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Thread: elevated NK cells, Intralipid already-- IVIG?

  1. #1
    Join Date
    Jan 2015
    Posts
    1

    Default elevated NK cells, Intralipid already-- IVIG?

    Dear Dr. Coulam,

    I am an American woman living in Germany, and my wife and I have been trying to start a family. (I have been trying to conceive.)

    I became pregnant in Feb 2013, but had a miscarriage at week 12 and a D&C. I had another in December 2013, this time only 6 weeks alone. I have had at least 2 chemical pregnancies since then.

    After many tests, all of which were fine, I was diagnosed with high NK cells (first in blood, then some months later in uterine tissue). I have done Intralipid but it doesn't seem to have the effect it should, and I am curious about other treatments, and perhaps other tests that should be done?

    Everything works a bit differently in Germany and I hope I am getting thorough treatment advice and proper testing-- I hope you might be able to advise me on this?

    As I said, I have done Intralipid treatments, starting with several in May/June 2014. At that time, based on a test which showed elevated NK cells in blood, I had Intralipid every other week, 5 times, 100ml 20% Intralipid in 500ml saline. I believe I had another chemical pregnancy just after in July (period 4 days late, extremely unusual for me.) We also have not inseminated again since then.

    The initial results showing elevated NK cells in blood were:
    CD3-/CD16+56+ (NK Cells) 6 %Lymph
    NK-Cells absolute 195 /μl
    CD3-/CD56+ Lymphozyten 7 %Lymph
    CD3-/CD56+ Lymphozyten abs 228 /μl

    We had not felt comfortable with the specialist who found the elevated NK cells in my blood, so we decided to seek a different doctor. In July 2014 we found our current doctor, with whom we are much happier-- she is quite respected, and is very kind.

    She wanted to test the number of uterine NK cells, not just the NK cells in blood as the first doctor had done. (She actually thought that my NK cell levels from my prior blood test weren't really so high.) However, the uNK values from the uterine test sample *did* come back clearly elevated.

    Those results (Oct 2014)

    605 uNK cells counted in 1mm surface (my translation of "uNK Zellen in 1mm Objektoberfläche gezählt")

    reference values given: normal, less than 300; slighly elevated, 300 - 600; clearly elevated, over 600

    Since I hadn't had Intralipids in 7 weeks prior to that test, we thought maybe they had worked their way out of my system. Also, she recommended a different treatment amount: I should only have 8ml Intralipid 20% in 100ml saline, but I should have it every week, instead of every 2 weeks.

    I did 3 treatments, and then we retested my uNK cells. (We had planned to do IUI in mid Dec.) Unfortunately, my doctor wrote me an email just beforehand to advice us to hold off on the IUI, as my numbers were only somewhat down.

    The values from the second test: 541 uNK /mm

    We will finally have an appointment with her in 2 weeks to discuss the treatment options. I asked if I should continue Intralipid until then, and she said it wasn't necessary.

    Do you think that other treatments that might improve my situation? I have heard a little about IVIG, but I think that I understand from the studies I have seen that Intralipid and IVIG are supposed to be similarly effective. Could IVIG possibly do something in my situation that Intralipid would not have already done? Or are there other options to treat elevated NK cells?

    And as I initially asked-- do you think that any other tests that should be done? (Tests involving activation, maybe? and if so, what might these be called?) When I asked our current doctor about this in November, she said that they only do a test that gives a cell count, not one that judges activation. I understand that cell count plays a role, as she explained, but it seems to me like activation is also important and that the picture of my situation is incomplete without it.

    But we don't know where else in Germany to turn for such tests, if they are even done here.

    If you would have advice-- either on treatments or tests-- we'd be most grateful!

    Thank you for reading this.

  2. #2
    Join Date
    Sep 2008
    Posts
    677

    Default

    To make sure that NK cells are the only reasomes you are having difficulties maintaining pregnancies you should be tested for other immunologic and thrombophilic risk factors for more information on theses risk factors you may visit the information on this website or visit the website of Fertility and Cryogenic Laboratories at FCLab.us. IvIg has been used for treatment of elevated NK cells not responsive to intralipids if the NK activation assay shows suppression of NK activity with IVIg.Since you are from so far away, we could do a consultation via the telephone and order the appropriate tests for you that could be mailed to us if you wish. To make such an appointment just call 847 869 7777. Dr. Coulam

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