Acta Chir Orthop Traumatol Cech. 2026; 93(2):119-122

Newborn with Bilateral Lower Limb Amputation Due to Twin Anemia Polycythemia SequenceCase report

Pavel Sadovský ml.1, Lucie Papežová1
Ortopedické oddělení Nemocnice České Budějovice, a.s.

We present a case report of a newborn with bilateral lower limb ischemic gangrene caused by spontaneous Twin anemia polycythemia sequence (TAPS). Due to the extent of tissue damage, bilateral lower limb amputation was performed on the fourth day after birth-left knee disarticulation and right transfemoral amputation. The postoperative course was uneventful, and the wounds healed by primary intention. This case represents an exceptionally rare complication of TAPS, in which timely prenatal diagnosis could have enabled early intrauterine intervention.

Keywords: TAPS, TTTS, newborn, gangrene, bilateral amputation.

Received: October 8, 2025; Revised: October 8, 2025; Accepted: February 13, 2026; Published: May 1, 2026  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
Sadovský P, Papežová L. Newborn with Bilateral Lower Limb Amputation Due to Twin Anemia Polycythemia Sequence. Acta Chir Orthop Traumatol Cech. 2026;93(2):119-122.
Share...
Download citation
  • BibTeX (.bib)
  • Bookends (.ris)
  • EasyBib (.ris)
  • EndNote (.enw)
  • EndNote 8 (.xml)
  • ISI WoS (.isi)
  • Medlars (.medlars)
  • Mendeley (.ris)
  • MODS (.xml)
  • Papers (.ris)
  • RefWorks (.txt)
  • RefManager (.ris)
  • RIS (.ris)
  • MS Word (.xml)
  • Zotero (.ris)
    • Open full article

    References

    1. Arshad A, McCarthy MJ. Management of limb ischaemia in the neonate and infant european journal of vascular and endovascular surgery. Eur J Vasc Endovasc Surg. 2009;38:61-65.
    2. Běhávková K, Vojtěch J. Komplikace monochoriálnî gravidity. Postgraduálnî medicîna. 2016;18: 323-325.
    3. Diehl W, Glosemeyer P, Tavares De Sousa M, Hollwitz B, Ortmeyer G, Hecher K. Twin anemia-polycythemia sequence in a case of monoamniotic twins. Ultrasound Obstet Gynecol. 2013;42:108-111.
    4. Lopriore E, Slaghekke F, Kersbergen KJ, De Vries LS, Drogtrop AP, Middeldorp JM, Oepkes D, Benders MJ. Severe cerebral injury in a recipient with twin anemia- polycythemia sequence, Ultrasound Obstet Gynecol. 2013;41:702-706.
    5. Opri F, Bianchini S, Nicoletti L, Monaco S, Opri R. Surgical antimicrobial prophylaxis in patients of neonatal and pediatric age undergoing orthopedic and hand surgery: a RAND/UCLA appropriateness method consensus study. Antibiotics. 2022;11:289.
    6. Sande MJA, Slaghekke F, Te Pas AB, Witlox RSGM, Lopriore E, Tollenaar L. Increased risk of persistent pulmonary hypertension of the newborn in twin anaemia-polycythaemia sequence donors. Fetal Diagn Ther. 2025;52:304-313.
    7. Siddappa A, Shaik L, Slusher T, Gayken J, Bjorklund A. Term neonate born with right upper extremity skin necrosis at birth: a case report. J Burn Care Res. 2024;6:801-804.
    8. Tollenaar L, Lewi L, Colmant C, Lanna M, Weingertner AS, Ryan G, Aréval S, Klaritsch P, Tavares de Sousa M, Khalil A, Papanna R, Gardener GJ, Bevilacqua E, Kostyukov KV, Bahtiyar MO, Kilby MD, Tiblad E, Oepkes D, Lopriore E. Spontaneous twin anemia polycythemia sequence: diagnosis, management, and outcome in an international cohort of 249 cases. Am J Obstet Gynecol. 2021;224:213.e1-213.e11.

    Return to the content