A Case Report of a Successful Monochorionic Diamniotic Twin Pregnancy in a Patient Affected by Sickle Cell Disease Treated With Erythrocytapheresis

Abstract

We describe a monochorionic diamniotic twin pregnancy in a 28-year-old woman with a severe form of sickle cell disease periodically treated with erythrocytapheresis (EA). During this high risk pregnancy, two sessions of EA were performed without complications, and pain control and fetal growth were optimal. Delivery was carried out by emergency cesarean section at 29(+3) weeks' gestation due to initial fetal distress following twin-to-twin transfusion. There were no significant complications for the newborn twins and the post-partum course was regular. The patient underwent a further EA 7 weeks after surgery. Close collaboration between obstetricians and hematologists with careful maternal-fetal monitoring and prophylactic EA during pregnancy led to a favorable outcome despite a low maternal body weight, a twin pregnancy, and a severe form of sickle cell disease.

Maternal sickle cell disease and twin pregnancy: a case series and review of the literature

“…This would be in keeping with the improvements in our understanding and management of sickle cell disease. The sickle complications reported were comparative to those in our study, including the development of painful VOC and ACS [27,[30][31][32]34,37,39]. Likewise, the maternal complications were also similar with four reports of pre-eclampsia or eclampsia [22,27,39] and one report of growth restriction [30].…”

“…Detail on the characteristics and outcome of the twin pregnancies is heterogeneous and included where provided. 19 publications were identified dating back to 1972 [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40]. The majority were large retrospective studies reporting the outcome of maternal SCD in both singleton and multiple pregnancies, only including limited information regarding the twin pregnancies.…”

“…Although the inclusion of SCD twin pregnancies is mentioned in all the publications, five (26.3%) studies [28,33,35,36,40] have no detail regarding the specific outcomes of these cases. Four case studies describe an in depth account of twin pregnancies: two singular case studies [37,39], one case series containing one twin pregnancy [34] and one case series [31] specifically reporting the outcome of four twin pregnancies with SCD.…”

Erythrocyte‐exchange with the OPTIA™ cell separator in patients with sickle‐cell disease

“…Noteworthy, only three patients in the Spectra group had a body weight < 30 kg : median weight 30 kg (range, 28-30), pre-EEX Hct 22.7% (21.7-34.6), post-EEX Hct 33.6% (32.1-37.6), exchanged RBC/Kg/bw 33. (10)(11)(12)(13)(14)(15)(16).…”

Prophylactic red blood cell exchange may be beneficial in the management of sickle cell disease in pregnancy

“…[24][25][26][27] Studies on prophylactic transfusions in SCD patients do not reach the same conclusions: while some indicate that they do not alter the outcome of pregnancy or only decrease the number of vasoocclusive events [28][29][30] others indicate that they might favorably affect overall maternal and fetal health. 31 A pragmatic approach may be to avoid routine prophylactic transfusions for an uncomplicated pregnancy, but to consider this option for women who develop severe SCD complications 29,32,33 or who are known to be at high risk for vasoocclusive events. A multicenter study of pregnant patients with SCD in the United Kingdom investigated the effects of prophylactic blood transfusion on maternal and fetal outcomes and recommended exchange transfusions in all females with homozygous SCD beginning at 28 weeks of gestation to reduce the risk of maternal complications in the third trimester and puerperium.…”