Clinic case No: PRT/10068: NAVDEEP HOMEOPATHIC HOSPITAL AND RESEARCH CENTRE, LUNAWADA GUJRAT – 389230.
Name of patient: Jui J.Pandya
Age: 23 yrs.
Weight : 52 Kg.
Height : 156 cm
Juhi Pandya was a 23 year old female who had been complaining of Headache with a history of an old cerebral venous thrombosis. She had come here for evaluation of cause of thrombosis and Homeopathic treatment.
She had throbbing headache in the right hemisphere 1 year back associated with ear pain and occasional giddiness and vomiting. Unendurable pain, hurried, worried, excitements and anxiety associated. At this point in time, she was investigated and found to have cerebral venous thrombosis involving the right transverse and sigmoid sinus and extended to proximal jugular vein on an MRI Venogram done on 22/07/2010. She was evaluated and found to have hemoglobin which was low, ANA (Anti Nuclear Antibody) Test for Autoimmune disease was positive, homocysteine which was elevated and dsDNA which was negative. She also had a history of prolonged APTT (Activated partial thromboplastine time) positive, and DRVVT (Dilute Russell’s viper venom test) Positive, so part of LUPUS ANTICOAGULANT TEST Positive at that point of time.
She was started on anticoagulation with Warf after giving heparin which she took from July 2010 to January 2011 (6 months).
She was the first of the three siblings born of non-consanguineous marriage. There was no history of thrombosis of deep venous thrombosis in the family.
On examination, vitals were stable with pulse rate of 96/min and blood pressure 110/70.There was no hepatosplenomegaly. Hyper pigmented knuckles were present.
CBC, S.iron, ANA,lupus assay, vitamin B12,S. Homocysteine, PNH,MRI Venography of Brain.
Cerebral Venous Thrombosis – Old Case.
Completed 6 months of anti-coagulation.
Lupus Anticoagulant Positive-Identified as a prothrombotic risk factor in this patient’s sample at this point in time.
Iron Deficiency Anemia
Juhi j.Pandya was found to have positive lupus anticoagulant as evidenced by positive tests.
A.Drvvt time assay
b.lips assay using Kaolin clotting time
C.ACA by ELISA – Negative
d.B2 glycoprotein I – Negative
Lupus anticoagulant is a clinicopathological disorder characterized by increased susceptibility to venous as well as arterial thrombosis. These patients can develop cardiac valvulitis, lower limb as well as abdominal vein thrombosis, dural sinus thrombosis, nonatheromatous arterial thrombosis as well as micro vascular thrombosis, (acrocynosis, digital ulceration and livedoreticularis). The mechanism of prothrombotic tendencies remains elusive but interference with endothelial cell function, impaired fibrinolysis and interference with protein C anticoagulant pathway, along with antibody mediated platelet activation have been described. LA is often detected in patient of SLE and other autoimmune disorder, malignanc, infections as well as complications of certain drugs. However, the ANA is positive and hence in her case, she needs follow for development of SLE.
She took 3 yrs.of the following Allopathic treatment from renowned Hematologist.
She would require anticoagulation for a minimum period of 3 years. Low dose Aspirin needs to be started as soon as possible. LMWH to be continued after conception till delivery and thereafter along with Ecosprin &warf, Folic Acid, Haemetenic capsules.
In addition she has Hyperhomocysteinemia. She was advised to take high dose/food rich in Vitamin B12 and Folic acid. This level needs to be repeated after 3 months.
Hyperhomocysteinemia could be secondary to hereditary deficiency of one of the enzymes involved in its metabolism.i.e.MTHFR (Methylene tetra hydro folate reductase) of cystathionine B-synthase. In India, it is after a result of deficiency of folates ofr vit B12.The vitamins required for metabolism of homocysteine. Pyridoxine-vitamin B6 is also required for these metaboilis.These patients are prone to premature atherosclerosis, coronary artery disease, arterial or venous thromboembolism, cerebrovascular disease.
She needs anticoagulant therapy for atleast 3 years. At that point in time she needs to be re-evaluated for further management. Dose of oral anticoagulant needs to be adjusted according to INR.Her INR needs to be kept around 2.5.Prothrombin time needs to be checked.
Repertorization on following symptoms/Rubrics: (Hompath Firefly)
[Kent ] [Generalities]Weakness, enervation (see lassitude, weariness):
[Kent ] [Stomach]Desires: Salt things:
[Special ] [Diarrhoea]Concomitants (Mind and mood):Aversion to:Light:
[Kent ] [Sleep]Dreams: Thirsty:
[Boenning ] [Heat and Fever In General]Concomitants:Mind:Giddiness, mental incoherence:
[Kent ] [Head]Pain,headache in general:Pains in :Nape of neck,with:
[Boericke ] [Head]Headache cephalalgia, cause:Type:Migraine, megrim, nervous:
[Boericke ] [Eyes]Vision:Asthenopia:Eye-strain, with spasm of accommodation:
[Kent ] [Ear]Itching in:External ear:
[Kent ] [Nose]Discharge:Blood:Morning:On blowing nose:
[Boenning ] [Appetite]Desire for:Earth, chalk, lime, sand, coal, etc.:
[Boenning ] [Appetite]Hunger:Appetite, without:
[Kent ] [Rectum]Urging,desire (see tenesmus):
[Kent ] [Rectum]Constipation (see inactivity):
[Special ] [Constipation]Character of the stools:Hard:
[Boger ] [Genitals]Menstruation:Menses:Profuse, excessive:
[Kent ] [Chest]Palpitation,heart:
[Phatak ] [Phatak A-Z]Appetite:Increased, hunger:Alternating with loss of appetite:
HOMOEOPATHIC TREATMENT AND MANAGEMENT
As per the Repertorization following medicines were given to her.
1. Sulphur 1M 2 Dose 1 tab every week for the removal of any suppression.
2. Nat.Mur 200 CH. Bid. For 6 months
3. Sanguinaria 200 CH. Only during the headache
4. Ferum Met 30 CH. Bid. For 6 months.
5. Calc.Carb 1M every 15 days.
After the continuous treatment from last 4 months the result was positive. The complaints were reduced. Patient was very happy. She and her family was very pleased and obliged with Homoeopathy. Investigation report becomes normal. ANA,Lupus Anticoagulant test, MR Venography of brain became normal.