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AAMJ / Vol. 3 / Issue 6 / November – December 2017
A A M J Anveshana Ayurveda Medical Journal
www.aamj.in ISSN: 2395-4159
Research Article
The Aggregation response of Platelets in different Prakṟti
Aditi Yashwant Pimpalkhare 1 Ravindra Pandurang Bhurke 2 Lomesh Pitambar Gedam 3
A b s t r a c t
Background: Ayurveda believes that the path to optimal health is different for each person
depending upon their constitution or Prakṟti. On the basis of Prakṟti, the population can be
categorized into several subgroups. The concept is claimed to be useful in predicting an indi-
vidual’s susceptibility to a particular disease, prognosis and selection of therapy. The present
study was carried out to study if the platelet Aggregation response varies in different prakṟti
subtypes. Methods: After obtaining Institutional Ethics Committee permission, normal healthy
individuals of either sex between the age group of 16 to 40 years were recruited in the study.
Their prakṟti evaluation was done using a standardized validated questionnaire as per the soft-
ware AYUSOFT, developed by CDAC, Pune. Their Platelet Rich Plasma (PRP) was incubated.
Platelets in the PRP were counted using a platelet counter. This working plasma was used to
study the Aggregation response of platelets to Adenosine Diphosphate in concentration of
5µM/L & 10 µM/L. Platelet aggregation was studied using Chronolog platelet aggregometer.
Results: We observed that in the study population of normal healthy participants (n= 90), ADP-
induced platelet aggregation was highest among the Kapha prakṟti individuals as compared to
the other prakṟti types. From statistical calculation using One-way Analysis of Variance
(ANOVA), we conclude that, difference between platelet aggregation of three different prakṟti
is extremely significant (P<0.0001) at 5 µM & (P<0.0002) at 10 µM concentration of ADP.
Conclusion: Our results suggest that identifying the prakṟti may help in individualizing therapy
or predicting proneness to a disease.
Keywords: Prakṟti, Platelet aggregation, Adenosine diphosphate, AYUSOFT, Chronolog platelet
aggregometer
1 & 3 Assistant Professor at D. Y. Patil University, School of Ayurveda, Nerul, Navi Mumbai, 2 Assistant Professor at R. A. Podar Medical College & Hospital, Worli, Mumbai, India.
CORRESPONDING AUTHOR
Dr. Aditi Yashwant Pimpalkhare
Assistant Professor,
D. Y. Patil University, School of Ayurveda,
Nerul,
Navi Mumbai, (India).
Email: [email protected]
http://aamj.in/wp-content/uploads/Volume3/Issue6/AAMJ_1600_1604.pdf
Pimpalkhare et.al,. : The Aggregation response of Platelets in different Prakṟti
AAMJ / Vol. 3 / Issue 6 / November – December 2017 1601
INTRODUCTION
yurveda is a science of self-understanding. Ayur-
vedic approach is very individualized, since the
path to optimal health is different for each person
depending upon their unique constitution or Prakṟti. Ayur-
veda believes that the individual’s constitution (Prakṟti) is
framed at the time of conception as a genetic code or
predominant Panchamahabhautic doṣa that can be ex-
pressed physically and mentally as disease proneness
and emotional response. (I) To achieve our aim of life it is
necessary that our body and mind remains healthy. For
that we need to know our Prakṟti because Prakṟti influ-
ences every aspect of all living beings from birth to death.
So a fine understanding of principles behind Prakṟti is
unavoidable.
Haemostatic function of blood is a unique feature as it is
the first stage of wound healing. This involves coagula-
tion, blood changing from a liquid to a gel. It involves
three stages mainly: 1. Vasoconstriction 2. Platelet ag-
gregation to form a plug 3. Clot formation. Platelet ag-
gregation is the temporary stoppage of bleeding; clot is
the permanent one. But we see time duration for stop-
page of bleeding differs from person to person. Aim of
this study is to find the relation between Prakṟti & platelet
aggregation. The major component involved in platelet
aggregation is ADP (Adenosine Diphosphate). So ADP
induced Platelet aggregation is calculated for each indi-
vidual of known prakṟti.
Thrombosis is a pathological extension of normal haemo-
stasis. Haemostasis is the arrest of haemorrhage in re-
sponse to a vascular injury. Thrombosis is a formation of
a blood clot in circulation. More is the platelet aggrega-
tion; more is the chance of Atherosclerosis. Less is the
platelet aggregation, more is the chance of haemor-
rhage. Using this study, we can identify which Prakṟti is
more prone to Atherosclerosis or bleeding disorders and
advise them to prevent further consequences with the
help of Āhāra, Vihāra, profession and drugs to avoid
complications. Also useful in explaining the variable out-
come of the antiplatelet drug therapy.
METHODS
Sample Size:
Total number of volunteers included in the study were 90.
Appropriate number of volunteers were screened so as
to recruit 30 volunteers of each Ekadoṣapradhan prakṟti
type by simple random sampling.
Study Population:
Normal healthy individuals (confirmed by history, physi-
cal examination and routine laboratory investigations, in-
cluding haematology, renal and liver function tests) be-
tween the age group of 16 to 40 years (both years inclu-
sive) of either sex, and willing to abide by trial proce-
dures were enrolled.
Plan of Study:
After taking the consent, Prakṟti was evaluated using
standardized and validated software AYUSOFT, devel-
oped by CDAC, Pune. Software gives the result as Per-
centage of each doṣa calculated. Individuals having
60% or more characters included in the sample as doṣa
pradhan prakṟti of that doṣa.
Then blood collection was done in fasting condition to
minimize circadian variation in platelet aggregability.
Blood samples were collected between 8 and 9 am from
an antecubital vein in the supine position. 20cc blood
collection was done from each volunteer; 10 ml in Citrate
bulb for Platelet aggregation; 5 ml in Plain bulb for Bio-
chemical examination; 5 ml in EDTA bulb for Hematol-
ogy. Routine haematological and biochemical investiga-
tions were done for confirmation of their healthy status.
Their Platelet Rich Plasma was incubated. Platelets in the
PRP were counted using a platelet counter. This working
plasma was used to study the Aggregation response of
platelets to Adenosine Diphosphate in concentration of
5M & 10M.
Image 1: Chronolog platelet aggregometer
Platelet aggregation was studied using Chronolog plate-
let aggregometer which works on the principle of Born
GVR turbidimetric method. (II) Aggregometer measures
platelet function on blood samples using electrical imped-
ance in whole blood or optical density in Platelet Rich
Plasma (PRP) with simultaneously measuring ATP release
by the luminescence method. The output can be con-
nected to either a strip chart recorder or to a computer.
This program performs computation of the traces report-
ing the results as maximum amplitude and slope. Lag time
and area under the curve analysis is also available for
each trace. Each graph, its values, patient demographics
and reagent information are then stored on computer
disk for later retrieval and printing. The front panel has a
A
Pimpalkhare et.al,. : The Aggregation response of Platelets in different Prakṟti
AAMJ / Vol. 3 / Issue 6 / November – December 2017 1602
24-character Liquid Crystal Display (LCD) for each chan-
nel. Aim is to study the response of platelets to Adenosine
diphosphate (ADP). The method was standardised with
two concentrations of ADP i.e. 5µMol/L and 10µMol/L.
OBSERVATIONS & RESULTS
A total of 90 participants were recruited in the study. The
distribution of these volunteers according to Prakṟti along
with their demographic data is shown in Table 1. Inter-
estingly, the BMI in vāta prakṟti was significantly less as
compared to kapha & pitta prakṟti. In Pitta Prakṟti indi-
viduals’ platelet count was less & bleeding time was
more. BMI was high in Kapha Pradhan prakṟti.
Table 1: Demographic & Haematological details
Prakṟti n (M:F)
Platelet
count
lacks
/mm3
Bleeding
time mins BMI
Vātapra-
dhan
30
(16:14)
2.76 ±
0.59 1.7 ± 0.5
20.21
±
2.87
Pittapra-
dhan 30(13:17)
2.67 ±
0.64 2 ± 0.5
20.91
±
2.69
Kaphapra-
dhan
30
(11:19)
2.78 ±
0.70 1.9 ± 0.4
22.10
±
3.55
Prakṟti Wise Average Platelet Aggregation:
Difference in the Average Platelet aggregation was sig-
nificant at 5 µM ADP concentration than at 10 µM con-
centration.
Table 2: Prakṟti wise Average Platelet Aggregation
Prakṟti
Average Platelet aggregation % ±
S. D.
5 µM 10 µM
Vātapradhan 63% ± 14 75% ± 10
Pittapradhan 52% ± 18 70% ± 13
Kaphapra-
dhan 72% ± 6.8 81% ± 7.5
Statistical analysis of average platelet aggregation in dif-
ferent Prakṟti:
H0 = Platelet aggregation is independent on Doṣapra-
dhan Prakṟti
H1 = Platelet aggregation is dependent on Doṣapradhan
Prakṟti
One-way Analysis of Variance ANOVA test is applied to
determine the Significance in Doṣapradhan Prakṟti in IN-
STAT software. The level of significance is set at 5% level,
P<0.05 level. Fcalculated > Ftable value indicates the signifi-
cance and it reveals that the effect is due to Doṣapra-
dhana Prakṟti.
At ADP Concentration 5 µM:
The P value is < 0.0001, considered extremely signifi-
cant. Variation among column means is significantly
greater than expected by chance.
ANOVA table
Source of var-
iation
Degrees of
freedom
Sum of
squares
Mean
square
between col-
umns 2 6620 3310
within columns 87 16834 193.5
Total 89 23454
F = 17.106
Table value for 2 df across and 87 df vertically at 5%
level of significance =3.101. Calculated value is greater
than table value. So null hypothesis H0 is rejected and
alternate hypothesis of significant difference between the
mean is accepted hence Doṣapradhan Prakṟti and Plate-
let aggregation are dependent and there is significant
difference in the Platelet aggregation in Vāta, Pitta and
Kapha pradhan Prakṟti at 5µm ADP concentration.
At ADP Concentration 10µM:
The P value is 0.0002, considered extremely significant.
Variation among column means is significantly greater
than expected by chance.
ANOVA table
Source of
variation
Degrees of
freedom
Sum of
squares
Mean
square
between col-
umns 2 2180 1090
within col-
umns 87 9389 107.92
Total 89 11569
F = 10.100
Table value for 2 df across and 87 df vertically at 5%
level of significance =3.101. Calculated value is greater
than table value. So null hypothesis H0 is rejected and
H1 of significant difference between the mean is ac-
cepted hence Doṣapradhan Prakṟti and Platelet aggrega-
tion are dependent and there is significant difference in
the Platelet aggregation in Vāta, Pitta and Kapha pra-
dhan Prakṟti at 10µm ADP concentration.
Pimpalkhare et.al,. : The Aggregation response of Platelets in different Prakṟti
AAMJ / Vol. 3 / Issue 6 / November – December 2017 1603
Graph 1: Platelet count versus Prakṟti
Image 2: Platelet aggregation of Vātaprakṟti:
Image 3: Platelet aggregation of Kaphaprakṟti:
Image 4: Platelet aggregation of Pittaprakṟti:
DISCUSSION
Everybody imparts different response to the internal & ex-
ternal disease causing agents. This response is depend-
ent on Prakṟti, the basic constitution of the body. These
prakṟtis show characteristics of the dominant Doṣa at an-
atomical, physiological and psychological levels. For the
transport purpose of blood, it has to be kept in liquid
form. This Dravata is the Aapmahabhutjanya guna of
Raktadhātu. But its degree will differ in each person ac-
cording to prakṟti. Pitta & Kapha are the two Doṣas
which are in liquid form circulate in the body with the
medium of blood. Vitiation of these two doṣas directly
affects the Dravata of Raktadhātu. (III) So in Pitta prakṟti
individuals, Raktadhātu will be more affected by Pitta
doṣa rather than Kapha doṣa. Atherosclerotic changes
(plaques) in the vessel or excessive platelet aggregation
will affect the Dravata of Raktadhātu. In that Kapha will
cause Atherosclerotic plaques similar to its guna & pitta
will cause internal bleeding or emboli formation. Since
Pitta has the “Aashrayashrayisambandh” with Rak-
tadhātu. So whenever Pitta is vitiated, it affects Rakta
dhātu and vice versa. (IV)
Sushruta says normal blood does not coagulate inside
the blood vessel. (V)(VII) It is always in liquid form. (IX) So
from this we can say consistency of blood is dependent
on healthy state of your body. According to Sushruta, in
all individuals with any Prakṟti, Raktadhātu is Asamhata.
It is neither a clear fluid nor dense. But the degree of
consistency may differ in different individuals. It is Prakṟti
dependent. (VI)
Here Sushruta clearly says that normal blood can prevent
bleeding. This we can correlate with the coagulation pro-
cess. But its degree will minutely differ according to
Prakṟti. We have observations that platelet aggregation
is maximum in Kapha Prakṟti & minimum in Pitta prakṟti
individuals. As Charaka has said Pitta dushta Rakta
shows delay in clotting. This can be seen as less platelet
aggregation in Pitta Prakṟti individuals. And Kapha
dushta Rakta is thick (VIII) or does not flow easily. (X) This
can be correlated with more platelet aggregation in
Kapha Prakṟti individuals.
While explaining bloodletting procedure, it is given that
vāta & pitta vitiated rakta is slow in aggregation or have
properties that prevent aggregation. (Dry, fast moving,
does not clot easily) (VI) (IX) In contrast, Kapha vitiated rakta
has properties in favour of aggregation of platelets.
(Cold, slimy, bleeding time is more, slow moving) (VI) So
from this study we can conclude that, Kapha prakṟti sub-
jects have maximum platelet aggregation. And pitta
prakṟti subjects have the least platelet aggregation.
1.5
2
2.5
3
3.5
VATAPITTA
KAPHA
2.762.67 2.78
Pla
tele
t co
un
t in
la
cks/
dl
Prakriti
PLATELET COUNT
Pimpalkhare et.al,. : The Aggregation response of Platelets in different Prakṟti
AAMJ / Vol. 3 / Issue 6 / November – December 2017 1604
Platelet aggregation varies between 18% to 93% in the
population included in this study. So we can say that nor-
mal healthy individual has wide range of platelet aggre-
gation. No subject had 0% or 100% Platelet aggrega-
tion. So there will be some or more Aggregation re-
sponse by the platelets in each individual. And that is
determined at the time of conception in the form of
Prakṟti.
CONCLUSION
Platelet aggregation depends on Prakṟti. Prakṟti can be
used as an objective tool for prognosis of Atherosclerotic
changes. Assessment of Prakṟti is an important parameter
to decide the line of treatment of anti-platelet drugs or
advise to avoid the atherosclerotic changes. Medical ge-
netics seeks to understand how genetic variation relates
to human health and disease. So now from this study we
can say that assessment of Prakṟti is a measure to judge
human health, disease proneness & drug response in an
individual.
Further scope of the study:
Although this work is done in a scientific way however
there are certain limitations of time and facilities availa-
ble.
1. Majority of volunteers are doing their graduation or
post-graduation. There may be variation in result, if vol-
unteers of other occupations will be included.
2. All the volunteers are from age group 16-40 years.
There is age related impairment in platelet aggregation,
so study can be done specifically including old age vol-
unteers.
ΛΛΛΛ
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Source of Support: Nil.
Conflict of Interest: None declared
ΛΛΛΛ
How to cite this article: Pimpalkhare et.al,. : The Aggrega-
tion response of Platelets in different Prakṟti. AAMJ 2017;
6:1600 – 1604.