Twin-to-twin transfusion syndrome as a cause of neonatal acute liver failure

Diagnostic criteria	Severity staging (Quintero staging system)
Presence of a monochorionic diamniotic pregnancy Polyhydramnios in the recipient with DVP of ≥8 cm and oligohydramnios in the donor with DVP < 2 cm	DVP < 2 cm in donor sac; DVP > 8 cm in recipient sac The bladder is no longer visible in the donor twin Critically abnormal Doppler in either twin: absent/reverse diastolic flow in the umbilical artery of the donor or recipient and/or absent/reverse flow in the ductus venosus or pulsatile flow in the umbilical vein of the recipient Hydrops in either fetus Demise of one or both twins

Cause	Assessment method	Result
Syphilis	Quantitative non-treponemal serological test	Negative
Toxoplasmosis	Serology (IgG and IgM)	IgG less than 1:16; IgM negative
Rubella	Serology (IgG and IgM)	Negative
Cytomegalovirus	Blood and urinary PCR	Negative
Herpes simplex virus	Blood PCR	Negative
Varicella virus	Blood PCR	Negative
Infection/sepsis	Blood culture	No growth
Hepatitis viruses A, B, and C	Serology (IgG and IgM)	Negative

	26/3	27/3	28/3	29/3	30/3	31/3	1/4	2/4	3/4	4/4	5/4	6/4	7/4	8/4	9/4
Hct (%)	46.1	36.7	50.4	42.2	35.4	40.5	39.3	32.9	40	41	34.6	32.4	31	36.2	34.3
Platelet (cell/mm³)	132K	97K	105K	77K	69K	75K	81K	62K	45K	120K	85K	79K	88K	75K	82K
AST (U/L)	4,580	4,290	–	267	156	72	44	29	30	–	28	–	–	–	47
ALT (U/L)	792	650	–	193	166	111	86	57	51	–	24	–	–	–	18
ALP (U/L)	232	227	–	215	262	309	319	302	369	–	372	–	–	–	369
TP (g/dL)	5.8	6.3	–	10.20	5.7	6.1	6.3	7.6	7.2	–	7.7	–	–	–	7.4
Alb (g/dL)	2.6	3.1	–	2.6	2.7	2.8	2.9	4.3	2.9	–	3.2	–	–	–	3.2
Glb (g/dL)	3.2	3.2	–	3.2	3.0	3.3	3.4	3.3	4.3	–	4.5	–	–	–	4.2
TB (mg/dL)	2.19	4.46	–	5.8	12.72	12.38	10.22	7.6	6.68	–	8.43	–	–	–	13.57
DB (mg/dL)	0.30	0.37	–	1.60	3.08	5.06	4.68	4.3	4.3	–	5.64	–	–	–	9.09
IDB (mg/dL)	1.89	3.09	–	8.60	9.64	7.32	5.54	3.3	2.3	–	2.79	–	–	–	4.48
Fibrinogen	–	–	76.0	103.3	142.1	–	–	147.9	172.3	233.2	204	–	–	–	211
PT (s) (13.5–16.4)	38.9	45.3	39.1	27.6	25.0	–	23.0	17.2	18.5	18	16.4	15.7	15.7	15	15.6
PTT (s) (29.5–42.2)	42.8	43.9	56.6	54.6	53.7	–	51.0	36.5	44.1	47.3	46.1	45.2	51.3	43.7	44.6
INR (1.05–1.35)	3.50	4.11	3.52	2.44	2.20	–	2.02	1.49	1.6	1.56	1.41	1.35	1.35	1.29	1.34
LP-PRC	–	15 mL/kg · 1	–	–	–	–	–	10 mL/kg · 1	–	–	–	–	10 mL/kg · 1	–	–
LP-Plt	–	10 mL/kg · 1	–	10 mL/kg · 1	10 mL/kg · 1	10 mL/kg · 1	–	–	15 mL/kg · 1	–	–	–	–	–	–
Cryo	–	–	1 unit	1 unit	1 unit	–	–	1 unit	1 unit	–	–	–	–	–	–
FFP	–	10 mL/kg · 3	10 mL/kg · 3	10 mL/kg · 2	10 mL/kg · 2	10 mL/kg · 2	10 mL/kg · 2	10 mL/kg · 2	15 mL/kg · 1	15 mL/kg · 1	15 mL/kg · 1	–	10 mL/kg · 1	–	–

DOI: https://doi.org/10.1515/abm-2019-0055 | Journal eISSN: 1875-855X | Journal ISSN: 1905-7415

Language: English

Page range: 163 - 170

Published on: Mar 31, 2020

In partnership with: Paradigm Publishing Services

Publication frequency: 6 issues per year

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© 2020 Chattip Prueksapraopong, Varisa Piriyakitpaiboon, Dissajee Lumbiganon, published by Chulalongkorn University
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

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