Case Studies 11 : Idiopathic Thrombocytopenic Purpura(ITP)
This is an interesting case of a condition known as Idiopathic Thrombocytopenic Purpura(ITP) having an autoimmune base. It presents with anaemia and thrombocytopenia as its key presentation.
A small girl aged 12 years was diagnosed to have this particular syndrome.
Her case history is as follows:
Complaints started since 1 year with presentation of petechial rashes all over the body. Haematological investigation revealed a very low platelet count, which indicated towards ITP.
She was then referred to a super-specialty hospital in Pune, where she had undergone 5rdp’s i.e. platelet transfusion. For next three months she had no c/o after which, the same episode repeated. She again had to undergo platelet transfusion. But this time the Physician informed that if the same complaints recurred in future, then it may pose danger to her life. They advised her for splenectomy which was the only option as platelet count was very low.
But her parents were not ready for it as they were also made aware that this surgery will reduce her immunity and she may be predisposed to frequent infections.
Meantime one of his friends shared his good experience about homoeopathic treatment in our hospital and advised him to try for it.
· Investigations:
|
Date |
21.04.2009 |
25.04.2009 |
11.05.2009 |
|
WBC |
14,000 |
23,000 |
26,000 |
|
Hb% |
11.3 gm/dl |
10.0 gm/dl |
10.0 gm/dl |
|
Platelets |
3,000/cmm |
82,000/cmm |
17,000/cmm |
So, the details of her complaints were:
· C/C:
1. Purpura and Petechial rash all over the body off and on since6-7 months.
Presently it started from face →both hands →abdomen →then all over body.
2. Vertigo since 3 days.
< Night. > Closing eyes.
< Opening eyes.
< Sudden change of position.
Associated with weakness & exhausted feeling.
3. Bleeding per rectum since 1-2 days.
· Past History:
1. Gastro-enteritis at the age of 1 yr.
2. Typhoid at the age of 1 yr.
3. Measles at the age of 8 yrs.
4. H/o Platelet transfusion twice for Thrombocytopenia.
· Physical Generals:
§ Habit : Nail biting.
§ Diet : Veg.
§ Appetite : Good. Can’t tolerate hunger.
§ Desire : Pungent, Sweets, Oily, Milk, Fruits, Ice Cream.
§ Aversion : Bitter.
§ Head : Headache on & off.
Location-Both temporal region.
Localized pain.
< Afternoon. > Pressure.
> Rest.
§ Eyes : Squint of Rt. eye.
§ Nose : H/o epistaxis, bright red color.
§ Mouth : Dryness of mouth.
§ Tongue : Red tip and slightly white coated.
§ Thirst : L.Q.S.I. Thirsty Patient.
§ Teeth : Caries of Lt. molar tooth.
§ Lips : Cracked with dryness.
§ Bowel : H/o loose motions with watery, offensive stool 10 days before with pain in abdomen around umbilical region. Frequency 10-12 times / day (for 2 days).
Otherwise satisfactory and normal stool.
§ Extremities : Cold to touch.
Lower Extremities: Pain in legs since 10 days.
§ Perspiration : Profuse over neck & back.
§ Sleep : 10 pm – 7 am. Sound, refreshing. Startlesand sometimes cries.
Coverings : Up to neck.
Position : Lies on abdomen.
§ Dreams : Of someone pricking her legs with glass piece.
§ Thermals : Chilly patient.
· Mind:
When asked about her nature, her grandmother narrated the following information:
The patient has 2 younger brothers and she is the eldest. They live in a joint family. Her paternal uncle has 2 sons, both are younger to her.
She studies in 7
th std. and is good at studies. She completes her work on her own, doesn’t have to be told to do so.
She likes to keep her things in perfect order and is particular about cleanliness also.
She gets angry very easily and that time throws tantrums if things are not done according to her will. She does not like if anyone gives importance to her younger brothers.
She has few friends and takes time to mix up with new people.
When her grandmother was narrating all this, I observed tears in the patient’s eyes and then she started weeping. She was probably uncomfortable speaking out in front of her grandmother. Once alone, she expressed herself more freely.
With continued weeping, she said, ‘I can’t tolerate anybody making fun of me and everybody keeps doing that to me.
One of my classmates used to mock at me repeatedly since I was in 5
th std. and in spite of this my best friend, made friendship with her and I always felt left-out.
Even at home all my brothers group together and I am left- out.
My aunt, my mother, my father, and even my grandmother don’t understand me and ill treat me.
My father also doesn’t let me go out to play, even though I really want to.
I am close to my grandmother only.
What are her likes and dislikes?
She is very fond of singing and dancing. Also she is very religious and prays regularly.
What are her fears?
Fear of being alone, of darkness & of ghosts. She is much afraid of dogs.
· Response:
After consultation she was admitted in the hospital early in the morning at about 5 am. Blood samples for routine investigations were taken at about 7 am in morning. Also the patient was complaining of per rectal bleeding. The indicated remedy was given to the patient. But considering her low Platelet count (2,000 cells /mm
3) and the P/R bleeding, she was advised to be shifted to a super-specialty hospital.
Same day evening, a haemogram was performed and her immediate reports showed platelet count to be 22,000 cells/mm
3. It was surprising for every one how drastically her platelet count increased within a few hours by a single dose of Homoeopathic medicine.
Then the patient was admitted in the ICU and she was given platelet transfusion . After transfusion, her platelet count was done again which was 23,000 cells/mm
3.
Her parents were in a state of confusion as her platelet count even after a transfusion, increased only by 1000 to a large extent, also the treatment was very expensive.The patient herself had become very fearful due to the procedure of transfusion. Considering all these points, her parents again got her back to me.
In 2-3 days, her platelet count increased, but her emotional state continued to deteriorate since she had come from the I.C.U. of other hospital. She used to cry continuously for 2-3 hours and at other times used to keep on smiling. Even these mental symptoms improved gradually. She was then discharged from the hospital in May 2009.
She was doing quite well until November 2009. During that time she suffered from an episode of cold & coryza for which she took allopathic medicines. Immediately after that she was seen to suffer from purpura and she had petechiae all over the body. Her parents immediately got her to me and at that time her platelet count was 2,000 cells/mm
3. Same remedy was administered. Without a single platelet transfusion within 1 week, her platelet count increased to 1,46,000 cell/mm
3 with simultaneous reducton in petechial rash and her general condition also improved.
Acute emergencies are not a limitation for Homoeopathy.yes proper selection of medicine is crucial
Investigations(After medication) :
|
Date |
Hb% (gm%) |
Plateletes (cells/mm3) |
|
30.11.2009 |
12.4 |
3,000 |
|
01.02.2009 |
12.6 |
6,000 |
|
02.12.2009 |
12.2 |
5,000 |
|
03.12.2009 |
12.9 |
8,000 |
|
05.12.2009 |
11.5 |
20,000 |
|
07.12.2009 |
11.4 |
66,000 |
|
09.12.2009 |
11.1 |
1,49,000 |
|
11.12.2009 |
12.2 |
1,99,000 |
|
15.12.2009 |
12.2 |
2,50,000 |
Totality :-
- Contradiction intolerance of.
- Fastidious.
- Irritability.
- Singing desire.
- Fear of dark, ghost, to be alone, dogs.
- Delusion persecuted she is.
- Teasing agg
- Biting nails.
- Desire : Pungent, Sweets, Sour, Cold Drinks.
- Aversion : Milk.
- Haemorrhage.
- Vertigo agg night
- Weakness.
- Thermal : Chilly.
- Miasm : Tubercular.
· Remedy Selected: CHINA ARS 30