We report the case of a 39-year-old woman, weighing 59 kg and 160 cm with a history of four miscarriages of seven to ten weeks with live embryo.
Sterility studies performed were within normal limits, except for a heterozygous Leiden Factor V diagnosis.
This alteration gives rise to a variant of human coagulation factor V that frequently causes hereditary hypercoagulability disorder, being the most common among the euros i.e., the commonest.
In these cases, the variant of factor V Leiden cannot be inactivated by activated protein C.
In pregnant women with this anomaly, prophylactic administration of low molecular weight heparin (LMWH) is recommended at therapeutic doses adjusted by weight kg as soon as pregnancy is diagnosed and up to 6-8 weeks.
It should be noted that in the last pregnancy the patient experienced an abortion despite being treated with LMWH, so the hematological origin of these is ruled out.
With the previous obstetric history (G4P0A4), the patient began a new pregnancy with therapeutic regimen of LMWH enoxaparin 40 mg/ 24 h, as soon as she was aware.
After five weeks, the patient underwent an immunological study.
The results show NK cell values above normal, with 18% of peripheral NK cells and 95% of them with CD56+CD16 expression (17% of lymphocytes).
According to the algorithm proposed by Ramos-Medina3 et al, for the patient's age, these values represent a high risk of presenting an immunological alteration associated with reproductive failure.
Based on the study concluded that: a percentage of NK cells > 18% is the best variable to discriminate women with reproductive failure, and for women older than 35 years, a high CD56+CD16 cell subset (100%) defines a special risk.
The off-label use of this drug is requested.
After the authorization by the management of the center and the signature of the pregnant woman of the informed consent, the administration of the GI regimen collected in the literature begins.
It begins with GA 400 mg/kg of weight every four weeks, from the knowledge of week 4 to week 13, once again a month; later, 200 mg/kg monthly until week 36, since the third trimester has been demonstrated.
After two doses of IGs, a new immunological study was requested, which showed a reduction of NK cells to 8% with 90% CD56+CD16 markers (7.2% of lymphocytes).
Figure 1.
1.
Treatment was administered according to schedule without incidents or adverse effects relevant to the established GI regime.
At week 40 + 1, the pregnant woman was born alive by elective cesarean section.
The LMWH thromboprophylactic regimen was started the day before the intervention and suspended on the same day.
The therapeutic dose is restarted at 12-24 hours and maintained for two months.
