Home-based Intravenous Immunoglobulin Therapy in a Patient with NK-associated Recurrent Pregnancy Loss

Objective. To assess the safety of intravenous immunoglobulin (IVIG) therapy to treat a woman with NK-associated recurrent pregnancy loss (PL) in a supervised home-based setting.

Methods: Case report of an unusual therapy.

Results: A 36-year-old woman had three consecutive PL between six and eight weeks gestation. The patient was evaluated by a hysterosalpingogram that identified arcuatus uterus. No other causes of PL were detected including parental kariotype, thrombophilia, antiphospholipid antibodies and anti thyroid antibodies. An extended immunological evaluation disclosed peripheral blood NK-cell counts between 13 and 25% in distinct evaluations. During the next 2 pregnancies the patient was treated in a hospital setting with IVIG (Flebogamma 5%) at a dosis of 25,000 mg, 3 weekly, beginning at the time of positive pregnancy test. The patient delivered 2 healthy babies [APGAR 10, 10] and [APGAR 9,10], respectively. The patient became became pregnant again and asked to get IVIG infusions in a home-based setting. Taking into account the previous experience of IVIG usage in hospital without adverse reactions, a home-based IVIG protocol was applied on a compassionate basis (IVIG is not approved for pregnancy and fertility usage). Flebogamma DIF 5% with the same protocol was used. Infusion rate was 30 to 90 ml/hour. During the beginning of the first 2 infusions the prescribing physician was present at home. During the following infusions text (SMS) messaging was maintained with the physician. A nurse was present at home during all infusions. Regular visits were maintained at the gynecology and clinical immunology units. Nurse reports revealed no adverse reactions related to IVIG administration, nor side effects during infusions. The pregnancy ended at 40 completed weeks of gestation [APGAR 9,10]. NK-cell monitoring during pregnancy disclosed a normalization of NK cell levels.

Conclusion. IVIG might be considered to be safely administered at home in pregnant women with recurrent PL associated with increased NK-cell levels.