LAD?

stilltrying

3 Posts
Reply Posted on: Jun 27, 2012 at 3:36pm
Question about the LAD test. If a couple has a dq match (partial) plus only one other partial hla gene match, but the woman's natural killer assay results, cytokines and all other tests (apa, ana, mthfr, lac, rip) are within normal limits, would you suggest getting the LAD test for the couple just to be sure there isn't a problem there with the partial dq & hla matching? Will absolutely do the test if there's even the slightest benefit. Thanks in advance for your help!

BTW, this message board is amazing! I've been reading through it and have learned so much! Wish all doctors were as helpful (and honest) as you!!!

d

Dr. Braverman

2024 Posts
RE: LAD? Posted on: Jun 27, 2012 at 5:57pm
The purpose of the LAD test is to see if you have made anti HLA antibodies. The assumption is then made(erroneously) that if they are made then you also made the protective or anti idiotypic antibodies.
Anti HLA antibodies are only made in the third trimester of a pregnancy , so if you have never been that far you will get no information from an LAD.
The only benefit of an LAD is if you have secondary recurrent pregnacy loss i.e. one full term pregnancy then losses, it may suggest that your problem is too many anti HLA(or anti embryo ) antibodies. The more matches you have in the HLA the less likely you will make anti HLA antibodes and the less likely the LAD will be postivie.
so to answer your question , if you have primary recurrent pregnancy loss i.e never had a Full term pregnancy it is useful , if not , then it is not useful.
For those that may have had the test anyway and had a postive result but never made it to end or even middle of a pregnancy this might signify other antibodies such as APA , Lupus, infection and should be worked up.
The biggest mistake I see are peeople with primary RPL who get LIT because of a negative LAD , it should be negative if t there was no Full Term PRegnancy.I hope that helps. I only wrote a long answer because you had to go and tell me how "amazing" this board is!!
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.

stilltrying

3 Posts
Reply RE: LAD? Posted on: Jun 27, 2012 at 6:46pm
Without this board, most of us wouldn't have a clue what was going on!

I have secondary rpl (since I had a successful full term pregnancy with 1 child years ago).

I have a couple of hla matches (partial only).

So just to confirm, that means that an LAD would be useful for my case because I've had a full term pregnancy (with subsequent losses since).

Or did I get that backwards?

Dr. Braverman

2024 Posts
RE: LAD? Posted on: Jul 2, 2012 at 7:35pm
You are absolutely correct!
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.

Mayaus

10 Posts
RE: LAD? Posted on: Oct 11, 2012 at 8:57pm
Hi Dr Braverman,

In my case, I also had a normal full term pregnancy without any issues, and had 6 miscarriages after that,

My LAD was negative and I did LIT but still lost three pregnancies after that. Recently I did two IVF cycles with LIT and neupogen on both cycles ( besides prednisone, clexane, ba, progesterone, metformin, antibitiocs and suplements ). Both cycles failed.

How would you address my LAD in this case if I am still miscarriaging and not having a postiive on my IVF cycles ? I haven't tried Ivig or Intralipids prior to my cycles ( just intralipids 6 months before my cycle ). Would you say that might be the answer ?

Is it ok to try Ivig + neupogen if I am being closely monitored for my WBC ???

Dr. Braverman

2024 Posts
RE: LAD? Posted on: Oct 11, 2012 at 9:04pm
Ok lets get the facts correct first.
1. A DQ match complete or partial is of NO significance
2. Since the other tests are also normal so far you have not idendified ANY immune issues
3. LAD is of no value unless you have had a full term pregnnancy , if you have a positive finding is most likely a poor prognostic sign not a good one. The more matches you have on the HLA(and your entire HLA should be screened) the less likely you are to have a postive LAD since this looks for antibodies you are making against your husbands HLA but if you are very similar your body wont react by making antibodies and most in this situation have a negative LAD.

I thnk you need to rething your course here, I would be happy to organize this for you.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.

Dr. Braverman

2024 Posts
RE: LAD? Posted on: Oct 11, 2012 at 9:18pm
ok my answers are getting mixed in under the wrong quesion, that a negative LAD after a full term pregnancy followed by 6 miscarriages the negative LAD is normal and to be expected, so I would suspect another cause here for all your losses. An elevated LAD would mean you did not get rid of these antibodies and that may actually be problem not a good thing. I would need to see your full workup to help you determine the correct treatment.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.

Mayaus

10 Posts
RE: LAD? Posted on: Oct 12, 2012 at 7:47pm
Thank you so much for your answer Dr Braverman. I agree that this forum is amazing and so is your availability to answer our questions.

I got a bit confused cause I thought you said on the previous post that negative or low LAD is significant for those who secondary losses ( that had a child prior to the losses ). I understand that my LAD should be positive after I have delivered my baby, no ?

What I don't get is that we have already addressed all the other possible causes by using Intralipids, neupogen, prednisolone, metformin, methyl folate, clexane, aspirin etc... maybe Ivig could be the answer ?

Do you think doing Ivig and neupogen at the same time is fine if I am monitored ? What would be the concern here ? Having my WBC too elevated ?

Thanks so much Dr Braverman !

Dr. Braverman

2024 Posts
RE: LAD? Posted on: Oct 12, 2012 at 7:52pm
I know this is not easy to understand so many in the field still dont understand. the HLA antibodies that are detected on the LAD appear in the 3rd trimester of a pregnancy. Usually immediately afterwards the "protective" or anti idiotypic antibodies appear and the anti HLA dissappear. This is why so many normal pregnant women that are tested after a normal pregnancy fail to have these antibodies.
So if you still have them after a pregnancy , the theory is that the "protective " antibodies never developed to eradicate the HLA antibodies and literature shows that these women that still have the anit HLA antibodies present(those present on the LAD test) have a poor prognosis for another miscarriage.
Having a negative LAD is normal in those that have had a normal previous pregnancy and not unexpected in those that have never made it to the third trimester.
I really would need to go over your case very carefully to help you. why dont you call me and schedule a consult. we can do by phone or SKYPE>
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.