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Polycythemia Ayurveda Understanding


By Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
Polycythemia means improve within the variety of purple blood cells within the physique. Right here the hemoglobin focus is elevated within the peripheral blood.

Varied views of understanding Polycythemia by means of Ayurveda

A. Ayurveda understanding by definition of polycythemia

Rakta Vriddhi – Polycythemia will be translated to ‘rakta vriddhi – improve in blood amount’ as defined in Ayurveda. Irregular purple blood cell rely will be considered.
Chirakalina Rakta Vriddhi – The variant of polycythemia i.e. polycythemia vera is a power situation and may be very troublesome to remedy. This situation will be accounted to as power type of rakta vriddhi which has not been handled comprehensively.
Learn – Understanding Blood Features, Vitiation And Remedy As Per Ayurveda

B. Ayurveda Understanding of Major and Secondary Polycythemia

Major Polycythemia – Since main polycythemia is triggered on account of inherent issues within the strategy of manufacturing of RBC the under talked about situations will be thought of from Ayurveda perspective –

  1. Dhatvagni Vaishamya – improve in blood (cells) triggered on account of error in formation of blood tissue on account of mildness / sluggishness of the rasa and rakta dhatvagni i.e. tissue hearth of rasa and blood tissue

In line with Ayurveda, the tissues are fashioned in chronological order. The rakta i.e. blood (cells) tissue is fashioned from rasa (plasma, fluid compartment of the blood) tissue. Every tissue may have its personal tissue hearth, the stability of which helps within the formation of excellent high quality and amount of the identical tissue and in addition a portion of that tissue which might nourish the following tissue within the sequence. The sub-tissue and tissue wastes are fashioned as finish merchandise.
Now if the tissue hearth is decreased in its useful capability it results in the destruction of the tissue and in addition the following tissue within the sequence. Quite the opposite if the tissue hearth is elevated in its useful capability it results in improve of that exact tissue and in addition the following tissue within the sequence.
Taking the case of diminished hearth of rasa tissue, there will probably be improve in amount of immature rasa tissue. This results in elevated formation of rakta i.e. purple blood cells that are immature and never wholesome. If the tissue hearth of rakta is diminished, there will probably be improve in amount of blood (cells) tissue.
Learn – Position Of Doshas In Blood Circulation, Diet And Aeration Of Physique

Each these can result in rakta vriddhi, a polycythemia like situation. Since it’s triggered on account of inside causes, this type of rakta vriddhi shall be thought of as main polycythemia.

  • Rakta Vriddhi – There could also be tendency to have elevated blood tissue and blood cells proper from beginning. This will likely predispose one to big selection of well being issues and ailments in future. They could develop a number of signs / ailments which have been enlisted in ‘rakta vriddhi’.
  • Vata vrddhi / prakopa – Irregular improve of vata will trigger irregular multiplication and improve of cells, blood cells in case of polycythemia.
    Learn – Rakta Pradoshaja Rogas – When Blood Is Vitiated By Doshas

Secondary polycythemia – This happens as a response to different components and underlying situations that promote RBC manufacturing.

This, in line with Ayurveda, could also be triggered on account of consumption of or publicity to

  • the etiological components main improve in blood
  • the etiological components resulting in pathological improve in doshas which in flip may result in pathological improve in blood (cells)

Under talked about situations will be thought of as causal for secondary polycythemia or types of secondary polycythemia.

a. Raktapitta – It’s a situation which is triggered on account of aggravation of pitta and rakta and mutual contamination of morbid blood and pitta. That is triggered on account of mixed etiological components of blood and pitta aggravation. Since this situation is triggered on account of exogenous causes, it may be thought of as secondary polycythemia.
b. Plihodara – Splenomegaly is usually seen in PV. Pliha / Plihodara i.e. enlargement of spleen has additionally been talked about amongst the signs of improve in rakta. Imbalances of erythropoietin ranges will be thought of to the imbalances of ranjaka pitta in liver and spleen. Ranjaka Pitta is that subtype of pitta which imparts purple coloration to the rasa tissue and converts it into rakta.
c. Hrdroga / Shwasa – Coronary heart or lung illness can result in low oxygen ranges within the physique. Hrdaya i.e. coronary heart is a standard root for each pranavaha (oxygen carrying – on this context) and raktavaha (blood transporting) channels of the physique. These situations might result in hypoxia which additional results in elevated erythropoietin which leads to formation of elevated purple blood cells. These occasions finally result in secondary polycythemia.
Learn – Hrid Roga: Causes, Sorts, Signs of Coronary heart Illness As Per Ayurveda

Physiological polycythemia – will be thought of to be ‘rakta vriddhi’ and a extra extreme type of this situation i.e. ‘rakta prakopa’ shall be thought of as polycythemia (main or secondary because the case could also be).

C. Ayurveda understanding from the attitude of signs, indicators and problems of Polycythemia and PCV –

1. Spleen and liver enlargement are talked about amongst the signs of rakta vriddhi.
2. Complications and Vertigo are talked about amongst the problems of raktapitta.
3. Hypertension could also be triggered when there may be aggravation of blood i.e. rakta vriddhi / prakopa within the channels carrying blood.
4. Blood clots could also be fashioned when the vitiated blood and pitta in raktapitta are excessively congested by the affiliation of aggravated kapha.

Among the many basic indicators and signs of polycythemia – itching and bruising will be thought of in kushta, ache in joints in vatarakta, stomach ache in gulma, dizziness in sammoha defined amongst the signs of rakta vriddhi.
Erythromelalgia and joint pains talked about amongst the signs of PCV will be included underneath Vatarakta. Vatarakta is a symptom of rakta vriddhi.

Additionally amongst the signs of PCV the under talked about situations talked about underneath the indicators and signs of rakta vriddhi shall be thought of –

Sl No Signs of PCV Signs talked about in rakta vriddhi (pathological improve in blood tissue)
1 Itching / reddish (purplish) discoloration of pores and skin kushta, vatarakta  
2 Bleeding / bruising / frequent nosebleeds / bleeding from gums raktapitta  
3 Numbness / tingling sensation in physique components, burning sensation within the ft, reddish discoloration vatarakta  
4 Fullness / distension of stomach gulma
5 Bleeding from gums upakusha
6 Dizziness / vertigo / blurring imaginative and prescient / tiredness / fatigue sammoha  
7 Reddish discoloration of pores and skin rakta tvak

The problems of polycythemia will be included into –

Ayurveda remedy in polycythemia and polycythemia vera

Rakta Vriddhi Chikitsa – line of remedy of pathological improve of blood tissue
Raktapitta Chikitsa – remedy of bleeding problems (blood contaminated with pitta and related to different vitiated doshas)
Grathita Rakta Chikitsa – A situation whereby the elevated blood cells would thicken the blood which can improve the chance of clot formation in polycythemia. Grathita Rakta has been defined within the raktapitta together with its remedy. Granthi within the blood i.e. matting of blood cells resulting in the formation of clot could also be triggered on account of improve of pruthvi i.e. earth aspect of the blood resulting in its viscocity. It might additionally happen on account of improve of ama and or kapha within the blood.
Vatarakta Chikitsa – Vatarakta presents with many signs of polycythemia and therefore the remedy of this situation will be thought of. Additionally within the remedy of vatarakta, bloodletting is the principle remedy, and so is phlebotomy an vital intervention within the remedy of polycythemia.
Kapha vriddhi chikitsa – If elevated kapha is discovered to afflict the blood in polycythemia, and if signs of kapha improve are discovered, kapha mitigating therapies, medicines and weight loss program shall be included.
Ama chikitsa – Enhance of ama within the physique and in addition in circulation would additionally affect the blood. On this situation ama relieving measures together with ama pachana – therapies and medicines / weight loss program to digest and relieve ama shall be included. The standing of agni additionally must be appeared into and addressed the imbalances therein.
Raktavruta Vata Chikitsa – It is a situation whereby the vitiated blood envelopes and blocks the vata thus hampering the traditional features of vata. This will even trigger issues in free movement of blood. The mixed aggravation of each vata and blood will result in big selection of problems / ailments or signs which mimic vatarakta in image and also will resemble the scientific image of polycythemia. Avarana remedy works right here. The blood must be taken into management and later the vata ought to be addressed.
Vata vrddhi Chikitsa – To scale back hyperactivity within the physique, the imbalances of vata ought to be handled correctly, if vata aggravation is present in polycythemia.
Learn – Vata Dosha – Introduction, 40 Issues To Know

Panchakarma in Polycythemia

Raktamokshana – Bloodletting is the very best remedy for problems triggered on account of contamination of blood and pathological improve of blood tissue. When elevated blood is eliminated by means of varied procedures of raktamokshana (administered contemplating the dosha affiliation with blood) the stress over the roots and channels of blood formation and transportation will probably be launched. This will likely consequentially remedy the problems brought on by the identical. Phlebotomy has been suggested within the remedy of polycythemia additionally. Phlebotomy is alleged to be a selected remedy for PCV or different main polycythemia syndromes. Raktamokshana or bloodletting is a perfect remedy for vatarakta, which is a symptom of raktavriddhi.
Virechana – Therapeutic purgation can be a super remedy for polycythemia. Purgation is the very best remedy for each morbid pitta and rakta. Pitta and blood have resident and residence relationship.
Vamana – Therapeutic emesis will be thought of if there may be pathological improve in kapha in sufferers of polycythemia and if loads of signs of kapha improve are discovered, which additionally trigger clotting of blood within the blood vessels.
Learn – Advantages of Vamana and Virechana Remedy – Charaka Sutrasthana 16

Remedy of Secondary Polycythemia

Signs of secondary polycythemia shall be handled on the traces of –

  • Kasa / svasa chikitsa – when cough / shortness of breath / hypoxia are current
  • Anidra chikitsa – when sleep disturbance / sleep apnea are current
  • Bhrama / Murccha chikitsa – when dizziness is current
  • Pandu / Dourbalya chikitsa – when fatigue is current
  • Shrama svasa / kshudra svasa / vata prakopa chikitsa – when poor train tolerance is current

Formulations

Fashionable view

Polycythemia is a state through which hematocrit and / or hemoglobin focus is elevated in peripheral blood. Hematocrit means quantity share of RBCs within the blood. Because of the presence of those additional cells the blood turns into thicker main elevated threat for a lot of well being points together with formation of blood clots. This situation can be recognized by the time period ‘Polyglobulia’.
Polycythemia brought on by every trigger would have its personal remedy choices. Goal of remedy is to carry blood cell ranges all the way down to regular.
Polycythemia Vera is a power situation for which there is no such thing as a recognized remedy. When handled promptly and comprehensively with efficient remedy it may be managed to a substantial extent. (Learn extra)

Sorts

1. Major Polycythemia / Polycythemia vera (PV)
Primarily 2 situations are included underneath this –

  • PFCP – Major Familial and Congenital Polycythemia – This situation is brought on by genetic mutations leading to enhanced responsiveness to regular ranges of erythropoietin.
  • PV – Polycythemia Vera – It’s a uncommon situation and usually related to leucocytosis (elevated WBC rely) and thrombocytosis (elevated platelet rely).

2. Secondary Polycythemia

Causes of secondary polycythemia –

  • Being positioned at a really excessive altitude
  • Having obstructive sleep apnea
  • Hypoxia – Coronary heart / lung illness which tends to trigger low oxygen ranges within the physique
  • Some sorts of tumor

Classification 2 (simplified from Wikipedia)

Absolute polycythemia – improve within the variety of RBCs
Relative polycythemia – lower in quantity of plasma

Different sorts of Polycythemia
Stress Polycythemia (Gaisbock’s illness, Stress erythrocytosis, Pseudopolycythemia)
Smoker’s Polycythemia
Relative Polycythemia
Polycythemia brought on by synthetically made erythropoietin
(Learn extra right here)

Mechanism of Polycythemia (pathogenesis)

Erythropoiesis i.e. purple cell manufacturing takes place in bone marrow and is regulated by a hormone named erythropoietin. Erythropoietin is essentially secreted by kidneys. About 10% of the identical hormone can be produced and secreted by the liver. Low oxygen ranges within the blood regulate secretion of erythropoietin. The erythropoietin finally stimulates RBC manufacturing within the bone marrow to compensate for the low oxygen ranges (hypoxia). This causes extra oxygen to be carried to the tissues. In about 1-5% of newborns neonatal polycythemia will be seen. Blood transfusion, switch of placental blood to the toddler after supply or power insufficient oxygenation of fetus on account of placental insufficiency are the commonest causes associated to this situation.

Signs

Issue in blood movement

In some individuals there could also be no signs of polycythemia whereas they might be minimal in few individuals. Under talked about are the final signs of polycythemia –

  • Fatigue
  • Weak spot
  • Headache
  • Dizziness
  • Bruising
  • Itching
  • Ache in joints
  • Stomach ache

Threat components

  • Age – PV is often seen in individuals round 60 years of age.
  • Intercourse – extra frequent in males
  • Household historical past – PV will not be essentially hereditary. Nonetheless, there seems to be a connection of PV with a sure genetic mutation.
  • Gene mutations – It’s discovered that the majority individuals with PV have mutation in Janus kinase 2 gene (JAK2 gene) although its position within the causation of the illness is unclear (Leukemia and Lymphoma Society). TET2 gene has additionally discovered to be related to PV.

Different Threat Components

  • Smoking – hypoxia brought on by power lung ailments and smoking (dependancy) trigger polycythemia, smoking generally is a vital threat issue
  • Power CO (Carbon Monoxide) publicity – in individuals working in undergrounds (tunnels) or parking garages, cab drivers who’re driving in cities that are extremely polluted and congested and in manufacturing unit staff whereby there may be loads of publicity to engine exhaust
  • Dwelling at excessive altitudes (on account of low oxygen ranges within the setting)
  • Sure hemoglobin abnormalities
    Learn – Ayurvedic People who smoke Weight loss program – Should Have Herbs In Your Weight loss program

Problems

  • Elevated ranges of circulating RBCs – This is able to improve the thickness of the blood. This in flip might get related to threat for clot formation. These occasions finally result in strokes, pulmonary embolism, coronary heart assaults and presumably dying.
  • Leukemia
  • Hemorrhage
  • Clotting issues
  • Kidney dysfunction / kidney stones
  • Gout
  • Myelofibrosis (spent marrow)- ends in scar tissue – leading to anemia from marrow failure
    Learn – Power Renal Failure Causes, Signs, Remedy In Ayurveda

Problems of secondary polycythemia

In secondary polycythemia the problems are associated to these of the underlying situation / illness.
Proper sided coronary heart failure and pulmonary hypertension are problems of power hypoxia triggered on account of extreme lung illness.
Generalized swelling, low BP, kidney dysfunction and poor useful standing happen within the type of problems on account of CHF.
A number of organs are affected on account of poor blood movement brought on by elevated thickness or viscosity, in infants affected by neonatal polycythemia. Kidney dysfunction, elevated blood stress in lungs, hypoxia and intestinal issues could also be triggered on account of this.

Problems of PV – may happen when PV will not be handled correctly –

  • Enlargement of spleen
  • Formation of blood clots
  • Peptic ulcers
  • Gout
  • Angina / coronary heart illness
  • Stroke
  • Different blood problems (myelofibrosis, leukemia)

Prognosis of polycythemia

In suspected polycythemia the under talked about exams could also be suggested –

Blood exams – Full blood rely to seek out out if there may be improve in purple cells, platelets and white blood cells in bloodstream is usually finished. Different particular exams could also be suggested as and when wanted. A routine or unintended blood examine will reveal polycythemia many occasions. Hemoglobin, hematocrit and RBC focus are evaluated greater than as soon as to substantiate the prognosis.
Medical examination – A radical medical historical past shall be taken by the doctor adopted by bodily examination. Power hypoxia could also be an vital clue, the indicators of which embrace cyanosis, clubbing of fingers or pursed lip respiratory. Redness of palms and soles could also be one more signal of polycythemia.
To display for lung or coronary heart illness – a chest X-ray, EKG and ECG could also be carried out. Hemoglobin evaluation could also be vital particularly if situations with excessive oxygen affinity or 2, 3-BPG deficiency are suspected. Blood take a look at to rule out CO poisoning can also be suggested.
It wants a cautious interpretation, however EPO (Erythropoietin) blood ranges will probably be useful. That is extra vital if there are indicators and evidences of hypoxia. EPO ranges are low as a response to elevated manufacturing of RBCs in Polycythemia Vera. Their ranges could also be extraordinarily excessive in case of tumors secreting erythropoietin.
Bone marrow biopsy – could also be instructed if wanted.
Genetic exams – if wanted will probably be finished by analyzing the bone marrow of the particular person for genetic mutations which may very well be linked with polycythemia vera.

Prognosis of Polycythemia Vera

This situation must be recognized by following the foremost and minor standards of prognosis included in the newest tips (established by ‘WHO’ in 2008). They’re –

Main standards for PV –

  • Hb degree larger than 18.5 gm/dl (males) or 16.5 gm/dl in girls (or comparable numbers primarily based on hematocrit)
  • Presence of JAK2 mutation

Minor standards for PV –

  • Bone marrow proof of elevated RBC manufacturing
  • Decreased EPO ranges

When to seek the advice of physician?

Name or seek the advice of a physician / emergency should you discover the under talked about signs –

Prevention of Polycythemia

Congenital and first polycythemia problems can’t be prevented. Under talked about are the preventive measures of preventable polycythemia.

  • Omitting / avoiding smoking
  • Omitting / avoiding publicity to carbon monoxide
  • Controlling hypertension and diabetes mellitus (threat components for coronary heart failure)

Remedy

Polycythemia is a power situation. It doesn’t have a recognized remedy.
Goal of remedy –handle the situation by not solely decreasing the RBC rely but additionally to scale back the chance of problems (like blood clots and so forth). Remedy of polycythemia will depend on the underlying trigger. Treating the underlying trigger may assist in resolving the situation.

Under talked about are the very best remedy choices for PV
Phlebotomy – The remedy choices are extra particular in case of PV or different main polycythemia syndromes. Phlebotomy (bloodletting) is probably the most important a part of the remedy. It consists of manually eradicating the blood by means of one of many veins with an intention to scale back the RBC rely. Specific amount of blood could also be eliminated at pre-set intervals till the RBC rely will get nearer to the traditional ranges. The objective of phlebotomy is to succeed in the really useful hematocrit i.e. lower than 45 in males and fewer than 42 in girls.
RBC decreasing medicine – To suppress the irregular manufacturing of RBCs, a number of drugs have been thought of together with phlebotomy. It might be really useful if purple blood cell development can’t be managed by phlebotomy. These medicine are known as as myelo-suppressive medicine. Many of those medicine (chemotherapeutic) are linked with unintended effects. Their use has been controversial and restricted.
JAK2 Inhibitors – could also be really useful when an individual doesn’t reply effectively to different drugs.

Different drugs – like aspirin (which helps to scale back the chance of clotting) and antihistamines (which assist to alleviate itching) could also be really useful to regulate the signs.
For main polycythemia hydroxyurea is the really useful drug particularly to these having larger threat of blood clot formation. Aspirin and different anti-platelet brokers could also be useful. The objective ought to be to deal with the underlying situation in case of secondary polycythemia.
Learn – How To Enhance Blood Circulation? 25 Ayurveda And Yoga Suggestions

Prognosis

The kind of polycythemia ought to be decided. The outlook on this illness relies upon primarily on the underlying trigger. The trigger is the important thing. Barring these with secondary causes, the general outlook for polycythemia sufferers is favorable.
In PV the remedy would concentrate on managing the situation and in addition the signs. At present there is no such thing as a complete remedy for this situation. Typically the standard of the individuals with PV will probably be nearly close to to regular and will be successfully managed with correct and well timed interventions. Newer interventions will focus in direction of serving to the development of the illness to decelerate.
Major polycythemia – In many individuals it’s incurable and runs a power course. In lots of others it’s controllable and treatable. Instance – untreated PV was thought to have a poor prognosis initially. In present day, the prognosis of the identical situation has tremendously improved to 10-15 years survival after prognosis, with remedy by phlebotomy alone (in opposition to 1-2 years life expectancy which was considered earlier). The survival charges and possibilities might enhance much more following the addition of medicines comparable to hydroxyurea or aspirin.

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