My Immunologic Profile

As discussed in my previous post, I had my blood test done last April 22 at the Reproductive Immunology Center in TM Kalaw. My husband and I got the results first week of May. However, my OB was still abroad so we had to wait for her to interpret the results. We were scheduled to see her in last May 19. And the results, according to her, are as follows:

LAT
Reaction Code: 1 (for both I and II), thus, negative
%PRA: 0
*This means that I should undergo Lymphocyte Immunotherapy (LIT). My OB wants to refer me to Dr. Ed Lim. However, she warned us that this procedure will be too costly. 4 donors will be needed, 1 of which is my husband, and 3 others who are not blood related. A session could cost about P60K, and I would need about 4 sessions. This is on top of Dr. Ed Lim's hefty PF.

Lupus Anti-Coagulants
KCT: 100 (normal is 75)
APTT: 25 (normal is 20)
DRVVT: 30 (normal is 30)
*She prescribed Aspirin for this. 1/4 tab during lunch. I believe this is for APAS.

ACA results were normal.
Anti-thyroid Antibodies
*I'm actually confused here. She said I'm borderline because I got 91.60 in Anti-thyroglobulin, although the normal is <100. And I was ANA Negative.

NK Cells
As for the NK Cells (my blood samples were sent to the US - Rosalind Franklin University, Chicago, IL), here are the ones that alarmed her.
% CD3: 88.2 (normal is until 85 only)
% CD19+cells, CD5+: 16.4 (normal is until 10 only)
*For these, she said, I would need to undergo IvIg. This costs about P125K per session. I don't know if we could ever affor this. With all our expenses, and my impending plans of WAHWhood..

*My OB, since she's Chinese, gave me a more affordable alternative that would hopefully help improve my overactive NK Cells' killing capacity - ACUPUNCTURE. She gave me the contact details of Sis. Regina Liu. She asked us to give it a couple of months. And if there's an improvement, we might just need LIT and no more IvIg. (fingers crossed. sigh.). Anyway, I already scheduled an appointment with Sis. Liu in her Panay clinic this coming May 25 (my brother's birthday).

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Recurrent Pregnancy Loss and Reproductive Immunology

I mentioned in my previous post that I consulted an OB who is specializing in Reproductive Endocrinology. She told me that having 2 MCs in a row is a manifestation of possible immunologic problems. Based on her explanation as well as based on my research, immunologic problems hinder the development of the baby inside the mother's uterus, and in worst cases, killing the baby in the process. It usually happens during the first trimester and if not treated, the immune system tends to get stronger and have more killing capacity resulting in another MC.

According to my new OB, there are 5 Categories of Immunologic Problems.

Category 1 is called Alloimmune Antibody. A layman's explanation of this is when the mother's body treats the father's blood as her own. A more scientific explanation would be that in a mother's placenta, there are HLA antigens that come from the father. Alloimmune antibody happens when the couple shares DQ alpha antigens in common. The G molecule put on the placental cells by the father is too similar to the G molecule that the woman's father put on her placenta to sustain her in her mother's uterus. As a result, she does not make the blocking antibody, the baby dies, and her immune system recognizes the placenta as "altered self" (i.e., a cancer cell).

Treatment for this is called LIT (leukocyte immunization therapy), which may cost up to P70,000 per session, and may require a couple of sessions until the mother's cells forms an antibody against the father's.

Category 2 is Antiphospholipid Antibody Syndrome (APAS). Studies show that 22% of women with recurrent pregnancy losses have antiphospholipid antibodies. The incidence of this problem increases in women by 15% with each pregnancy that is lost. It is a significant consequence of infertility, implantation failures and recurrent pregnancy losses. APAS does not have a known etiology.

Antiphospholipid antibodies can cause thrombosis or blood clots in the blood vessels of the placenta. As we know, the placenta supplies the needed nutrition to the growing fetus. However, in an APAS case, with thrombosis happening in the placenta, it is unable to supply the fetus with the nutrition it needs, so the fetus may stop growing and may eventually die. There are some instances though when the fetus survives, but due to the intrauterine growth restriction in the mother's uterus, the baby may be too small at birth.

A damaged placenta may also lead to pre-eclampsia in the mother. Pre-eclampsia is a dangerous condition resulting in high blood pressure, edema (swelling) or kidney malfunction.

Treatment of APAS usually involves a small daily dose of Aspirin, which acts as anticoagulant, since patients with APAS have "sticky or thick blood". When a woman with APAS gets pregnant, she may also be given heparin. Heparin is a blood thinner. It can only be given by injection. The needle is very thin, and is put just under the skin. Most patients can do this by themselves. Heparin decreases the risk of thrombosis and pregnancy loss.

Category 3 is Positive Anti Nuclear Antibody (ANA). Women with this problem need antibodies to DNA, or DNA breakdown products in the embryo or in the pregnancy. These antibodies form first in the blood as IgM. As the problem gets worse, they appear as IgG and live in the lymphatic system and lymph nodes. With more losses, they form IgA antibodies which have their home and action in the organs including the uterus. These antibodies can be against pure double stranded DNA (ds DNA), single-stranded DNA (ss DNA), or smaller molecules called polynucleotides and histones that make up the single strands. Autoantibody to DNA leads to inflammation in the placenta.

My doctor said that if my tests turn positive in Category 3 (I really hope not), I will be given steroids.

Category 4 is called Antisperm Antibody. In this case, the mother's body rejects the sperm. When antisperm antibodies develop, they will inactivate or attack sperm from the husband and any donor (i.e., they are not partner specific). The presence of antisperm antibodies in women strongly predicts that she will also have Category 5 Immune Problems.

Category 5 is the most difficult and most expensive to cure, according to my doctor. Category 5 involves the Natural Killer Cells. This killer cells sees the growing embryo as a threat to the mother's body, like cancer, thereby ends up killing or expelling the embryo.

I will be undergoing tests to check on these Categories and to find answers to my recurrent miscarriages. The tests will be done in a clinic in TM Kalaw Avenue, Manila. The first set would cost us about P12,500. This will be a comprehensive blood test, covering the first 3 categories. My doctor did not request for a test for Category 4 anymore (Antisperm), since I do not any problem with fertilization and conception. The test for Category 5 (Natural Killer Cells) is more expensive. It will cost us USD560 as the test will be done in the US. My blood sample will be shipped, which costs P5,000.

Right now, my husband and I are still in the process of raising funds for those tests. What worries us is that the test will just be the first step in this journey. Treatment and further tests will be another. We admit that in these difficult times, it would be really hard for us to afford these tests and treatments. But we know that God will help us get through this tough situation. God will send us help from above. Our ardent wish is to have a baby of our own and to raise a happy family. So simple. Yet it seems so hard..

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