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Thread: Elevated NK Assay, but Cytokines normal - IVIG, intralipids, something else?

  1. #1
    Join Date
    Aug 2014
    Posts
    1

    Default Elevated NK Assay, but Cytokines normal - IVIG, intralipids, something else?

    I am 35 and a half, and have a history of recurrent early loss/implantation failure (5 chemical pregnancies in the past 15 months, 3 from natural cycles, one from IUI and one from IVF). For the first year, it was just classified as unexplained infertility by my RE. This spring, I did additional testing with a reproductive endocrinologist and found that my cytokines and NKs were both elevated, and I have a heterozygous mutation in both MTHFR and Fac13. And my homocysteine level is a bit elevated.

    At the beginning of this cycle, I started on prednisone, Lovenox, Fish Oil, Calcium, Vitamin D, Vitamin E, Baby Aspirin, Metanx, prenatals, and have since added progesterone and estradiol.
    I am currently 5 weeks pregnant. My HCG has been rising steadily, but I just got the results of my immune labs, and my numbers are a little out of whack. My cytokines are within range, but my NK activity is pretty elevated. We're trying to figure out the best plan of action to bring everything under control. Would you recommend IVIG or intralipids in this situation? Or something else altogether? We are in the process of appealing insurance denial of IVIG, but we're not sure how long that will take. We're trying to figure out if we can afford an infusion out of pocket... if only it weren't so expensive.

    In the meantime, my RI is upping my prednisone from 20mg to 30mg and adding PIO and estrogen patches. I go back in next week and they will re-run all the labs.

    Here are my results from last week (4 weeks pregnant):

    NK Assay
    50:1 = 25.2
    25:1 = 16.8
    %CD3 = 75.9
    %CD19 = 14.6
    %CD56 = 13.4
    %CD19+CELLS,CD5+ = 6.2

    TH1/TH2 Cytokine Ratio
    TNF-A:IL-10 (CD3+CD4+) = 25.7
    IFN-G:IL-10
    (CD3+CD4+) = 12.1

    These are my betas so far...
    8/15 - 42
    8/20 - 481
    8/22 - 1478
    8/25 - 3564

  2. #2
    Join Date
    Sep 2008
    Posts
    677

    Default Treatment for this siutation includes either IVIg or iuntralipid. To be sure you NK

    Quote Originally Posted by 25August2007 View Post
    I am 35 and a half, and have a history of recurrent early loss/implantation failure (5 chemical pregnancies in the past 15 months, 3 from natural cycles, one from IUI and one from IVF). For the first year, it was just classified as unexplained infertility by my RE. This spring, I did additional testing with a reproductive endocrinologist and found that my cytokines and NKs were both elevated, and I have a heterozygous mutation in both MTHFR and Fac13. And my homocysteine level is a bit elevated.

    At the beginning of this cycle, I started on prednisone, Lovenox, Fish Oil, Calcium, Vitamin D, Vitamin E, Baby Aspirin, Metanx, prenatals, and have since added progesterone and estradiol.
    I am currently 5 weeks pregnant. My HCG has been rising steadily, but I just got the results of my immune labs, and my numbers are a little out of whack. My cytokines are within range, but my NK activity is pretty elevated. We're trying to figure out the best plan of action to bring everything under control. Would you recommend IVIG or intralipids in this situation? Or something else altogether? We are in the process of appealing insurance denial of IVIG, but we're not sure how long that will take. We're trying to figure out if we can afford an infusion out of pocket... if only it weren't so expensive.

    In the meantime, my RI is upping my prednisone from 20mg to 30mg and adding PIO and estrogen patches. I go back in next week and they will re-run all the labs.

    Here are my results from last week (4 weeks pregnant):

    NK Assay
    50:1 = 25.2
    25:1 = 16.8
    %CD3 = 75.9
    %CD19 = 14.6
    %CD56 = 13.4
    %CD19+CELLS,CD5+ = 6.2

    TH1/TH2 Cytokine Ratio
    TNF-A:IL-10 (CD3+CD4+) = 25.7
    IFN-G:IL-10
    (CD3+CD4+) = 12.1

    These are my betas so far...
    8/15 - 42
    8/20 - 481
    8/22 - 1478
    8/25 - 3564



    Both IVIg and intralipid have been used to treat this situation. To see which would be better for you is for you to have your blood drawn for NK activiation with suppression with both IVIg and intralipid. This test may be done at FCLab at FCLab.us. Dr. Coulam

  3. #3
    Join Date
    Sep 2008
    Posts
    677

    Default

    Quote Originally Posted by 25August2007 View Post
    I am 35 and a half, and have a history of recurrent early loss/implantation failure (5 chemical pregnancies in the past 15 months, 3 from natural cycles, one from IUI and one from IVF). For the first year, it was just classified as unexplained infertility by my RE. This spring, I did additional testing with a reproductive endocrinologist and found that my cytokines and NKs were both elevated, and I have a heterozygous mutation in both MTHFR and Fac13. And my homocysteine level is a bit elevated.

    At the beginning of this cycle, I started on prednisone, Lovenox, Fish Oil, Calcium, Vitamin D, Vitamin E, Baby Aspirin, Metanx, prenatals, and have since added progesterone and estradiol.
    I am currently 5 weeks pregnant. My HCG has been rising steadily, but I just got the results of my immune labs, and my numbers are a little out of whack. My cytokines are within range, but my NK activity is pretty elevated. We're trying to figure out the best plan of action to bring everything under control. Would you recommend IVIG or intralipids in this situation? Or something else altogether? We are in the process of appealing insurance denial of IVIG, but we're not sure how long that will take. We're trying to figure out if we can afford an infusion out of pocket... if only it weren't so expensive.

    In the meantime, my RI is upping my prednisone from 20mg to 30mg and adding PIO and estrogen patches. I go back in next week and they will re-run all the labs.

    Here are my results from last week (4 weeks pregnant):

    NK Assay
    50:1 = 25.2
    25:1 = 16.8
    %CD3 = 75.9
    %CD19 = 14.6
    %CD56 = 13.4
    %CD19+CELLS,CD5+ = 6.2

    TH1/TH2 Cytokine Ratio
    TNF-A:IL-10 (CD3+CD4+) = 25.7
    IFN-G:IL-10
    (CD3+CD4+) = 12.1

    These are my betas so far...
    8/15 - 42
    8/20 - 481
    8/22 - 1478
    8/25 - 3564
    Hcg levels look good. NK cells are elevated and be treated with either IVIg or intralipid. Without the results of t he suppression assays it is difficult to telol which you would respond to the best. Dr. Coulam

  4. #4
    Join Date
    Jul 2005
    Posts
    226

    Default

    Dr. Coulam - does this test also look at the killing power of the NK cells?
    Thanks

    Nancy

  5. #5
    Join Date
    Sep 2008
    Posts
    677

    Default Yes, it does. De Coulam

    Quote Originally Posted by inciidadmin View Post
    Dr. Coulam - does this test also look at the killing power of the NK cells?
    Thanks

    Nancy

    Yes, it does. Dr. Coulam

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