Antenatal management of alloimmune thrombocytopenia with intravenous gamma-globulin: A randomized trial of the addition of low-dose steroid to intravenous gamma-globulin

OBJECTIVES: Our purposes were to investigate maternal infusions of intravenous gamma-globulin used to increase the platelet count in thrombocytopenic fetuses with alloimmune thrombocytopenia, 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. STUDY DESIGN: 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/mu l (n = 47) and from the first fetal blood sampling to birth of 69,000/mu l (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. CONCLUSION: Intravenous gamma-globulin treatment is appropriate for thrombocytopenic fetuses with alloimmune thrombocytopenia before use of weekly in utero platelet transfusions, even in severe thrombocytopenia.