NK Cells, Thyroid Antibodies - Intralipids

Jo

3 Posts
Reply Posted on: Sep 21, 2012 at 8:33pm
Dear Dr Braverman,

I am 30 years old. Have had 6 IVF attempts of which 5 were failed and 1 was successfull with twins but Hetrotropic and eventually a misscarriage. I am Hypothyroid with both Antibodies positive TPO - 300 and ATG 8.86. I have had Natural Killer testing done 3 times : I am not sure what part of the cycle i was. I am negative for ANA and all other antibodies including ovarian, APA, Lupus etc.

NK 1: Test date 29-0-4-2011 ( I believe this was tested after a negative thaw ET cyle failed) date of ET 18-04-2011

Total Leucocytes WBC: 17,300 - RANGE 5000-10,500
Lymphocytes - 26.0 Range :20-40%
Absolute Lymphocyte Count : 4498 Range 1000 to 3000/c.mm
CD3 Percentage - 71% Range : 56 to 86%
Absolute CD3 count - 3189 range 723 -2737
CD 16+56 percent - 24.23% range 5.6 to 31.0%
CD 16 +56 absolute cell count 1089 range 173-1392
CD 19 18.34%

NK 2 : Test Date 20-5-2011 (repeat for the results above) (18days after negative beta hcg)

Total Leucocytes WBC: 9000 - RANGE 5000-10,500
Lymphocytes - 47.0 Range :20-40%
Absolute Lymphocyte Count : 4230 Range 1000 to 3000/c.mm
CD3 Percentage - 77 Range : 56 to 86%
Absolute CD3 count - 3277 range 723 -2737
CD 16+56 percent - 12.95% range 5.6 to 31.0%
CD 16 +56 absolute cell count 547.5 range 173-1392
CD 19 not tested
Natural Killer Cells (CD3/CD16/CD56) : Date 6/07/2011Test Description Observed Value Biological Reference IntervalLymphocyte Markers :Total Leucocytes (WBC) count 5,900 4,000 to 10,500/c.mmLymphocytes 40.0 20 to 40%Absolute Lymphocyte Count 2,360 1000 to 3000/c.mmCD3 Percentage 73% 56 to 86 %Absolute CD3 Count 1,723 723 to 2737CD(16+56) percent 10.27% 5.6 to 31.0 % **CD(16+56) absolute cell count 242.4 173 to 1392CD 19 - 17.10%
CD45/CD3/CD4/CD8 TestTest Description Observed Value Biological Reference IntervalTotal Leucocytes (WBC) count 5,900 4,000 to 10,500/c.mmCD45 absolute (Lymphocyte gated) 2,218 1000 to 3000/c.mmCD3 (TCells) Percentage 73 56 - 86 %CD3 (T-cells) Absolute 1,610 723 - 2737 (cells/uL)CD4 (HelperTCells) Percentage 39 33 - 58 %CD4 (HelperTCells) Absolute 864 404 - 1612 (cells/uL)CD8 (Suppressor T-Cells) Percentage 34 13 - 39 %CD8 (Suppressor T-Cells) Absolute 746 220 - 1129 (cells/uL)CD4/CD8 Ratio 1.16 0.9 - 2.5Haemoglobin (Hb) 12.3 12.5 to 16 gm/dLPlatelet count 368 150 to 450 X 1000/c.mm.My question for you is whether if you feel I am NK cells positive as my RE here is giving me mixed reponses. I always receive Lovenox 40 and Predisone starting after Egg retrieval in every cycle. Do you feel I need to take it from the start of the cycle? Shall I consider Intralipids for the Thyroid Antibodies?

Regards
Jo

Dr. Braverman

2004 Posts
RE: NK Cells, Thyroid Antibodies - Intralipids Posted on: Sep 21, 2012 at 9:19pm
The immune system is an orchestra there are no solo acts. So looking to see if you are "NK" cell positive adds nothing to your diagnosis or treatment options. I think you need to call me and get a complete and accurate assesment of your issues. I would be happy to help you.
But to answer your questions some of your actived NK cell levels are elevated.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.

Jo

3 Posts
Reply RE: NK Cells, Thyroid Antibodies - Intralipids Posted on: Sep 21, 2012 at 9:23pm
Thank you Doctor. I have made a consultation appointment with you and will be speaking to you soon. What is exactly the treatment to calm my NK cells - I am not open to IVIG due to it being a blood product. Will Intralipids be helpful in this scenario?

Dr. Braverman

2004 Posts
RE: NK Cells, Thyroid Antibodies - Intralipids Posted on: Sep 22, 2012 at 6:48am
Yes intralipids would work fine if it is only the NK cells that are the problem. I use it quite frequently with excellent results.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.

Jo

3 Posts
Reply RE: NK Cells, Thyroid Antibodies - Intralipids Posted on: Sep 22, 2012 at 7:30am
Hello Doctor Braverman,

How many Intralipid infusions do you suggest if its only a NK & ATA issue for a long protocol IVF cycle or any IVF cycle. My RE feels I should do one infusion 14-16 days prior to egg transfer and a second one 7 days prior to egg transfer. The third one only if beta is positive.

Regards.

Dr. Braverman

2004 Posts
RE: NK Cells, Thyroid Antibodies - Intralipids Posted on: Sep 22, 2012 at 8:10am
There is never a standard dose it really depends on all of the immune findings not just the NK and ATA levels(which lovenox may be a good choice as well). absolutely routine I give one dose of the ILs prior to transfer then retest immune findings with pregnancy to determine how much and when the next dose should be. The frequency of the first IL doses depends on how elevated the NK activity is and what other medicaitons we are using along with it.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.