism persisted after birth. We speculate that the greater degree of blood chimerism in the recipient compared with the donor was related to the pathophysiology of twin–twin transfusion syndrome before laser surgery.