In twin to twin transfusion syndrome in donor twin all the signs & symptoms are present, except?

Appeared in: RUHS, Jaipur, M.Sc Nursing Entrance Exam-2018

Explanation

Plethora, a ruddy or flushed appearance, is a hallmark sign in the recipient twin, not the donor.
It results from hypervolemia (excess blood volume) and polycythemia (an abnormally high red blood cell count) due to the unbalanced blood transfusion from the donor.
The donor twin, in contrast, becomes pale and anemic from blood loss.

Option A: This is incorrect because oligohydramnios (deficient amniotic fluid) is a classic sign in the donor twin. It is caused by reduced blood flow to the kidneys, leading to decreased urine production.
Option C: This is incorrect because hypovolemia (low blood volume) is a primary problem for the donor twin, as it continuously pumps blood to the recipient.
Option D: This is incorrect because anemia (low red blood cell count) is a direct consequence of the donor twin losing blood and red blood cells to the recipient.

Clinical Relevance

Nursing practice connection: Use the key finding related to Pathophysiology of Twin-to-Twin Transfusion Syndrome (TTTS) and its effects on the donor twin to guide bedside assessment, documentation, and the next nursing action.
Nurses play a vital role in monitoring high-risk monochorionic pregnancies for signs of TTTS via regular ultrasounds, assessing for discordant fetal growth and amniotic fluid levels.
Postnatally, the nursing team must be prepared for two infants with opposite problems: one anemic and hypovolemic (the donor) and one polycythemic and hypervolemic (the recipient), requiring different and immediate interventions.
What if? If the question asked for a sign in the recipient twin, 'Polyhydramnios' or 'Plethora' would be correct answers, as these result from the excess blood volume received.

How to Approach the Question

First, identify the core subject: Twin-to-Twin Transfusion Syndrome (TTTS) and specifically the 'donor' twin.
Note the negative keyword 'except'. This means you are looking for the option that does NOT apply to the donor twin.
Recall or deduce the pathophysiology: the donor twin gives away blood, while the recipient receives it.
Evaluate each option based on the consequence of blood loss (donation):
Does blood loss cause low amniotic fluid (Oligohydramnios)? Yes.
Does blood loss cause low blood volume (Hypovolemia)? Yes.

Concept Tested & Keywords

Concept Tested: Pathophysiology of Twin-to-Twin Transfusion Syndrome (TTTS) and its effects on the donor twin.
Stem keywords: twin to twin transfusion syndrome, donor twin, signs & symptoms
Lead-in keywords: except
Negative lead-in flag: The question asks for the sign that is NOT present (except), requiring elimination of the correct signs.

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E6 Nelson Textbook of Pediatrics(2024) — Volume 1 pp. 1049-1051, 1043-1045

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