Can IVIg and LIT be avoided?

Mickie

20 Posts
Reply Posted on: Oct 2, 2012 at 10:10pm
Hi Dr. Braverman,

Here are a few questions that I have regarding recent bloodwork results. I am about to be 30 years old and have had a molar pregnancy, 2 miscarriages, live birth, chemical pregnancy, live birth, miscarriage, and cheminal pregnancy.

NK 50:1 should be less than 15 (mine is 15.9)%CD56 should be less than 12 (mine is 20.4)B cell IgG (in the leukocyte antibody detection panel) should be greater than 50% (mine is only 6.3%)I am also positive for anti-phospatidic acid IgM, anti-ssDNA antibodies (moderate positive) and anti-histone antibodies (weak positive). Also, my ANA is elevated - its been as high as 1:640. I have also been diagnosed w/ Hashimoto's Thyroidiits (but not on any thyroid meds).I do not have a problem getting pregnant (no need for IVF).Do you think these items will need to be treated (and how should they be treated) before another attempt at pregnancy?? Do you think I can have success whilst avoiding IVIg and LIT (financially and logistgically near impossible). Thank you!

Dr. Braverman

2005 Posts
RE: Can IVIg and LIT be avoided? Posted on: Oct 3, 2012 at 6:26am
Yes in cases like this I have used clexane of course for the ANA issues, and intralipids for the elevated NKa and CD56 levels. Please understand this is based solely on what you have told me, to give you a recommendaton that you should follow I would need to get a very detailed history from you and run some of my own testing. I would be happy to help you , if you want just call my office and they will schedule a consultation for you.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.

Mickie

20 Posts
Reply RE: Can IVIg and LIT be avoided? Posted on: Oct 3, 2012 at 3:31pm
Thank you Dr. Braverman for your reply.I understand that intralipids would treat the high nk levels and lovenox/aspirin to treat the positive APA.But, what would be done to increase my low LAD level (IgG of 6.3%) if LIT and IVIg is off the table? Is this low LAD level really such a problem if I have already had two live births?
Also, what would be done to treat the anti-ssDNA antobodies (moderate positive) and the anti-histone antibodies (weak positive)? Again with IVIg off the table.

Thanks again,

Mickie

Dr. Braverman

2005 Posts
RE: Can IVIg and LIT be avoided? Posted on: Oct 3, 2012 at 3:45pm
contrary to the incorrect thinking about LAD, if you have had a live birth you DONT want to have a positive LAD this is a sign you did not get rid of your anti HLA antibodies by failing to make the protective or blocking antibodies. The LAD does NOT test for blocking antibodies it only makes the incorrect assumption that if you have the bad anti HLA antibodies you probably made the protective ones.
It is good that yoru LAD was low, it means that is not your problem. Also you dont make anti HLA antibodies until the 3rd trimester you also should not see them in someone who has never made it past the first trimester.
The clexane should cover your other issues.

(look at my blogs for more on the LAD testing issue). LIT is recommended to frequently for the wrong reason . It may however still be good for other issues.

clexane should take care of the rest of the issues. Again you must utlimately follow your own doctors advice as he knows your case , this is just a guideline for similar issues.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.

Mickie

20 Posts
Reply RE: Can IVIg and LIT be avoided? Posted on: Oct 4, 2012 at 2:22pm
Hi Dr. Braverman,

Thank you again. Your last response made my husband and I breathe a big sigh of relief (avoiding LIT!)

My last question to you is: What is the significance of Anti-ssDNA being "Moderate Positive" and Anti-Histone being "Weak Positive"? (Anti-dsDNA and Anti-Scl70 were both negative).

How are these treated?

Best regards-
Mickie

Dr. Braverman

2005 Posts
RE: Can IVIg and LIT be avoided? Posted on: Oct 4, 2012 at 2:25pm
lovenox with or without prednisone(depends on many other factors). Good Luck.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.

Mickie

20 Posts
Reply RE: Can IVIg and LIT be avoided + serotonin question Posted on: Oct 5, 2012 at 2:41pm
Hi Dr. Braverman,

Your said that it was a good thing that my LAD levels are low given that I have had two previous live births (i.e. no LIT/treatment required in this area):

[T-cells]IgG 16.9%
[B-cells]IgG 6.3%
Flowcytometry: Negative

However, I read articles that state that both of these values should be well above 50% despite the fact that I've had two live births and that LIT is required to treat. Please clarify because I am very confused now.

Also, my "serotonin, serum" level is 27 ng/ML (reference range of 26-165). Would you treat this? If so, how?

Thanks so much again.

Dr. Braverman

2005 Posts
RE: Can IVIg and LIT be avoided? Posted on: Oct 5, 2012 at 3:36pm
there is a lot of confusion about LAD that I have been trying to clear up on our website. I hope I explain this well. The LAD looks for the presence of "bad" HLA antibodies, that means these antibodies WILL attack the pregnancy. It does not measure the production of the 'good" antibodies called protecive or blocking antibodies. It has been incorreclty asummed that if the bad ones are there the good ones must be too? This has been disproven.
When you are pregnant the your body first makes the bad antibodies in the third trimester, then you make the good ones which do away with . So if you come around to your next pregnancy and they are still there that is bad, it means you did NOT make the protective ones.
New studies have shown that a high LAD with a history of a previous full term pregnancy is a poor sign for success of the next ones.
Since we dont know from LIT who will and wont make the protective antibody we have to be very carefull who we recommend it to , especially if they have already completed a full term pregnancy.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.

Mickie

20 Posts
Reply RE: Can IVIg and LIT be avoided? Posted on: Oct 5, 2012 at 8:44pm
Hi Dr. Braverman,

Just to confirm and make sure I understand, for the following facts:

Leukocyte Antibody Detection

Flowcytometry: Negative

[T-cells] IgM+ 1.0
[T-cells] IgG+ 16.9
[B-cells] IgM+ 28.6
[B-cells] IgG+ 6.3

Two previous full term healthy pregnancies (2009 and 2011).

You would NOT recommend LIT, is this correct?

Dr. Braverman

2005 Posts
RE: Can IVIg and LIT be avoided? Posted on: Oct 5, 2012 at 8:51pm
That is correct. New literature recently published shows that the presence of LAD IGG antibodies after a full term pregnancy is actually a poor prognostic indicator and places the patient at significantly "HIGHER" risk for another miscarriage.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.