Antenatal management of alloimmune thrombocytopenia with intravenous gamma-globulin: a randomized trial of the addition of low-dose steroid to intravenous gamma-globulin.
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.
Bussel
J B
JB
Department of Pediatrics, Cornell Medical College, New York, NY, USA.
Berkowitz
R L
RL
Lynch
L
L
Lesser
M L
ML
Paidas
M J
MJ
Huang
C L
CL
McFarland
J G
JG
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
D016756:Immunoglobulins, Intravenous; D007518:Isoantibodies; D003907:Dexamethasone; D011241:Prednisone