Antenatal management of alloimmune thrombocytopenia with intravenous gamma-globulin: A randomized trial of the addition of low-dose steroid to intravenous gamma-globulin
Antenatal management of alloimmune thrombocytopenia with intravenous gamma-globulin: A randomized trial of the addition of low-dose steroid to intravenous gamma-globulin
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DOI：
10.1016/s0002-9378(96)70582-3
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发表时间：
1996-05-01
影响因子：
9.8
通讯作者：
McFarland, JG
中科院分区：
文献类型：
--
作者：
Bussel, JB;Berkowitz, RL;McFarland, JG
目的：我们的目的是研究母体静脉注射丙种球蛋白用于增加同种免疫性血小板减少症的血小板减少胎儿的血小板计数，预防颅内出血，并确定每天1.5 mg地塞米松和60 mg泼尼松是否增加静脉注射丙种球蛋白的效果。研究设计：54名患有同种免疫性血小板减少症和胎儿血小板减少症的妇女被随机分配到静脉注射丙种球蛋白1 gm/kg/周，加或不加地塞米松。4 ~ 6周后，无应答者继续接受静脉注射丙种球蛋白加每天60 mg泼尼松（“抢救”）。总体而言，从第一次到第二次胎仔血样采集的平均血小板增加为36，000/mu l（n = 47），从第一次胎仔血样采集到出生的平均血小板增加为69，000/mu l（n = 54）。总共有62%到85%的胎儿有反应。无颅内血肿。“抢救"增加血小板计数在5 10无应答者静脉注射丙种球蛋白。结论：静脉注射丙种球蛋白治疗是适当的血小板减少胎儿同种免疫性血小板减少症使用前，每周在子宫内血小板输注，即使在严重的血小板减少症。
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.