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

Am J Obstet Gynecol. 1996 May;174(5):1414-23. doi: 10.1016/s0002-9378(96)70582-3.


Objectives: 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.

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/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.

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.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cerebral Hemorrhage / prevention & control
  • Dexamethasone / administration & dosage*
  • Dexamethasone / adverse effects
  • Dexamethasone / therapeutic use
  • Dose-Response Relationship, Drug
  • Drug Therapy, Combination
  • Female
  • Fetal Blood
  • Fetal Diseases / therapy*
  • Humans
  • Immunoglobulins, Intravenous / administration & dosage
  • Immunoglobulins, Intravenous / therapeutic use*
  • Isoantibodies / immunology*
  • Maternal-Fetal Exchange
  • Platelet Count
  • Prednisone / therapeutic use
  • Pregnancy
  • Prospective Studies
  • Salvage Therapy
  • Thrombocytopenia / blood
  • Thrombocytopenia / immunology
  • Thrombocytopenia / therapy*
  • Treatment Outcome


  • Immunoglobulins, Intravenous
  • Isoantibodies
  • Dexamethasone
  • Prednisone