Trinitrotoluene Battles Hypoproliferative Anaemia
NATIONAL JOURNAL OF HOMOEOPATHY 2001 Jul / Aug VOL III NO 4.
Dr Adil Chimthanawala
'China / Carcinosin

Ms F A aged 16yrs, a student of Std X, approached us on 11/11/99 with the complaints of

1. Gradually progressive weakness, dizziness, palpitation and breathlessness < on slight exertion (NYHA Gr III) - 2 1/2 months.
2. Low grade, continuous fever, No chills or rigors.
3. Occ Cramps in the calves < on walking

Persistent pain at the popliteal fossa (Back of knees) < night.
She had difficulty in getting sleep and has no taste even for tea (which was initially one of her favorite drinks but now despises it).

All these complaints started 5 momths ago with the onset of high-grade remittent fever accompanied with chills and rigors. Took certain Antibiotics/Antimalarials (details not known), 4 days after which, she developed bleeding gums and a generalised erythematous to purple rash.

She was hospitalised, (Hb-4gm%, PS-anisopoikilocytosis +++, Thrombocytopaenia, Neutropenia).
Blood transfusion given with IV supplements. 7 such Blood Transfusion till date. Rash subsided within 18-20 days, but rest of her symptoms continued. Still on symptomatic drugs.

Basically a shy, reserved girl who is very sensitive, apprehensive, nervous and weeps easily. Very fastidious in her day-to-day work.

Thermals - chilly patient
Appetite - decreased. Desires - salt, milk, eggs. Aversion - coffee, tea.
Thirst - average
Urine -8-10 times /24 hrs, occ burning +
Stool - Well formed, semisolid, 1 to 2 days. No blood, mucus, worms.
Perspiration - average
Menses - started 14 yrs, reg 3/30 days, bright red, Occ Leucorrhoea +. Now, since 4 months, reg 1/35-40 days, scanty, pains ++.
Sleep - 6-61/2 hrs, alert, sleeps on abdomen, with body completely covered. Restless, knee chest position.
Dreams - of her disease, swimming in high seas/oceans. Hairfall ++, Dandruff +

Past H/O - Pneumonia at 5 1/2 months age, Pin worms at age of 5 -12 yrs. Filliform warts, Lt finger, cauterised 2 yrs ago.

Family H/O - Father - DM on antidiabetics. PGM - Ca breast: died

Pt as a person: Loves music, dancing, singing, reading.Pt was hospitalised for investigations and replacement therapy,
O/E GC - not satisfactory,
conscious, restless, warm,
P- regular, 120/min, slow, weak,
Resp - laboured, 28/min,
BP- 90/60 mm Hg, Oedema feet +, JVP Not Raised,
No cyanosis / clubbing, Pallor +++, No lymphadenopathy
Skin pale, purpuric spots on extremities +.
RS - Trachea central, Air entry = Both sides, Vesicular BS,
Bilateral scattered ronchi ++,
CVS -apex = Lt 5th ICS, inside the midclavicular line, HS1/2 muffled,
Short systolic murmur parasternal -4,5th ICS (Gr II/VI). No S3 gallop.
P/A -Soft, Nontender, Liver-Just palp, Spleen/ Kidneys - Not palpable, No e/o ascites.
CNS - NAD

Diagnoses: Severe Anaemia? Haemolytic? Drug induced?

Discussion

1. Myelofibrosis comes under the spectrum of Hypoproliferative anaemias, generally caused due to exposure to radiation, Chemicals and Drugs or in genetic disorders as Downs syndrome, Neurofibrosis etc. Leukemia’s, Lymphomas and Tuberculosis do lead to this disorder.
2. Miasmatically, this is a Drug Miasm. An incurable disease. Fibrosis indicates an end stage of Tubercular Miasm.
3. China was given for extreme pallor. PCF.
4. Trinitrotoluene (TNT) was thought of as a pathological prescription on the basis of Bone Marrow report. The Severe anaemia and its effects as Breathlessness, dizziness, restlessness, insomnia, cramps, tendency to Hemorrhages under the skin, etc did show good results.
5. Carcinosin - a multipolycrest was given on the basis of Drug disease, Family/Past/Personal History and Mental generalities.
6. Prognosis - with no infections till date, and seeing the progress of the patient, it can be concluded that prognosis is fairly good.