August 20th, 2018

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Title:
Intravenous Immunoglobulin and Partner Specific Thrombocyte Transfusion Immunotherapy in Selected Cases of Recurrent Miscarriage
Authors:  Gyozo Petrányi, M.D., Ph.D., D.Sc., Péter Simsa, M.Sc., Ágnes Padányi, Ph.D.,† Beatrix Kotlán, Ph.D., Judit Jakab, M.D., and Vilmos Fülöp, M.D., Ph.D., D.Sc.
  OBJECTIVE: To summarize the immunological diagnostic methods and treatment options for the successful intravenous immunoglobulin (IVIG) and thrombocyte transfusion immunotherapy in recurrent miscarriage (RM) patients.

STUDY DESIGN: A total of 191 couples with RM were selected for the study. Gynecological, endocrinological, genetic, infectious, and autoimmune backgrounds were excluded. Immunological tests were performed to identify cases with alloimmune etiology (immunologically related RM [IR/RM]). IVIG, thrombocyte transfusion (partner-specific transfusion [PST]), and a combination of the above (IVIG+PST) were administered to IR/RM patients.

RESULTS: In IR/RM patients, partner-specific cytotoxic T lymphocyte precursor frequency (1:8,238) was 8 times higher and NK cell activity was also significantly higher (58.6%) than in normal controls (1:67,517 and 38.1%, respectively). In the sera of IR/RM patients the erythrocyte antibody rosette inhibitory activity was decreased (15.9%) as compared to that of the controls (49.5%). Partner-specific mixed lymphocyte culture (MLC) reactivity showed bidirectional results. While 63% of the patients’ sera expressed enhancing or neutral effects on the basic partner-specific MLC reactions in 37% of the cases, maternal sera blocked the antipaternal MLC reactivity. The overall efficacy of immunotherapy (IVIG, PST, and combination) in selected alloimmune RM cases was 91.5%.

CONCLUSION: The efficacy of immunotherapy in RM cases depends on the diagnostic selection of RM patients with alloimmune background. Instead of leukocytes, thrombocytes could be used for immunotherapy with similar efficacy.
Keywords:  abortion, habitual; abortion, recurrent; blocking antibodies; immune related recurrent miscarriages; immunity; immunologic factors; immunotherapy; IVIG; intravenous immunoglobulins; miscarriage; miscarriage, recurrent; pregnancy complications
   
   
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