Introduction
Haemolysis means destruction of RBCs1 or reduction of lifespan of normal red cells i.e less than 120 days. To compensate this, the bone marrow increases the RBC production by 6-8 fold, resulting in expansion of active marrow volume and premature release of reticulocytes. Anaemia is when the rate of destruction exceeds the rate of production. 2. As there is compensatory erythroid hyperplasia, there will folate deficiency along megaloblastic anaemia. In case of autoimmune haemolytic anaemia, the antibodies responsible are IgG or M and rarely it will be IgE or A. 3 If there is weak complement activation, the hemolysis will be extravascular Antibody coated red cells will lose their membranes to macrophages in the spleen and the spherocytes will be present in blood.
This is a case study of 20 year old female with pain on all over the joints for one year. The pain is of piercing and continuous in nature severe at bilateral metacarpal phalangeal, proximal interphalangeal joints. She also complaints of tiredness, loss of appetite, hair fall and loss of weight thereafter. In Ayurveda classics most of the symptoms such as Angamarda, Ruja, Toda, and Parswaruja are similar to symptoms of disease Pandu.4 So patient was treated with Amapachana, Snehapana followed by virechana. For Amapachana Amruthotharam Kashayam5 50ml BD with Vaiswanarachoornam6 1tsp BD before food and Simhanada guggulu 71 BD after food was given internally for first 7days. Then patient was admitted in IP for next 7 days and was given Dadimadi ghrutham8in the dose such as 30, 60, and 90,120,150,180,210 for snehapana which is indicated for Pandu, which reduced the Vatika symptoms shown in the patient.
Patient was showed samyak Snigdha lakshanas on the 7th day. Then after 3days of Abhyanga with dhanwantaram tailam9 and mild nadi sweda patient was given Gandharva Erandam for virechana which helped in samana of vata and reduced the shithilata of dhathus by srotosodhana property. After Discharge for correcting the alpa raktha, nisarata, ojo bala varna hani , she was administered Manjishtadi kashayam 50ml BD 10 with mandooravatakam 1tsp BD11 before food and Yogaraja churnam12 1tsp with honey at night after food for one month. After intervention there was reduction of pain in all over the joints within first 5 days and significant improvement in Hb count after 30 days.
Materials and Methods
Source of Data
Ahalia Ayurveda Medical College, Kayachikitsa OPD
Treatment Shedule
Table 1: Table showing details of Therapeutic Intervention
| From 1 st day to 7th day | The Following internal medicines was given· Amruthotharam Kashayam 50ml BD· Vaiswanarachoornam 1tsp BD before food· Simhanada guggulu 1 BD after food |
|---|---|
| From 8th to 10th day | Abhyangam with Dhanwantaram tailaNadi sweda |
| On 10th day | Virechana with Gandharva Eranda |
Assessment and Result
Subjective Parameters: Symptoms of vatika pandu such as Angamarda, Ruja, Toda, Parswa ruja were assessed before treatment and got reduced after first 5 days of Amapachana treatment.
Objective Parameters: Hb Count which was 8g/dl got improved to 10mg/dl after intervention.
Discussion
The case study is aimed to find out the effect of intervention in reducing the symptoms of Autoimmune Hemolytic Anaemia. Most of the clinical symptoms in this study resembles with symptoms of Vatika Pandu in Ayurveda Classics. In pandu pittapradhana tridosha get vitiate results in dhathunam gauravam, sithilatha, Alpa Raktha and Meda, Nisara. So For Reducing the gaurava of dhathus or srotorodha, Ama pachana is essential. For that Amruthotharam along with vaiswanaram and Simhanada Guggulu was given. These formulations are told for treating avarana or srotorodha condition which helped in cleansing the srotas. For pacifying the vata , snehapana was administered with Dadimadi ghrutha for 7days after attaining proper deepana and pachana.The ghrutha yoga is told to be effective in reducing the Vata symptoms like Ruja and as its mentioned for mudavata ,the yogam helps in balancing the proper vata gati.. In pandu samprapathi uttarothara dhatu poshana is arrested and results in depletion of raktha poshaka rasa due to vitiation of pitta pradhana Tridosha. Here also patient having the lakshanas of vatika pandu and oja kshaya associated with Bala Nasha as a result of impaired dhathu poshana .So for reversing the Alparaktha, Ojo bala varna hani , Nisarata Rasāyana and balya chikitsa is to done. For Raktha prasada and Rakta dhathu vardhana , Manjishtadi kashayam is administered to the patient. She was also administered Yogaraja churnam and mandoora vatakam after attaining proper sodhana and Agni deepana.
Conclusion
The intervention is effective in reducing the symptoms and there was significant improvement in Hb. Future studies are needed to evaluate the effect of medicines in large group of subjects.
References
1. Stanley Davidson Davidsons. principles and practice of medicine. 22nd edition edited by Brian R walker. 24th chapter page number 1026. [Crossref][PubMed][Google Scholar]
2. Anita Hill and Quentin A. Hill Autoimmune hemolytic anemia Department of Haematology. Leeds Teaching Hospitals. Leeds. United Kingdom2018 Nov PMID: 30504336 [Crossref][PubMed][Google Scholar]
3. Stanley Davidson Davidsons. principles and practice of medicine. 22nd edition edited by Brian R walker. 24th chapter page number 1027. [Crossref][PubMed][Google Scholar]