Du har lite höga värden för fertilitet på NK. De ska vara under 15%
lgG conc 12.5 50:1 ** 1.,5
Är du säker på att det ska vara 1,5 här och inte en annan siffra efter 1:an?
Annars så visar de siffrorna hur din killing power påverkas av Ivig, eftersom jag misstänker att det var ett litet skrivfel så tror jag nästan att Intrapelider fungerar bättre eller lika bra för dig (det är de som står längst ner). Det är bra eftersom de är mycket billigare.
Vad det gäller din LAD så ser den ganska bra ut, det sista värdet är det viktigaste, det ska vara över 30 men helst över 50 som du har. Dr G kan dock rekommendera LIT eftersom ni har en match och det totala genomsnitter är under de önskade 30 (därav står det negative). Men det är ett gränsfall.
För %CD19 så brukar det vara prednisolon och clexane och det skulle du med största säkerhet få ändå pga av matchningen.
Jag tror att Dr G kommer att rekomendera följande till att börja med:
3 x Intralepider (dag 7-10/plus/v 6,5) (Ca £350 per drip)
Clexane från dag 7 (£5 per dag)
Prednisolon från dag 7 (billigt)
Trombyl att starta omgående (alt baby asprin, köp i england i rätt dos så slipper du dela tabletter)
Ev 2xLIT (£500-£750 per gång plus blodprover)
Jag bifogar ett utdrag på engelska som förklarar hela NK assay:
15.2.1 What is the NK assay?
The NK assay from RFU has three components. The lab mix a sample of NK cells from your blood with a sample of target K562 cells (specimen cells). They incubate the sample for two hours and then measure what percentage of the K562s have been killed by your NKs. They perform the same test at three dilutions. 50:1 (50 NK cells to every K562 cell), 25:1 (25 NK cells to every K562) and 12.5:1 (12.5 NKs to every K562). For normal fertility you want all three of these measurements to be below 15% i.e., you want your NKs to kill off less than 15% of the target cells in two hours. This would mean you would have a normal level of NKactivity/killing power. Elevated levels mean that your NKs are more aggressive/active than ideal for fertility.
The second part of the assay is the same test but with a solution of IVIG added at two concentrations. If your basic levels are elevated, you would want to see them reduced to below 15% (i.e., brought into the normal range) when IVIG is added. Dr Sher disputes the value of the second part of the test as he feels it may not reflect how your NKs would behave with IVIG in the body, but Beer Centre, ARGC and Dr Gorgy do believe that it gives a good indication. If it shows that your levels do come down it shows that a) your NKs do appear to respond to medication and b) they specifically seem to respond to IVIG.
The third part of the assay is a basic immunophenotype – a measure of the concentration in your blood of CD3+ cells (all T cells apart from NKs), CD19+ (all B cells), CD56+ (all NK cells) and CD19+5+ (B cells associated with autoimmunity).
When Dr Gorgy runs this test, he tends to request a fourth part of the assay (usually shown on a separate sheet) where the 50:1 is repeated but with a solution of intralipid added, to see if that produces a suppression in NKa in the test tube.
Example test results:
NK Assay (% killed) panel
50:1 27.3 10-40% note that for fertility, the normal range is below 15%
25:1 22.0 5-30% note that for fertility, the normal range is below 15%
12.5:1 14.1 3-20% note that for fertility, the normal range is below 15%
IgG conc 12.5 50:1 21.4 note that this result shows some suppression – but not down to below 15%
IgG conc 12.5 25:1 17.0 note that this result shows some suppression – but not down to below 15%
IgG conc 6.25 50:1 18.4 note that this result shows some suppression – but not down to below 15%
IgG conc 6.25 25:1 12.4
% CD3+ 64.0 60 – 85% note that this result is normal
% CD19+ 5.9 2 – 12% note that this result is normal
% CD56+ 25.2 2 – 12% note that this result is elevated
% of CD19+ cells, CD5+ 17.5 5 – 10% note that this result is elevated
NK Assay w/intralipid
50 :1 w/intralipid 1.5 mg/ml 13.9% note that this result shows suppression down to below 15% which is a good sign
25 :1 w/intralipid 1.5 mg/ml 7.4% note that this result shows suppression down to below 15% which is a good sign
15.2.4 Please explain my NK assay results?
The first part of the test (50:1, 25:1, 12.5:1) shows what percentage of target cells your NKs killed off within two hours. You want all these numbers to be below 15% for normal fertility. (Higher levels may be great for fighting viruses or cancer but not good for fertility.)
The second part of the test shows whether adding a solution of IVIG to your samples modified the results. If the first part of test shows elevated NKa, you want this part of the test to show that adding IVIG successfully reduced your NKa to normal (below 15%).
The third part of the test shows the concentration of various types of cells in your blood.
CD3+ cells are supposed to be below 86%. Elevated levels are likely to be associated with autoimmune conditions and infertility issues.
CD19+ are supposed to be below 8%.
CD56+ (NK cells) are supposed to be below 12%.
CD19+5+ are supposed to be below 10%. Elevated levels are likely to be associated with autoimmune activity including antihormonal antibodies. Accordingly, Dr Gorgy tends to prescribe additional progesterone to ladies with elevated levels of CD19+5+ in case the activity includes anti-progesterone antibody activity.
15.2.11 What are the treatment options for elevated NKa?
The most basic treatment is corticosteroids. Usually a low dose of clexane is added on the grounds that NKa may compromise blood flow to the uterine lining or the placenta. Most immune docs will then use intralipids and/or IVIG drips on top of the basic treatment.
For elevated CD19+5+ B cells, Dr Gorgy tends to prescribe additional progesterone.
Where elevated NKa is associated with a low LAD or with an infection e.g., Chlamydia, some docs believe that the elevation will reduce if the infection is treated or the low LAD is addressed with LIT.
During pregnancy, some docs will want to retest your NKa periodically to determine which treatment to give you and to monitor for any immune flares. A lot of immune Tx ladies seem to experience a flare in immune activity at around 18-22 weeks of pregnancy whereas, in ‘normal’ ladies, immune activity is usually suppressed during pregnancy (see Pregnancy).
Jag saknar din NK assay men det verkar att IVIG gör bättre supresion än intralipid fast det kan fungera med intralipid också iom <15%.