A Case of Post COVID Thrombocytopenic Purpura

 

Dr. Swapna Potdar presents a case of post-COVID thrombocytopenic purpura in a girl of 13.  Never well since COVID, tendency to catch infections easily and desires freedom, were among symptoms leading to the simillimum

 

This case is of a 13 years old girl, suffering from ITP or idiopathic thrombocytopenic purpura, that I saw in April 2024.

Her complaints had started about a year prior in March 2023. Apparently, when she returned from a short journey, she started experiencing fatigue, dizziness, and loss of appetite. These symptoms started to get worse and there was a development of bruises and petechiae.

Her doctors went in for a complete medical examination, and found that her platelet count had dropped to 44,000 per mcl (normal range 1.5 – 4.50 lakhs per mcl). Some conservative treatment was given but platelets further dropped to 15,000, and then to 2000, which was extremely alarming. She was hospitalized and further investigations were done.

Her Haemoglobin that time was found to be 10.8 g/dl,

RBC count was 3.98 ml/cu mm (4.0-5.2)

NLR Neutrophils to lymphocyte ratio was 6% (Normal 1-3)

High Neutrophils 81.2% (35-65)

Low Lymphocytes 13.5% (20-60)

Immuneglobulin panel, IgG, IgM, IgA, IgE were within normal limits.

Ultrasound of her abdomen was normal except for bilateral polycystic ovaries.

ANA (Antinuclear antibody) was negative.

On the basis of these tests, it was concluded that there was no autoimmune or cancerous cause and she was suffering from idiopathic thrombocytopenic purpura.

She was given IgG or immunoglobulin treatment, and also intravenous platelets. Luckily she did not experience bleeding episodes, which could have proved life threatening.

After IgG, platelets improved to 1,22,000, but again started dropping in a week. She was then put on Omnacortil, a steroid drug, and Azoram immunosuppressant, the dose of which needed to be gradually increased as her platelets would not hold.

She started experiencing more weakness, joint pains, headache, body ache, and dizziness, so much so, that she could not go to school. A bright child who had been an all-rounder in sports, studies and extracurricular activities, found herself unable to get up from her bed without help and a lot of struggle. Since this blood disorder started, she had multiple infections, like chicken pox, and recurrent colds, coughs and fever.

The immune suppressants were stopped in March 2024, in view of the above, and her platelets again started to fall from 1,20,000 to 87,000, then 66,000 per mcl, and she still continued to have recurrent infections related to her respiratory tract, and fever.

It has been a year since her struggles started, and now modern medicine seemed to have no answer or solution for her. She was told to come back only if her platelets fell to 40,000.

She was brought to me by her parents on 16th April 2024 in the midst of this dilemma. I observed that she has a congenital nystagmus. She is very articulate about what she has to say, and about what she feels. She is intelligent, studious, and loves to talk on intellectual topics.

She is selective about friends as she needs no-nonsense conversations. She seems mature and open about her arguments with her parents when they keep nagging her for studying. She has a lamenting tone when describing her complaints.

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She feels limited and restricted. “ I want to learn Taekwondo, but I can’t even think of it now. I want to go back to basketball practice.” She had a big argument with her parents for this. She wants to get well soon and start doing all her activities.

She loves to play the piano, loves to study. Always tops her class. Loves science and math.

She loves chocolate, rice, wheat roti, and spicy food.

She complains of burning eyes, and pain in her forehead, especially when upset. This pain irritates her further, and she becomes snappish. She still manages to go to school now, but is completely exhausted from the process.

Her mother mentioned that ever since she got omicron infection in 2022, which is a variant of SARS-CoV-2 or the COVID virus, her resistance seems to have gone down. Apparently, she only had fever for 4-5 days, and her RT PCR was negative. But she often complained of pain in her spine and eyes, also weakness since then.

She had her menarche 4 months back. Menses have not been regular, and are very heavy since her platelet problem.

The important pointers seemed to be:

Never well since COVID omicron infection,
Menarche 4 months back,
Restricted feels, desires freedom
Creative
Audacious
Chocolates desires
Averse to vegetables
Exhaustion
Tendency to catch infections easily
Thrombocytopenia
The above totality suggests the tubercular miasm predominantly and repertorisation does bring us towards remedies that have predominance of the tubercular miasm.

 

She has never been well since omicron infection, which is a variant of the SARS Covid virus. I would like to refer here, to my previous article on the indications and utility of Tuberculinum Aviaire in Covid infection.

https://hpathy.com/scientific-research/a-retrospective-study-to-evaluate-the-safety-and-efficacy-of-homoeopathic-prophylaxis-in-ncovid19-with-tuberculinum-aviaire-and-homeopathic-remedies/#comments

And, Tuberculinum Aviaire has proved to be invaluable in the many after effects of not only Covid but also the Covid vaccine, by virtue of the symptom similarity, miasm correspondence and pathophysiology.

Just as Tuberculinums need their freedom, are prone to catch every infection around; are the rebels of rules, and are the most exhausted people of our materia medica, Tuberculinum it was going to be. But on the basis of the study of Tuberculinum Aviaire in Covid, and the fact that she has never been well since omicron, I decided upon Tub Av 1M single dose, along with Ferrum phos, 6X, and Calcarea phos 6X one pellet a day to support her bone marrow function.

I have been using and studying Biochemics from a pathophysiological point of view for about two decades, and find that when the vital reaction is not strong enough to respond to the indicated homeopathic remedy, biochemic cell salts are very useful to support cellular function and help to bring about a healing response.

Here is a reference to a detailed study on the Biochemics.

https://hpathy.com/book-reviews/revealing-the-secrets-of-homeopathic-biochemics-by-dr-swapna-potdar/

A month later platelets rose from 66,000 to 75,000 per mcl.

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Tub Av 1M was repeated as a single dose every month, and biochemic support continued.

Tuberculinum aviaire, is the least potent, meaning most harmless of the Tuberculins having a comparatively short duration of action.

I also gave her Hamamelis 30C to be taken in case she had heavy menstrual flow. Usually one or two doses helped to control the bleeding to a moderate level.

Her platelets continued their steady ascent from 75,000 per mcl, to 85,000 per mcl, a month later. The following month there seemed to be a plateau. Her haemoglobin which was 11.3 g/dl was gradually falling to 11.2 g/dl and now was at 10.7 g/dl, though her platelets had improved.

Clinically she was doing much better. Her spells of dizziness had completely stopped, No body pain, feels much more fresh since we started medication.

But Haemoglobin needs to be taken care of. I looked again into her case. There seemed to still be a problem with the bone marrow function as her red cell counts were low.

I now decided to go to Calcarea phos 1M, as an intercurrent remedy. This remedy is vital for all cellular and metabolic processes in the body. The indicated remedy holds well after Calcarea phos says the materia medica by all authors. It also resonated with her other tubercular traits.

The biochemical support with Ferrum Phos 6X and Calcarea phos 6X was continued. Two months later her platelets rose to 1,66,000 per ml, and Haemoglobin to 11.1 gm%.

Everything seemed to be going well. Her menses also were well in time and stopped in 5 days with the help of Hamamellis 30C.

The following month, was not so easy for her. She started to complain of recurring cold, cough and evening rise of temperature for more than two weeks. Platelet count this time came down to 97,000 per mcl, while haemoglobin was steady at 11.0 g/dl.

I then gave her Tuberculinum bov 1M a deeper acting tuberculin, and having symptom similarity to her. The Biochemics Ferrum phos 6X and Calcarea phos 6X continued at one pellet daily.

At this stage of her treatment when she is clinically much better, it indicates that her vital reaction has improved, and she could now favourably respond to the deeper acting tuberculin.

A month later, platelets rose to 2,15,000 per mcl, and her haemoglobin now was 14.2 g/dl.

The levels continue to be well maintained since a year now.

The young girl is in the pink of health, back to school on her bicycle, playing basketball, piano and Taekwondo, and she is topping her class in exams.

This case was a great learning and gave a lot of insight into understanding what the vital response calls for with the symptoms and blood work. Also, how to time intercurrents, and the use of organ remedies, which were cell salts in this case.

Homeopathy rekindled the dreams and happiness for this promising young girl, and her entire family.

About the author

Swapna Potdar
Dr. Swapna Potdar (MD Hom, DHom (UK )has been a practicing homeopath in Pune, India since 1997. Her cases and articles have been regularly published in various Indian, and international journals. Her scholarly research paper on 'Usefulness of Homoeopathy in Idiopathic Granulomatous Mastitis in Women - A case series' of 11 cases has been published by the IJRH, 'Indian Journal of Research in Homoeopathy', the official publication of the Central Council of Homoeopathy India. Her Research work on a protocol for treatment and prevention during COVID was published in Hpathy and Dr. Swapna is the recipient of the prestigious 'Award for Excellence in Homoeopathy' in April 2022. She is regularly invited as a speaker by homoeopathic colleges and study forums to speak on renal care, paediatric cases and biochemics, etc. Her book ‘Revealing the Secrets of Homeopathic Biochemics’ has been very well reviewed and read the world over, for its modern understanding of Biochemics based on pathophysiology. She has vast experience in treating autism, ADHD, granulomatous mastitis, autoimmune conditions, renal diseases and complex cases, as well as allergies and hyperactive airway diseases, and the treatment of animals.

 

https://hpathy.com/clinical-cases/a-case-of-post-covid-thrombocytopenic-purpura/