TAPS -Twin Anemia Polycythemia Sequence

TAPS is a form of TTTS, but differs in that red blood cells are disproportionally shared, not the volume of blood. You could lose your babies before ever having a chance to save them. We are here to help you before, during and after your pregnancy to understand your risks for TAPS, the questions to ask, the protocol of care during and after delivery and care after birth. TAPS is a rare chronic form of TTTS where red blood cells are disproportionately shared to the babies through very small vessels in their single monochorionic placenta (although very rarely it can also happen to dichorionic placentas that have fused). As a result, one baby, the TAPS recipient, gets more than normal red blood cells becoming polycythemic and the other baby, the TAPS donor, receives too little red blood cells and becomes anemic. TAPS can become life-threatening for both babies. TAPS differs from classic TTTS because it is the red blood cells only that are unequally shared in the placenta, not the volume of blood. For this reason, there are no physical symptoms in the mother creating a very dangerous situation if she is not in the care of a doctor who knows how to monitor for it. TTTS shared blood vessels are larger where TAPS shared vessels are small under 1mm in size. Visually, you can think of TTTS shared blood vessels like yarn and TAPS shared blood vessels like dental floss. TAPS can be diagnosed spontaneously during pregnancy, after laser surgery for TTTS where shared vessels were missed during the procedure, or after delivery. Because there are no physical symptoms in the pregnant mother, she must get MCA (middle cerebral artery) dopplers in the brains of the babies to diagnose or rule out TAPS starting weekly at 16 weeks gestation through delivery of her babies. There may also be secondary signs on ultrasound where the TAPS donor baby may show a lighter color and echogenic or thicker placental share and/or an enlarged heart (cardiomegaly) and the TAPS recipient baby might have a starry sky liver (white marks on it like stars). When babies are born pale and dark, the reason can be TTTS or TAPS. It is crucial to understand that to confirm a diagnosis, reticulocyte levels must be taken as well as an analysis of the placenta. Reticulocytes are immature red blood cells and will be very high in a TAPS donor baby who has been anemic for a very long time. The reticulocyte levels will be very different with babies with TAPS and very similar with TTTS which usually would happen acutely without the time needed to build up reticulocytes in the TTTS donor. There will not be any excessive amniotic fluid with babies born with TAPS. Also, you can flip the placenta over and look to the maternal side and will see a very pale side with a very dark side to confirm TAPS. With TTTS, the maternal side of the placenta will be very similar in color. Lastly, the placenta needs to be injected with dye by a pathologist to determine the number, direction of flow, and size of the shared vessels in the placenta to determine the smaller TAPS vessels, larger TTTS vessels, placental share, and insertion of the cords. Mothers must be in the care of an MFM (Maternal Fetal Medicine Specialist) and not just an OB by 16 weeks for ultrasounds weekly even when everything looks perfect. Without MCA dopplers, your pregnancy may seem perfect and the babies completely healthy, but remember, TAPS is a silent killer. Please contact us for direct help and guidance and join our active, growing private TAPS Facebook Group for more support and help in your pregnancy. Surrounding yourselves with other parents who understand will uplift and empower you and provide you a safe place to share your children. https://www.facebook.com/groups/fighttaps

**** World TAPS Awareness Day is December 8, 2022 ****

With increased awareness, there will NEVER be undiagnosed TAPS again. Join us as we connect the world to shine a light on the fight against twin anemia polycythemia sequence and share facts, families, and other ways that you can get involved and help.

but we are not and together we will truly make a difference across the world.