Bone Marrow Histopathological Changes in Visceral Leishmaniasis

Abstract

Over a period of two years (June 1989-May 1991, bone marrow trephine biopsies from 16 patients with visceral leishmaniasis were examined histologically to assess the correlation between the peripheral blood counts and bone marrow status. Only 25% of patients had normal peripheral blood counts. Of the remainder, 25% had anemia alone, 25% had anemia with thrombocytopenia, and 25% had pancytopenia. The anemia was microcytic/hypochromic in 88.7% of cases and normocytic in 12.3% of cases. Thrombocytopenia was a notable feature, with mean platelet count of 115 ± 72.47 x 10 9 /L, and eight patients having thrombocytopenia below 120 x 10 9 /L. There was diffuse bone marrow hypercellularity in 13 cases and focal hypocellularity in three. The increased cellularity was attributable to trilineage hyperplasia, with a predominance of erythroid activity in most cases. Increase in the histiocytic population was a prominent feature in all the cases. In 10 cases, most of the histiocytes were found to be full of LD bodies, while in the other six, the parasite load was much less. Megakaryocytes were abundant in number, forming aggregates in most cases. Other notable features included erythrophagocytosis (nine cases) and moderate perivascular plasmacytosis (13 cases). Ann Saudi Med 1996;16(3):304-307. Leishmaniasis. 1996; 16(3): 304-307 Visceral leishmaniasis (VL), also known as kala-azar, is endemic in the southern (Gizan Province) and southwestern regions (Asir Province) of Saudi Arabia. MO Al-Sohaibani, Bone Marrow Histopathological Changes in Visceral1-3 On the other hand, the cutaneous form of leishmaniasis is prevalent in the eastern and central regions, particularly in Al-Hassa and Al-Qassim.2 Previous reports from the Kingdom 1-4 have dealt with the clinical features of VL, which are found to be similar to those described in patients from elsewhere.To the best of our knowledge, a detailed study demonstrating bone marrow findings in patients with VL has no routine histologic techniques. Four micron sections were cut and stained with hematoxylin and eosin, Giemsa, and reticulin stain by silver impregnation. Material and MethodsThe study was conducted on 18 patients of pediatric age group, admitted to King Fahad Hospital at Al-Baha with clinical features suggestive of VL. The duration of their illness ranged from two weeks to one year. Each patient underwent a complete clinical workup, including a detailed history and physical examination, followed by diagnostic bone marrow or splenic puncture in which Leishman-Donovan bodies (LDB) or amastigotes were demonstrated.Adequate trephine bone marrow biopsies were obtained from the posterior iliac crest with a Jamshidi needle in 16 patients, who are the subjects of this report. Biopsies were fixed in 10% neutral buffered formalin, then decalcified for one hour and processed by routine histologic techniques. Four micron sections were cut and stained with hematoxylin and eosin, Giemsa and reticulin stain by silver impregnation.Microscopically, the marrow cellularity was assessed acco...