Wayne State University, USA
Title: Abnormal dopplers in monochorionic twins-Is TAPS or maternal anemia at play?
Ola Hadaya is graduated from Wayne State's medical school. She'll graduate med school sooner than some finish their undergraduate work.Hadaya was able to enter the medical program early because she skipped the third, fifth and seventh grades, according to a university spokesperson.She was just 11 when she started high school in New Jersey.By 15, she'd graduated high school, having taken enough advanced placement courses to have shaved off a full year of college credits from her to-do list. She'd also completed a chemistry course at Princeton while attending high school.When she graduated from Rutgers with an undergraduate degree in Middle Eastern studies and a minor in biology, she then applied to Wayne State.She was one of fewer than 300 accepted to the school that year, and will graduate Monday with 283 others.Hadaya will follow in the footsteps of her father, also a doctor. Her mother is a mechanical engineer.Wayne State doesn't ask applicants for their age, the school said, so the admissions officers might not have known Hadaya was so young when she started the graduate work.
Abnormal middle cerebral artery peak systolic velocities (MCA-PSV) in monochorionic twins raise concern for twin twin transfusion syndrome (TTTS) and twin anemiapolycythemia sequence (TAPS) as well as other causes of fetal anemia, including infectious and alloimmunizing etiologies. Rarely is severe maternal anemia considered the culprit behind the abnormal dopplers. We present a case of a 32 year old primigravida with monochromic diamniotic twins found to have an elevated MCA-PSV of initially one and then both twins, with no other ultrasonographic evidence suggestive of TAPS. Her workup was negative for parvovirus infection and alloimmunization but remarkable for severe maternal iron deficiency anemia. Treatment with IV iron was initiated, and the MCA-PSV’S normalized. A comparison of hemoglobin levels of the twins following delivery did not fulfill TAPS post-natal criteria. The significance of this case report is that presents a unique case, not before described in the literature, of severe maternal iron deficiency anemia resulting in abnormal fetal MCA-PSV’s. The fetus may not be as impervious to maternal iron deficiency anemia as has long been believed, but these effects appear to be reversible with treatment.