DQ testing after positive NK?

erosybelle

11 Posts
Reply DQ testing after positive NK? Posted on: Feb 1, 2011 at 11:39pm
Hello Dr. Braverman,

After 4 years of infertility, several failed IUIs, a failed IVF, and an early miscarriage,
I've tested positive for high levels of ATAs, TPO = 392, Anti-thyroid globulin levels are >3000,
I've recently tested (through Reprosource labs) my NK assay, with CD56+ at 33.1%.
I've also been diagnosed with Hashimoto's thyroiditis.

As I understand it, the treatment for the elevated NK and ATAs would be IVIG or Intralipid.
Although I know you recommend a full panel of tests, it seems the treatment would be the same
regardless of the HLA-DQ results. What are the reasons for the full panel of testing once one
immune issue has been established, if the treatments are the same and the testing is
expensive and not covered by insurance?

Also - do you do your own testing in-house, or do you use an outside lab?
What would be the estimated cost for the full panel of tests?

Thanks very much!
erosybelle

Dr. Braverman

2004 Posts
Re: DQ testing after positive NK? Posted on: Feb 2, 2011 at 6:55pm
There are many tests missing from your panel that I would normally order. I dont disagree with you that given your current results the full HLA testing would only give you the answer "why" are the levels elevated but would not change the management. Looking at the NKT and cytokine levels might give you a better case for IVIG vs. intralipids , but again with those levels IVIG would most likely be my first choice. The cost of our panel varies depending on insurance coverage, worst case out of pocket is generally around 800 dollars if there is no insurance coverage.

I hope that helps.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.

erosybelle

11 Posts
Reply Re: DQ testing after positive NK? Posted on: Feb 2, 2011 at 10:16pm
Hello Dr. Braverman,

Thank you very much for your response.

If we are reading our results correctly, then it seems that the Intralipid is producing comparable results to the IgG/IVIG. We are self-pay, and also have some concerns about the IVIG. What is the cost per treatment for the IVIG compared to the Intralipid, and are they done at your clinic in Long Island or Manhattan?

Could you suggest some resources to learn about in which situations IVIG works better than Intralipid?

Here are the numbers for my NK testing, comparing control group to samples with IgG and Intralipid:
NK Assay (from Reprosource labs):

50:1 E:T: 7.8%
25:1 E:T 5.4%
12.5:1 E:T 3.0%

50:1 E:T with IgG 12.5 %: 3.0%
25:1 E:T with IgG 12.5 %: 2.4

50:1 E:T with IgG 6.25 %: 1.8
25:1 E:T with IgG 6.25 %: 1.9

NK Assay with Intralipid RF
50:1 E:T w/Intralipid 1.5mg/ml: 4.4%
25:1 E:T w/Intralipid 1.5mg/ml: 2.0%

CD3+ (Pan T cell): 58.8 (60.0 - 85.0 normal range)
CD19+ (B cells: 4.5 ( 2.0 -12.0 Normal range)
CD56+: 33.1 High ( 2.0 - 12.0 normal range)
CD19+/CD5+: 4.4 (5.0 - 10.0 normal range)

Thank you very much for your time and help as we try to make sense of these results.
-erosybelle

Dr. Braverman

2004 Posts
Re: DQ testing after positive NK? Posted on: Feb 3, 2011 at 4:12am
Its hard to make a complete diagnosis and decide on the best treatment as your testing is very incomplete. If you go to our website you can see how much is missing and we work off of an index to decide on the best treatments and that requires more testing. We also discuss the benefits of both IVIG and intralipids, most from our experience as there are no comparative studies that have been done. We currently have the largest pool of data comparing IVIG to intralipids while looing at the full index of immune cells. It seems that intralipids are not as effective as IVIG in some cases but most cases we get the desired affect.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.

erosybelle

11 Posts
Reply Re: DQ testing after positive NK? Posted on: Feb 12, 2011 at 3:53pm
Hi Dr. Braverman,

Thanks again very much for your guidance.

We'd like to call up and make an appointment for a test panel and consultation.
One question we had was: specifically what tests are included in the full panel?
We have had a number of tests done already (including the NK test I described),
and of course it's always important to keep costs within reach as we are self-pay.

We look forward to hearing from you, and thanks again for your expertise
and for making yourself available in this wonderful forum!

-erosybelle

Dr. Braverman

2004 Posts
Re: DQ testing after positive NK? Posted on: Feb 15, 2011 at 5:09am
all the tests that we perform are on the website under diagnostic testing. Many insurances cover some if not all of the testing , the lab would call you prior to the blood being drawn to go over all the costs, most out of pocket would be about 800 dollars.
If you call my office Kim will set up a consultation for you so I can go over your history , see what you've had done , then order exactly what you will need.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.

erosybelle

11 Posts
Reply Re: DQ testing after positive NK? Posted on: Mar 2, 2011 at 4:05am
Dear Dr. Braverman,

We are looking forward to our consultation with you this Thursday (March 3) at 2:30 PM.

I spoke with Margaret about having a blood draw to begin the diagnostic testing.
We've had a lot of tests done already, but not the HLA-DQ-Alpha or the LAD.

One concern is that I have a vasovagal response - if too much blood is taken,
or if the needle is moved during the draw, I can have a seizure reaction and lose consciousness.
This has happened a couple of times before. So, I can generally only have a maximum of 3 tubes
drawn at any given visit.

Also - you don't accept our insurance, so we are self-pay for all the testing and consultation.

For these reasons, I'm hoping we can test selectively to avoid redundancy with tests we've already done.

Could you please tell us how many tubes are usually necessary for the test panel?

Thank you very much, and we look forward to meeting you in person,
Nora Cage and Martin Keith

Dr. Braverman

2004 Posts
Re: DQ testing after positive NK? Posted on: Mar 2, 2011 at 5:28am
Until the consult and after I have seen the blood work you have already had performed, its hard to say what tests we will need. Suffice to say that I will still keep the blood draws to yoru minimum that you can tolerate and we will certainly do what ever it takes to avoid any complications during your blood draw.
I look forward to speaking with you
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.