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Twin anemia polycythemia sequence (TAPS) is a form of twin-to-twin transfusion syndrome that occurs very rarely and may not be diagnosed until after delivery. The condition leads to increased risk of perinatal morbidity and mortality. We present two cases of monochorionic diamniotic twins, in which the diagnosis of TAPS was made after documenting a discrepancy in the echodensities of the two portions of the placenta. Postnatal hemoglobin differences between the twins confirmed the diagnosis of TAPS. On the basis of these two cases, it appears that the heterogeneity in placental echogenicity is a sign of TAPS and Doppler measurement of middle cerebral artery peak systolic velocity is helpful for early diagnosis and management with timely delivery. © 2014 John Wiley & Sons, Ltd.Monochorionic twin gestations are at risk for twin-to-twin transfusion syndrome. The recommended diagnostic criteria do not include regular monitoring of middle cerebral artery peak systolic velocity (MCA-PSV).Twin anemia polycythemia sequence (TAPS) is rare and difficult to predict.We discuss two cases of TAPS that were diagnosed on the basis of discordant placental echodensities and MCA-PSV Doppler findings.In monochorionic diamniotic twins gestations, when the echodensities between the two portions of the placenta are discrepant, measuring the MCA-PSV can help in timely detection of TAPS.