title: Antenatal management of alloimmune thrombocytopenia with intravenous gamma-globulin: a randomized trial of the addition of low-dose steroid to intravenous gamma-globulin.
abstract: OBJECTIVE
  Our purposes were to investigate maternal infusions of intravenous gamma-globulin, to prevent intracranial hemorrhage, and to determine whether 1.5 mg dexamethasone and 60 mg prednisone per day add to the effect of intravenous gamma-globulin.
  
  
  METHODS
  Fifty-four women with alloimmune thrombocytopenia and thrombocytopenic fetuses were randomized to intravenous gamma-globulin 1 gm/kg per week with or without dexamethasone. Nonresponders after 4 to 6 weeks received continued intravenous gamma-globulin plus 60 mg of prednisone per day ("salvage").
  
  
  RESULTS
  Dexamethasone did not add to the effect of intravenous gamma-globulin. Overall, there was a mean platelet increase from the first to the second fetal blood sampling of 36,000/microliters (n = 47) and from the first fetal blood sampling to birth of 69,000/microliters (n = 54). A total of 62% to 85% of fetuses responded. There were no intracranial hemorrhages. "Salvage" increased the platelet count in 5 of 10 nonresponders to intravenous gamma-globulin.
  
  
  CONCLUSIONS
  Intravenous gamma-globulin treatment is appropriate for thrombocytopenic fetuses with alloimmune thrombocytopenia before use of weekly in utero platelet transfusions, even in severe thrombocytopenia.
authors.affiliation: Department of Pediatrics, Cornell Medical College, New York, NY, USA.
authors.forename: J B
authors.initials: JB
authors.lastname: Bussel
authors.forename: R L
authors.initials: RL
authors.lastname: Berkowitz
authors.forename: L
authors.initials: L
authors.lastname: Lynch
authors.forename: M L
authors.initials: ML
authors.lastname: Lesser
authors.forename: M J
authors.initials: MJ
authors.lastname: Paidas
authors.forename: C L
authors.initials: CL
authors.lastname: Huang
authors.forename: J G
authors.initials: JG
authors.lastname: McFarland
mesh_terms: D002543:Cerebral Hemorrhage / Q000517:prevention & control; D003907:Dexamethasone / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D005312:Fetal Blood; D005315:Fetal Diseases / Q000628:therapy*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage / Q000627:therapeutic use*; D007518:Isoantibodies / Q000276:immunology*; D008431:Maternal-Fetal Exchange; D010976:Platelet Count; D011241:Prednisone / Q000627:therapeutic use; D011247:Pregnancy; D011446:Prospective Studies; D016879:Salvage Therapy; D013921:Thrombocytopenia / Q000097:blood / Q000276:immunology / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D016756:Immunoglobulins, Intravenous; D007518:Isoantibodies; D003907:Dexamethasone; D011241:Prednisone