A Case Study of Acute Exacerbation of Thrombocytopenic Crisis in Liver Cirrhosis Patient with Ayurveda Medicines

Shukla N*

Head of Kayachikitsa, Shree Gulabkunverba Ayurveda College, Gujarat Ayurved University, Jamnagar, India

*Corresponding author: Nishant Shukla, Head of Kayachikitsa, Shree Gulabkunverba Ayurveda College, Gujarat Ayurved University, Jamnagar, India

Received: February 16, 2017; Accepted: March 14, 2017; Published: March 20, 2017

Short Communication

Liver has important role in haematopoiesis that causes derangement of cellular component in liver parenchymal disease. Thrombocytopenia is not a rare phenomenon in liver parenchymal disease [1]. In certain cases there may be severe thrombocytopenia that may be referred as thrombocytopenic crisis that manifest as bleeding symptom. Acute thrombocytopenia crisis with < 1500/ cumm may have fatal outcome and requires prompt medicine. The clinical entity has been described in Ayurveda classics as Raktapitta (bleeding disorders), patient was treated as per Ayurveda guidelines with prompt positive outcome. The detail of the case was presented in this paper.

Patient was a known case of liver parenchymal disease managed on conventional management. Patient presented with haematuria, frank blooding per rectum, ecchymosis, swollen joints – synovitis, loss appetite, mild rise of temperature (99ºF). Patient’s haematological profile was suggestive of thrombocytopenic crisis the haematological reports of 30th Dec, 2015 were haemoglobin – 9gm/dl, TLC – 8900/ dl, N – 72, L -24, E – 3, B – 0, M – 1, ESR – 15/hr, Total platelet count – 1500/dl, urine was full of RBC, crystals – ab, patients biochemical reports were RBS – 82mg/dl, total cholesterol – 236mg/dl, SGPT – 42, and S. Alk. Phos – 183. Patient was examined clinically that revealed ecchymosis and synovitis, CVS examined was normal with normal apex sound and all four valves, no added sounds or murmurs were audible on physical examination – auscultation. Respiratory system examination was not suggestive – dyspnoea gr I was observed with no added lung sounds breathing sounds were normal. Abdominal examination revealed mild hepatomegaly gr I with no ascites, normal positioned umbilicus, no other mass or tenderness was observed. Patient was conscious, oriented, and able to respond to verbal commands, i.e. higher mental functions were not affected (during physical examination) and all refluxes were non-significant. Patient’s relative complained of occasional giddiness or unconsciousness (not exceeding 1/2min)

Patient provisional diagnose was suggested as TriyakRaktapitta – acute thrombocytopenic crisis. Patient was well informed about probable outcome of the treatment and danger related to condition of patient. Patient was managed with ayurvedic medicines classically prescribed for bleeding disease in ancient ayurvedic texts. The goals set for managing the conditions were – checking bleeding (internal & external), arrest target organ damage (vital organ damage), arrest all possibilities of internal bleeding, improving thrombocytopenia – short term measures & long term measures.

This clinical entity has been described in ancient Ayurveda classics as TriyakRaktapitta. In the disease Raktapitta Pitta the body humor responsible for digestion & metabolism acquires certain qualities of Rakta (blood) that increases the volume of Rakta. This may be correlated with deranged mechanism of coagulation due to impairment in organs of Rakta i.e. disease of liver and spleen [2,3]. The disease has been described first by Acharya Charaka in Charaka Samhita. Pitta getting characteristics of Rakta may be interpreted as the coagulation defect in blood that may lead to oozing from different orifices, in acute exacerbation it may even come out from skin and hair follicles. The disease can be treated with medicines and purification process (Panchakarma). The general guidelines in treating these patient is to observe characteristic of Rakta (bleeding), general condition and associated complaints of patient, constitution of patient, etc. before crafting treatment to ensure fulfillment of above listed management goals.

Patient was managed with classical Ayurveda medicines mentioned by Acharya Charaka containing Vaidurya, Mukta, Mani and Gairik [4] in equal quantity (125mg each) with dry black grapes water was administered every two hourly, till bleeding symptoms persists. Patient was also administered combination of Shatavari (A. racemose) 1gms, Yastimadhu (G. glabra) 1gms, Dhatriloha (classical ayurvedic formulation) 250mg, MuktaPisti (triturated pearl) 125mg, Kamdudha (Gairik i.e. copper sulphate triturated with rose water) 125mg with honey five times a day for first five days followed by four times a day for a fortnight and later three times a day. Patient was also administered Liv 52 [5] (ayurvedic formulation manufactured by Himalaya Drug Company) 2 tsp thrice a day.

Patient responded well with Ayurveda treatment, patient recovered from the problem within a week period without platelet infusion or BT. The following table shows the development in patient (Table 1, 2).

Table 1: Pathological Parameters.




  
    BT 
    AT 
  
  
    AT 1 
    AT 2 
    AT 3 
    AT 4 
    AT 5 
    AT 6 
    AT 7 
    AT8 
    AT 9 
    AT 10 
    AT 11 
  
  
    30th Dec,    2015 
    1st Jan,    2016 
    2nd Jan,    2016 
    5th Jan 2016 
    10th Jan,    2016 
    15th Jan,    2016 
    20th Jan,    2016 
    1st Feb,    2016 
    15th Feb,    2016 
    2nd Mar,    2016 
    30th Mar,    2016 
    1st May,    2016 
  
  
    Plat 
    1500 
    2800 
    5500 
    9000 
    15000 
    35000 
    42000 
    45000 
    75000 
    78000 
    85000 
    105000 
  
  
    Hb 
    9 
    9 
    9.2 
    9.8 
    10.3 
    10.9 
    11.5 
    11.5 
    11.5 
    11.8 
    12 
    12 
  
  
    TLC 
    8900 
    8900 
    9000 
    7500 
    8000 
    8200 
    8000 
    7500 
    8000 
    8000 
    7200 
    7500 
  
  
    RBS 
    82 
    ND 
    ND 
    ND 
    76 
    ND 
    ND 
    83 
    ND 
    78 
    ND 
    87 
  
  
    SGPT 
    42 
    ND 
    ND 
    ND 
    43 
    ND 
    ND 
    ND 
    ND 
    39 
    ND 
    37 
  
  
    AlkPhos 
    183 
    ND 
    ND 
    ND 
    153 
    ND 
    ND 
    ND 
    ND 
    135 
    ND 
    121



Table 1:  Pathological Parameters.

Table 2: Symptoms & Sign.




  
    BT 
    AT 
  
  
    AT 1 
    AT 2 
    AT 3 
    AT 4 
    AT 5 
    AT 6 
    AT 7 
    AT8 
    AT 9 
    AT 10 
    AT 11 
  
  
    30th Dec,    2015 
    1st Jan,    2016 
    2nd Jan,    2016 
    5th Jan,    2016 
    10th Jan,    2016 
    15th Jan,    2016 
    20th Jan,    2016 
    1st Feb,    2016 
    15th Feb,    2016 
    2nd Mar,    2016 
    30th Mar,    2016 
    1st May,    2016 
  
  
    Bleeding    PR 
    +++ 
    +++ 
    ++ 
    + 
    Ab 
    Ab 
    Ab 
    Ab 
    Ab 
    Ab 
    Ab 
    Ab 
  
  
    Haematuria 
    ++++ 
    +++ 
    ++ 
    + 
    Ab 
    Ab 
    Ab 
    Ab 
    Ab 
    Ab 
    Ab 
    Ab 
  
  
    Ecchymosis 
    +++ 
    +++ 
    +++ 
    +++* 
    ++ 
    ++ 
    + 
    Ab 
    Ab 
    Ab 
    Ab 
    Ab 
  
  
    ConsciousnessF 
    - 
    - 
    - 
    - 
    - 
    - 
    - 
    - 
    - 
    - 
    - 
    - 
  
  
    Appetite? 
    ++ 
    + 
    + 
    =♣ 
    = 
    = 
    = 
    = 
    = 
    = 
    = 
    = 
  
  
    Sleep? 
    +++> 
    ++ 
    ++ 
    = 
    = 
    = 
    = 
    = 
    = 
    = 
    = 
    = 
  
  
    Bowel 
    +? 
    = 
    = 
    = 
    = 
    = 
    = 
    = 
    = 
    = 
    = 
    = 
  
  
    Thought    process? 
    = 
    = 
    = 
    = 
    = 
    = 
    = 
    = 
    = 
    = 
    = 
    = 
  
  
    FPatient    was conscious and able to respond to verbal stimulus, 
      ?Loss of    appetite was observed, 
      ?Sleep    time, onset of sleep, night sleep and day sleep, sleep pattern and awakening    was taken in consideration, 
      ?No    significance, 
      >Disturbed    sleep, 
      ?Normal bowels, 
      ♣Means normal appitate, 
      ⋅No new    spot was present.



Table 2:  Symptoms & Sign.

Summary and Conclusion

Outstanding and promising results were observed in single case thrombocytopenic crisis, Patient responded well to the treatment with marked improvement was observed within few days of treatment. The success has been important because patient improved with infusion of platelet, which has added benefit of reducing risk any kind of HIV or HPV infection or rejections that may occur even if proper care has been taken. The treatment is cost effective, prompt and holistic in nature. This single case study based on clinical practice is important for planning research for ITP, hematologic complication in liver cirrhosis, and other bleeding disorders.

References

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Citation: Shukla N. A Case Study of Acute Exacerbation of Thrombocytopenic Crisis in Liver Cirrhosis Patient with Ayurveda Medicines. Austin Emerg Med. 2017; 3(1): 1050. ISSN : 2473-0653

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