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Case presentations: THROMBOCYTOPAENIA AND LEUCOPAENIA OF DENGUE FEVER: A CASE SERIES by Prof. Ranjit Nimbalkar

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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 [1995, 87(1-2):2-7]; Type: Journal Article, Research Support, U.S. Gov't, P.H.S.
3. 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 [1999, 40(4):238-242]
Type: Journal Article
4.  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

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Comments

  1. Prof Dr Mamata Bhagwat22 November 2017 at 08:39

    Perfect documentation and Crystal clear explanation. Great job Prof Ranjit Nimbalkar ji.

    ReplyDelete
  2. Unknown22 November 2017 at 09:28

    Many thanks Sir for sharing your knowledge and clinical experience.

    ReplyDelete
  3. Vishipushi22 November 2017 at 09:44

    Doctor, 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.

    ReplyDelete
  4. Vaidya Pawan Madaan22 November 2017 at 10:37

    Wonderful compilation.
    Heartiest congrats.

    ReplyDelete
  5. Dr Gautam Jogad22 November 2017 at 11:07

    This comment has been removed by the author.

    ReplyDelete
  6. Dr Gautam Jogad22 November 2017 at 11:11

    Wonderful results

    ReplyDelete
  7. Unknown22 November 2017 at 13:27

    Time 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.

    ReplyDelete
    Replies
    1. anubandh ayurved22 November 2017 at 16:34

      Totally agree with you sir.
      I'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...

      Delete
  8. Unknown23 November 2017 at 08:35

    Very good case study,
    This type of studies are required to encourage Ayurveda practiceners and establish Ayurveda prescription for diseases.

    ReplyDelete
  9. Unknown23 November 2017 at 16:45

    How's this drugs work on increase wbc and platelets .?
    Any sastra reference ?

    ReplyDelete
    Replies
    1. anubandh ayurved23 November 2017 at 19:55

      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...

      Delete
    2. Unknown23 November 2017 at 23:35

      Thank u sir

      Delete
  10. Unknown25 November 2017 at 15:07

    Mashallah keep it up sir

    ReplyDelete

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Case-presentation: 'रेवती ग्रहबाधा चिकित्सा' (Ayu. Paediatric Management with ancient rarely used 'Grah-badha' Diagnostic Methodology) by Vd. Rajanikant Patel

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[2/25, 6:47 PM] Vd Rajnikant Patel, Surat:  रेवती ग्रह पीड़ित बालक की आयुर्वेदिक चिकित्सा:- यह बच्चा 1 साल की आयु वाला और 3 किलोग्राम वजन वाला आयुर्वेदिक सारवार लेने हेतु आया जब आया तब उसका हीमोग्लोबिन सिर्फ 3 था और परिवार गरीब होने के कारण कोई चिकित्सा कराने में असमर्थ था तो किसीने कहा कि आयुर्वेद सारवार चालू करो और हमारे पास आया । मेने रेवती ग्रह का निदान किया और ग्रह चिकित्सा शुरू की।(सुश्रुत संहिता) चिकित्सा :- अग्निमंथ, वरुण, परिभद्र, हरिद्रा, करंज इनका सम भाग चूर्ण(कश्यप संहिता) लेके रोज क्वाथ बनाके पूरे शरीर पर 30 मिनिट तक सुबह शाम सिंचन ओर सिंचन करने के पश्चात Ulundhu tailam (यह SDM सिद्धा कंपनी का तेल है जिसमे प्रमुख द्रव्य उडद का तेल है)से सर्व शरीर अभ्यंग कराया ओर अभ्यंग के पश्चात वचा,निम्ब पत्र, सरसो,बिल्ली की विष्टा ओर घोड़े के विष्टा(भैषज्य रत्नावली) से सर्व शरीर मे धूप 10-15मिनिट सुबज शाम। माता को स्तन्य शुद्धि करने की लिए त्रिफला, त्रिकटु, पिप्पली, पाठा, यस्टिमधु, वचा, जम्बू फल, देवदारु ओर सरसो इनका समभाग चूर्ण मधु के साथ सुबह शाम (कश्यप संहिता) 15 दिन की चिकित्सा के वाद
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Case-presentation- Self-medication induced 'Urdhwaga-raktapitta'.

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This is a c/o SELF MEDICATION INDUCED 'Urdhwaga Raktapitta'.  Patient had hyperlipidemia and he started to take the Ayurvedic herbs Ginger (Aardrak), Garlic (Rason) & Turmeric (Haridra) without expertise Ayurveda consultation. Patient got rid of hyperlipidemia but hemoptysis (Rakta-shtheevan) started that didn't respond to any modern drug. No abnormality has been detected in various laboratorical-investigations. Video recording on First visit in Govt. Ayu. Hospital, Pani-gate, Vadodara.   He was given treatment on line of  'Urdhwaga-rakta-pitta'.  On 5th day of treatment he was almost symptom free but consumed certain fast food and symptoms reoccurred but again in next five days he gets cured from hemoptysis (Rakta-shtheevan). Treatment given as per availability in OPD Dispensary at Govt. Ayurveda College hospital... 1.Sitopaladi Choorna-   6 gms SwarnmakshikBhasma-  125mg MuktashuktiBhasma-500mg   Giloy-sattva-                500 mg.  
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