Case presentations: THROMBOCYTOPAENIA AND LEUCOPAENIA OF DENGUE FEVER: A CASE SERIES by Prof. Ranjit Nimbalkar
Introduction:
Dengue fever, generally doesn’t cause much harm or
is not fatal in normal adults. But of course there are chances of its landing
into Dengue shock syndrome, where complications of hypotension & tissue
edema are common. Dengue haemorrhagic
fever is another dangerous condition, where due to bone marrow depression,
there is considerable fall in white cells & platelets, causing a risk of
secondary infections & bleeding disorders respectively. As per the studies,
children are moresusceptible to thrombocytopaenia1,2.
In this case series, 5 cases of post
dengue thrombocytopenic patients have been included. All showed gradual fall of
WBCs & Platelets will be presented. All the 5 patients were previously
treated by their family doctors for symptoms like fever, headache & body
ache3. Dengue NS1 was positive. They were relieved from these
symptoms like fever, bodyache etc., but still showing gradual downfall in WBC
& platelet counts. They were treated
by Ayurvedic Herbal combination only for increasing these counts.
The combination was made up of 8 herbs,
viz. Aamalaki (Emblicaofficinalis),
Musta (CyperusRotundus), Guduchi4 (Tinosporacordifolia),
Yashtimadhu (Glycirrhizaglabra), Bala (Sidacordifolia), Pippali (Piper
longum), Patola (Trichosanthesdioeca) &Vidari (Purariatuberose).
The clinical details of these subjects
are tabulated as under:
Case
1:
14/Mpatient
showed onset of symptoms like severe headache, fever & chills on 14 Oct 2014.he
was treated symptomatically by his family physician. Symptoms were relieving
slowly. His Dengue NS1 came positive after 4 days of onset, i.e. on 18/10/2014.
His platelets & WBCs started to show steady fall from 1,76,000/cmm&
3530/cmm to 99,000/cmm& 2050/cmm respectively, in 6 days thereafter.
Ayurvedic treatment was started. He was given the powders of herbs as mentioned
in the table, 500mg each, 4 times a day. CBC was done periodically. Within 6
days, his reports came to normal.
Name
|
O.M.
|
|
Age/gender
|
14/M
|
|
14/10/2014
|
Symptoms occurred
|
Severe headache, fever with chills.
|
18/10/2014
|
Dengue NS1 date
|
Positive
|
18/10/2014
|
Plt count
|
1,76,000/cmm
|
TLC
|
3530/cmm
|
|
19/10/2014
|
Plt count
|
1,61,000/cmm
|
TLC
|
3200/cmm
|
|
21/10/2014
|
Plt count
|
1,30,000/cmm
|
TLC
|
1940/cmm
|
|
23/10/2014
|
Plt count
|
1,05,000/cmm
|
TLC
|
2150/cmm
|
|
24/10/2014
|
Plt count
|
99,000/cmm
|
TLC
|
2050/cmm
|
|
24/10/2014
|
Rx started
|
Dhatri,
musta, guduchi, yashti, bala, pippali, patola, vidari. All powders 500 mg each, 4 times a day with honey
|
25/10/2014
|
Plt count
|
1,35,000/cmm
|
TLC
|
2550/cmm
|
|
27/10/2014
|
Plt count
|
2,50,000/cmm
|
TLC
|
2880/cmm
|
|
30/10/2014
|
Plt count
|
3,63,000/cmm
|
TLC
|
5400/cmm
|
Case 2:
11/M
patient showed onset of symptoms like severe headache & fevers on 16 Oct 2014.he
was treated symptomatically by his family physician. Symptoms were relieving
slowly. His Dengue NS1 came positive after 4 days of onset, i.e. on 20/10/2014.
His platelets & WBCs started to show steady fall from 1,88,000/cmm&
3400/cmm to 1,00,000/cmm& 2900/cmm respectively, in 7 days thereafter. At
this count his family opted for Ayurvedic treatment instead of admission. He
was given the powders of herbs as mentioned in the table, 500mg each, 4 times a
day. CBC was done periodicaly. Within 3 days, his reports came to normal.
Name
|
YT
|
|
Age/gender
|
11/M
|
|
16/10/2014
|
Symptoms occurred
|
Severe headache, high grade fever.
|
20/10/2014
|
Den NS1
|
Positive
|
17/10/2014
|
Plt count
|
1,88,000/cmm
|
TLC
|
3400/cmm
|
|
19/10/2014
|
Plt count
|
1,86,000/cmm
|
TLC
|
2900/cmm
|
|
20/10/2014
|
Plt count
|
1,56,000/cmm
|
TLC
|
2900/cmm
|
|
22/10/2014
|
Plt count
|
1,33,000/cmm
|
TLC
|
3100/cmm
|
|
24/10/2014
|
Plt count
|
1,00,000/cmm
|
TLC
|
3800/cmm
|
|
24/10/2014
|
Rx started
|
Dhatri,
musta, guduchi, yashti, bala, pippali, patola, vidari. All powders 500 mg each, 4
times a day with honey
|
25/10/2014
|
Plt count
|
1,33,000/cmm
|
TLC
|
4000/cmm
|
|
27/10/2014
|
Plt count
|
2,79,000/cmm
|
TLC
|
4300/cmm
|
|
30/10/2014
|
Plt count
|
3,65,000/cmm
|
TLC
|
4600/cmm
|
Case 3:
11/M
showed onset of symptoms like severe headache, bodyache & fevers on 25 oct2014.
He was treated symptomatically by his family physician. Symptoms were relieving
slowly. His Dengue NS1 came positive after 5 days of onset, i.e. on 31/10/2014.
His platelets & WBCs started to show steady fall from 1,25,000/cmm&
3690/cmm to 1,00,000/cmm& 2490/cmm
respectively, in 4 days thereafter. At this count his family opted for
Ayurvedic treatment instead of admission. He was given the powders of herbs as
mentioned in the table, 500mg each, 4 times a day. CBC was done everyday.
Within 3 days, his reports came to normal.
Name
|
CC
|
|
Age/gender
|
11/M
|
|
25/10/2014
|
Symptoms occurred
|
Severe headache, body
ache, mild to moderate fever.
|
31/10/2014
|
Den NS1
|
Positive
|
31/10/2014
|
Plt count
|
1,25,000/cmm
|
TLC
|
3690/cmm
|
|
2/11/2014
|
Plt count
|
1,21,000/cmm
|
TLC
|
2680/cmm
|
|
3/11/2014
|
Plt
count
|
1,00,000/cmm
|
TLC
|
2490/cmm
|
|
3/11/2014
|
Rx started
|
Dhatri, musta, guduchi, yashti, bala, pippali, patola,
vidari. All
powders 500 mg each, 4 times a day with honey
|
4/11/2014
|
Plt count
|
1,05,000/cmm
|
TLC
|
2890/cmm
|
|
6/11/2014
|
Plt count
|
1,05,000/cmm
|
TLC
|
3950/cmm
|
|
7/11/2014
|
Plt count
|
1,45,000/cmm
|
TLC
|
4250/cmm
|
|
9/11/2014
|
Plt count
|
1,75,000/cmm
|
TLC
|
5200/cmm
|
|
10/11/2014
|
Plt count
|
3,40,000/cmm
|
TLC
|
6,640/cmm
|
Case 4:
21/M pt
started c/o fever with chills on 14th Aug 2015. Took antibiotic
treatment from local doctor. Fever continued. Dengue NS1 came positive on 17th
August. Platelet count 1,00,000/cmm. TLC, 3900/cmm.Repeated platelet count on
17 Aug 2015.Platelets 70,000/cmm.
Started
Ayurveda treatment. Platelets on 21 Aug came out to be 1,14,000/cmm and TLC
8300/cmm. Repeat hemogram on 25 Aug showed platelets 2,26,000/cmm and TLC
7000/cmm.
Name
|
PJ
|
|
Age/gender
|
21/M
|
|
14/08/2015
|
Symptoms occurred
|
Chills, body
ache, mild to moderate fever.
|
17/08/2015
|
Den NS1
|
Positive
|
Plt count
|
1,00,000/cmm
|
|
TLC
|
3900/cmm
|
|
19/08/2015
|
Plt
count
|
70,000/cmm
|
TLC
|
2500
|
|
19/08/2015
|
Rx started
|
Dhatri, musta, guduchi, yashti, bala, pippali, patola,
vidari. All
powders 500 mg each, 4 times a day with honey
|
21/08/2015
|
Plt count
|
1,14,000/cmm
|
TLC
|
8300/cmm
|
|
25/08/2015
|
Plt count
|
2,26,000/cmm
|
TLC
|
7000/cmm
|
Case 5:
24/M pt
started c/o high grade fever 1040 F on 27 Aug 2015. Hemogram was
normal. Dengue NS1 came positive on 28 Aug 2015. Platelets 36000/cmm and TLC
3200/cmm. admitted in hospital.
On 30 Aug 2015, platelets further declined to
20,000/cmm and on 31 Aug 2015, 15,000/cmm.
Ayurveda
treatment started on 31 Aug 2015. Platelets were not infused. Patient was only
under observation.On 1 Sep 2015, platelets fellupto 8,000/cmm and TLC was
9,000/cmm. Still as there was no active bleeding, treating doctor did not
infuse platelets. On 3rd Sep, 2015, platelets became 32,000/cmm, on 4th
Sep, 82,000/cmm, on 5th Sep 1,32,000/cmm. Pt was discharged.
Name
|
VG
|
|
Age/gender
|
24/M
|
|
27/08/2015
|
Symptoms occurred
|
high grade fever.
|
29/08/2015
|
Den NS1
|
Positive
|
Plt count
|
36,000/cmm
|
|
TLC
|
3200/cmm
|
|
30/08/2015
|
Plt count
|
20,000/cmm
|
TLC
|
3200/cmm
|
|
31/08/2015
|
Plt count
|
15,000/cmm
|
TLC
|
6600/cmm
|
|
31/08/2015
|
Rx started
|
Dhatri, musta, guduchi, yashti, bala, pippali, patola,
vidari. All
powders 500 mg each, 4 times a day with honey
|
1/09/2015
|
Plt
count
|
8,000/cmm
|
TLC
|
9,000/cmm
|
|
3/09/2015
|
Plt count
|
32,000/cmm
|
TLC
|
7000/cmm
|
|
4/09/2015
|
Plt count
|
82,000/cmm
|
TLC
|
Not done
|
|
5/09/2015
|
Plt count
|
1,32,000/cmm
|
TLC
|
10,200/cmm
|
From the
above tables, it is can be said that all the subjects responded really well to
the Ayurvedic Herbal combination.
Assembling
Samprapti:
Symptom
|
DushtaDosha
|
DushtaDooshya
|
Gunas
|
Severe headache
|
Vataprakopa
|
Rasa,Rakta
|
Rooksha, Chala
|
Severe bodyache
|
Vataprakopa
|
Asthi, Majja
|
Rooksha, Chala
|
High grade fever
|
Pitta prakopa
|
Rasa,Rakta
|
Ushna,Teekshna
|
Possibility of
bleeding
|
Pitta prakopa
|
Rasa, Rakta
|
Ushna,Teekshna
Drava
|
As per above logic, the vitiated
Gunas came to be: Rooksha, Chala, Ushna, Teekshna& Drava. Vitiated Doshas
to be Vata & Pitta. Rasavaha, Raktavaha, Asthivaha & Majjavahasrotasas were
found to be vitiated.
Moolasthanas of these srotasas,
viz. Hrudaya, Yakrut, Pleeha, Meda, Asthi & Sandhi were also considered during
coining of the herbal formulation.
In view
of all this logic, powders of following herbs were selected:
1.
Aamalaki Emblicaofficinalis Sheeta, Rasayana
2.
Musta CyperusRotundus Sheeta, Manda, Sugandhi
3.
Guduchi Tinosporacordifolia Rasayana, Jwaraghna
4.
Yashtimadhu Glycirrhizaglabra Sheeta, Snigdha
5.
Bala Sidacordifolia Sheeta, Rasayana,
Balya
6.
Pippali Piper longum Ushna, Rasayana
for Rakta
7.
Patola Trichosanthesdioeca Sheeta, Balya, Rasayana
8.
Vidari Purariatuberosa Sheeta, Balya,
Rasayana
Powders
of all were mixed together & given to the subjects with honey, 4 times a
day. 500mg of each herb i.e. total 4gm medicine to be taken at a time.
Other
regimen like soft & light diet, rest & plenty of Luke warm water
orally, was advised to all. Haemogram was advised everyday or alternate day as
per need.
From the
above tables it is quite clear that all the patients responded to the Ayurvedic
Herbal combination quickly & were out of danger zone in less than 7 days.
Thus they escaped the hospitalisation & hazards of platelet infusion. All
the cost& loss of working hours was also saved.
Conclusion:
Ayurvedic herbal combination can
be effectively tried at the very first instance of thrombocytopenia & leucopoenia,
to avoid further complications.
Of
course we all need to generate huge data to make some final statement, but
still, this study can be considered as pilot study.
If you
want to try this combination for your patients, a kind request to use it in a
precise manner and keep proper documentation of all the results, so that we can
approach the scientific world with genuine documentated results.
References:
1.
Expert Review of Anti-Infective Therapy Dengue Fever: Diagnosis and
Treatment; VirojWiwanitkit; Disclosures;Expert Rev Anti Infect
Ther. 2010;8(7):841-845.
2. Dengue fever with thrombocytopenia: studies towards
defining vulnerability of bleeding.
(PMID:7786355); García S, Morales R, Hunter RF; Department of Internal
Medicine, HospitalUniversitario Ramón Ruiz Arnau; Boletin de la AsociacionMedica de
Puerto Rico
The natural history of dengue illness based on a study of
hospitalised patients in Singapore.
(PMID:10487075; Tai DY, Chee YC, Chan KW; Department of General Medicine,
Tan Tock Seng Hospital, Singapore; Singapore Medical Journal
21 Health Effects of Alkaloids
from African Medicinal Plants;V Kuete - Toxicological Survey of African Medicinal Plants, 2014 - researchgate.net
Case Courtesy & Presentation:
Dr. Ranjit Nimbalkar
Ph.D. (sch.), M.D. (Rognidan);
Professor
Dept of RogNidan, Ashtang AyurvedMahavidyalaya,
Pune 411030, Maharashtra, India
Mobile No.: +91 9850066935
Email: drranjitn@rediffmail.com
Clinic Address:
Anubandha Healthcare
495, Sadashiv Peth,
Opposite Doorvankur Dining Hall,
Tilak Road, Pune: 411030, Maharashtra, India.
Compiled & Edited by
Dr.Surendra A. Soni
M.D.,PhD (KC)
Associate Professor
Dept. of Kaya-chikitsa
Govt. Ayurveda College
Vadodara Gujarat, India.
Email: surendraasoni@gmail.com
Mobile No. +91 9408441150
Perfect documentation and Crystal clear explanation. Great job Prof Ranjit Nimbalkar ji.
ReplyDeleteTx mam..
DeleteMany thanks Sir for sharing your knowledge and clinical experience.
ReplyDeleteTx Mam
DeleteDoctor, this is awesome explanation and wonderful case study data. I am now in search of a dengue patient to take him to you for the faster recovery.
ReplyDeleteWonderful compilation.
ReplyDeleteHeartiest congrats.
Tx sir
DeleteThis comment has been removed by the author.
ReplyDeleteWonderful results
ReplyDeleteTx sir
DeleteTime and plt pattern is not compatible with WHO course of dengue illness except in case 5. In that too increase in plt is natural. I send WHO chart at whatsapp to Ayurvedapeeth Group.
ReplyDeleteTotally agree with you sir.
DeleteI'm completely aware that with this small data, we cannot claim result of medicine.
That's why, please go through the last para... Quoting here again...
"Of course we all need to generate huge data to make some final statement, but still, this study can be considered as pilot study.
If you want to try this combination for your patients, a kind request to use it in a precise manner and keep proper documentation of all the results, so that we can approach the scientific world with genuine documentated results."
In other words, this is only beginning no any final conclusion.
Pls come forward and treat as much as cases you can, then our collective effort may prove something.
Tx for your keen interest and tx for the very useful WHO table...
Very good case study,
ReplyDeleteThis type of studies are required to encourage Ayurveda practiceners and establish Ayurveda prescription for diseases.
Tx a lot for all your blessings sir...
DeleteHow's this drugs work on increase wbc and platelets .?
ReplyDeleteAny sastra reference ?
Once we undoubtedly establish the cause and effect relationship, then furter research needs to be taken up for this purpose... May b technic of reverse pharmacology help for this...
DeleteThank u sir
DeleteMashallah keep it up sir
ReplyDelete