By Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
Polycythemia means improve within the variety of pink blood cells within the physique. Right here the hemoglobin focus is elevated within the peripheral blood.
Numerous views of understanding Polycythemia by way of Ayurveda
A. Ayurveda understanding by definition of polycythemia
Rakta Vriddhi – Polycythemia may be translated to ‘rakta vriddhi – improve in blood amount’ as defined in Ayurveda. Irregular pink blood cell depend may be considered.
Chirakalina Rakta Vriddhi – The variant of polycythemia i.e. polycythemia vera is a power situation and could be very troublesome to treatment. This situation may be accounted to as power type of rakta vriddhi which has not been handled comprehensively.
Learn – Understanding Blood Capabilities, Vitiation And Remedy As Per Ayurveda
B. Ayurveda Understanding of Major and Secondary Polycythemia
Major Polycythemia – Since main polycythemia is prompted as a consequence of inherent issues within the strategy of manufacturing of RBC the beneath talked about circumstances may be thought-about from Ayurveda perspective –
- Dhatvagni Vaishamya – improve in blood (cells) prompted as a consequence of error in formation of blood tissue as a consequence of mildness / sluggishness of the rasa and rakta dhatvagni i.e. tissue fireplace of rasa and blood tissue
In response to 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 can have its personal tissue fireplace, the stability of which helps within the formation of excellent high quality and amount of the identical tissue and likewise a portion of that tissue which might nourish the subsequent tissue within the sequence. The sub-tissue and tissue wastes are fashioned as finish merchandise.
Now if the tissue fireplace is decreased in its useful capability it results in the destruction of the tissue and likewise the subsequent tissue within the sequence. Quite the opposite if the tissue fireplace is elevated in its useful capability it results in improve of that individual tissue and likewise the subsequent tissue within the sequence.
Taking the case of diminished fireplace of rasa tissue, there will likely be improve in amount of immature rasa tissue. This results in elevated formation of rakta i.e. pink blood cells that are immature and never wholesome. If the tissue fireplace of rakta is diminished, there will likely be improve in amount of blood (cells) tissue.
Learn – Position Of Doshas In Blood Circulation, Vitamin And Aeration Of Physique
Each these can result in rakta vriddhi, a polycythemia like situation. Since it’s prompted as a consequence of inside causes, this type of rakta vriddhi shall be thought-about as main polycythemia.
- Rakta Vriddhi – There could also be tendency to have elevated blood tissue and blood cells proper from delivery. This will predispose one to big range of well being issues and ailments in future. They might 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 circumstances that promote RBC manufacturing.
This, in accordance with Ayurveda, could also be prompted as a consequence 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)
Beneath talked about circumstances may be thought-about as causal for secondary polycythemia or types of secondary polycythemia.
a. Raktapitta – It’s a situation which is prompted as a consequence of aggravation of pitta and rakta and mutual contamination of morbid blood and pitta. That is prompted as a consequence of mixed etiological components of blood and pitta aggravation. Since this situation is prompted as a consequence of exogenous causes, it may be thought-about as secondary polycythemia.
b. Plihodara – Splenomegaly is commonly 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 may be thought-about to the imbalances of ranjaka pitta in liver and spleen. Ranjaka Pitta is that subtype of pitta which imparts pink shade 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 typical root for each pranavaha (oxygen carrying – on this context) and raktavaha (blood transporting) channels of the physique. These circumstances could result in hypoxia which additional results in elevated erythropoietin which ends up in formation of elevated pink blood cells. These occasions finally result in secondary polycythemia.
Learn – Hrid Roga: Causes, Varieties, Signs of Coronary heart Illness As Per Ayurveda
Physiological polycythemia – may be thought-about to be ‘rakta vriddhi’ and a extra extreme type of this situation i.e. ‘rakta prakopa’ shall be thought-about as polycythemia (main or secondary because the case could also be).
C. Ayurveda understanding from the angle of signs, indicators and issues 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 issues of raktapitta.
3. Hypertension could also be prompted when there’s 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 common indicators and signs of polycythemia – itching and bruising may be thought-about 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 may be included below Vatarakta. Vatarakta is a symptom of rakta vriddhi.
Additionally amongst the signs of PCV the beneath talked about circumstances talked about below the indicators and signs of rakta vriddhi shall be thought-about –
|Signs of PCV
|Signs talked about in rakta vriddhi (pathological improve in blood tissue)
|Itching / reddish (purplish) discoloration of pores and skin
|Bleeding / bruising / frequent nosebleeds / bleeding from gums
|Numbness / tingling sensation in physique components, burning sensation within the ft, reddish discoloration
|Fullness / distension of stomach
|Bleeding from gums
|Dizziness / vertigo / blurring imaginative and prescient / tiredness / fatigue
|Reddish discoloration of pores and skin
The issues of polycythemia may be included into –
Ayurveda therapy in polycythemia and polycythemia vera
Rakta Vriddhi Chikitsa – line of therapy of pathological improve of blood tissue
Raktapitta Chikitsa – therapy 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 therapy. Granthi within the blood i.e. matting of blood cells resulting in the formation of clot could also be prompted as a consequence of improve of pruthvi i.e. earth aspect of the blood resulting in its viscocity. It might additionally happen as a consequence of improve of ama and or kapha within the blood.
Vatarakta Chikitsa – Vatarakta presents with many signs of polycythemia and therefore the therapy of this situation may be thought-about. Additionally within the therapy of vatarakta, bloodletting is the principle therapy, and so is phlebotomy an vital intervention within the therapy 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 remedies, medicines and weight-reduction plan shall be included.
Ama chikitsa – Enhance of ama within the physique and likewise in circulation would additionally affect the blood. On this situation ama relieving measures together with ama pachana – remedies and medicines / weight-reduction plan to digest and relieve ama shall be included. The standing of agni additionally must be seemed into and addressed the imbalances therein.
Raktavruta Vata Chikitsa – This can be a situation whereby the vitiated blood envelopes and blocks the vata thus hampering the conventional features of vata. This may even trigger issues in free circulate of blood. The mixed aggravation of each vata and blood will result in big range of problems / ailments or signs which mimic vatarakta in image and also will resemble the scientific image of polycythemia. Avarana therapy works right here. The blood must be taken into management and later the vata needs to be addressed.
Vata vrddhi Chikitsa – To cut back hyperactivity within the physique, the imbalances of vata needs 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 therapy for problems prompted as a consequence of contamination of blood and pathological improve of blood tissue. When elevated blood is eliminated by way of numerous procedures of raktamokshana (administered contemplating the dosha affiliation with blood) the strain over the roots and channels of blood formation and transportation will likely be launched. This will consequentially treatment the problems brought on by the identical. Phlebotomy has been suggested within the treatment of polycythemia additionally. Phlebotomy is alleged to be a selected therapy for PCV or different main polycythemia syndromes. Raktamokshana or bloodletting is a perfect therapy for vatarakta, which is a symptom of raktavriddhi.
Virechana – Therapeutic purgation can also be a great therapy for polycythemia. Purgation is the very best therapy for each morbid pitta and rakta. Pitta and blood have resident and residence relationship.
Vamana – Therapeutic emesis may be thought-about if there’s 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
Polycythemia is a state by which hematocrit and / or hemoglobin focus is elevated in peripheral blood. Hematocrit means quantity proportion of RBCs within the blood. As a result of presence of those further 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 also be identified by the time period ‘Polyglobulia’.
Polycythemia brought on by every trigger would have its personal therapy choices. Goal of therapy is to carry blood cell ranges all the way down to regular.
Polycythemia Vera is a power situation for which there isn’t any identified treatment. When handled promptly and comprehensively with efficient therapy it may be managed to a substantial extent. (Learn extra)
1. Major Polycythemia / Polycythemia vera (PV)
Primarily 2 circumstances are included below 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 sometimes related to leucocytosis (elevated WBC depend) and thrombocytosis (elevated platelet depend).
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 varieties of Polycythemia
Stress Polycythemia (Gaisbock’s illness, Stress erythrocytosis, Pseudopolycythemia)
Polycythemia brought on by synthetically made erythropoietin
(Learn extra right here)
Mechanism of Polycythemia (pathogenesis)
Erythropoiesis i.e. pink 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 also 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 may be seen. Blood transfusion, switch of placental blood to the toddler after supply or power insufficient oxygenation of fetus as a consequence of placental insufficiency are the most typical causes associated to this situation.
Problem in blood circulate
In some folks there could also be no signs of polycythemia whereas they might be minimal in few folks. Beneath talked about are the overall signs of polycythemia –
- Weak spot
- Ache in joints
- Belly ache
- Age – PV is often seen in folks round 60 years of age.
- Intercourse – extra frequent in males
- Household historical past – PV is just not essentially hereditary. Nonetheless, there seems to be a connection of PV with a sure genetic mutation.
- Gene mutations – It’s discovered that the majority folks 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 Danger Elements
- Smoking – hypoxia brought on by power lung ailments and smoking (habit) trigger polycythemia, smoking is usually a important threat issue
- Power CO (Carbon Monoxide) publicity – in folks working in undergrounds (tunnels) or parking garages, cab drivers who’re driving in cities that are extremely polluted and congested and in manufacturing facility employees whereby there’s loads of publicity to engine exhaust
- Dwelling at excessive altitudes (as a consequence of low oxygen ranges within the surroundings)
- Sure hemoglobin abnormalities
Learn – Ayurvedic People who smoke Weight loss program – Should Have Herbs In Your Weight loss program
- Elevated ranges of circulating RBCs – This may improve the thickness of the blood. This in flip could get related to threat for clot formation. These occasions finally result in strokes, pulmonary embolism, coronary heart assaults and probably demise.
- Clotting issues
- Kidney dysfunction / kidney stones
- Myelofibrosis (spent marrow)- leads to scar tissue – leading to anemia from marrow failure
Learn – Power Renal Failure Causes, Signs, Remedy In Ayurveda
Issues of secondary polycythemia
In secondary polycythemia the issues are associated to these of the underlying situation / illness.
Proper sided coronary heart failure and pulmonary hypertension are issues of power hypoxia prompted as a consequence of extreme lung illness.
Generalized swelling, low BP, kidney dysfunction and poor useful standing happen within the type of issues as a consequence of CHF.
A number of organs are affected as a consequence of poor blood circulate brought on by elevated thickness or viscosity, in infants affected by neonatal polycythemia. Kidney dysfunction, elevated blood strain in lungs, hypoxia and intestinal issues could also be prompted as a consequence of this.
Issues of PV – may happen when PV is just not handled correctly –
- Enlargement of spleen
- Formation of blood clots
- Peptic ulcers
- Angina / coronary heart illness
- Different blood problems (myelofibrosis, leukemia)
Analysis of polycythemia
In suspected polycythemia the beneath talked about checks could also be suggested –
Blood checks – Full blood depend to seek out out if there’s improve in pink cells, platelets and white blood cells in bloodstream is usually executed. Different particular checks could also be suggested as and when wanted. A routine or unintended blood test will reveal polycythemia many instances. Hemoglobin, hematocrit and RBC focus are evaluated greater than as soon as to verify the analysis.
Scientific examination – An intensive 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 embody cyanosis, clubbing of fingers or pursed lip respiration. 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 needed particularly if circumstances with excessive oxygen affinity or 2, 3-BPG deficiency are suspected. Blood take a look at to rule out CO poisoning may be suggested.
It wants a cautious interpretation, however EPO (Erythropoietin) blood ranges will likely 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 recommended if wanted.
Genetic checks – if wanted will likely be executed by analyzing the bone marrow of the troubled individual for genetic mutations which could possibly be linked with polycythemia vera.
Analysis of Polycythemia Vera
This situation must be identified by following the foremost and minor standards of analysis included in the latest pointers (established by ‘WHO’ in 2008). They’re –
Main standards for PV –
- Hb stage larger than 18.5 gm/dl (males) or 16.5 gm/dl in ladies (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 beneath talked about signs –
Prevention of Polycythemia
Congenital and first polycythemia problems can’t be prevented. Beneath 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)
Polycythemia is a power situation. It doesn’t have a identified treatment.
Goal of therapy –handle the situation by not solely lowering the RBC depend but in addition to scale back the chance of issues (like blood clots and many others). Remedy of polycythemia relies on the underlying trigger. Treating the underlying trigger may assist in resolving the situation.
Beneath talked about are the very best therapy choices for PV
Phlebotomy – The therapy choices are extra particular in case of PV or different main polycythemia syndromes. Phlebotomy (bloodletting) is essentially the most important a part of the therapy. It contains manually eradicating the blood by way of one of many veins with an purpose to scale back the RBC depend. Specific amount of blood could also be eliminated at pre-set intervals till the RBC depend will get nearer to the conventional ranges. The objective of phlebotomy is to achieve the really useful hematocrit i.e. lower than 45 in males and fewer than 42 in ladies.
RBC lowering medication – To suppress the irregular manufacturing of RBCs, a number of drugs have been thought-about together with phlebotomy. It might be really useful if pink blood cell development can’t be managed by phlebotomy. These medication are known as as myelo-suppressive medication. Many of those medication (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 nicely 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 greater threat of blood clot formation. Aspirin and different anti-platelet brokers could also be useful. The objective needs to be to deal with the underlying situation in case of secondary polycythemia.
Learn – How To Enhance Blood Circulation? 25 Ayurveda And Yoga Suggestions
The kind of polycythemia needs 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 therapy would deal with managing the situation and likewise the signs. At present there isn’t any complete treatment for this situation. Typically the standard of the folks with PV will likely be virtually close to to regular and may 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 vastly improved to 10-15 years survival after analysis, with therapy by phlebotomy alone (in opposition to 1-2 years life expectancy which was considered earlier). The survival charges and possibilities could enhance much more following the addition of medicines comparable to hydroxyurea or aspirin.