Hematological Characteristics of Yemeni Adults and Children With Visceral Leishmaniasis. Could Eosinopenia Be a Suspicion Index?

Abstract

Background and objectivesDelay in the diagnosis of visceral leishmaniasis (VL) particularly in non-endemic areas is associated with higher mortality. In our experience, we found that marked bone marrow eosinopenia was a very frequent accompaniment of VL and might be a useful clue for the diagnosis, which indicates the opportunity for further morphological assessment. The aim of this study was to describe the hematological characteristics including peripheral blood and bone marrow findings of Yemeni adults and children with VL.MethodsWe conducted a descriptive analytic study to evaluate systematically peripheral blood and bone marrow findings of Yemeni adults and children with VL. Peripheral blood and bone marrow aspiration of patients with bone marrow aspirate confirmed VL were examined. Forty-seven patients with the main age (±SD) of 17.34±11.37 years (Range: 1–60) were included in the study. Fifty-one non-VL subjects with splenomegaly and pancytopenia or bicytopenia served as control group.ResultsAll patients with VL had anemia, 41 (87%) leukopenia, 42 (89%) neutropenia, 44 (94%) thrombocytopenia, 42 (89%) eosinopenia, 34 (72%) pancytopenia and 13 (28%) had bicytopenia. In bone marrow examination 40 (85%) showed hypercellularity, 44 (94%) eosinopenia, 24 (51%) dyserythropoiesis, 22 (47%) lymphocytosis, 8 (17%) plasmacytosis, 27 (57%) decreased iron stores and 20 (43%) showed decreased sideroblasts. Comparison of VL patients with the control group showed significantly more frequent peripheral blood eosinopenia and lymphopenia and marrow eosinopenia. There was no significant difference between adults and children in any of the hematological features.ConclusionAnemia, leukopenia, neutropenia, thrombocytopenia, eosinopenia, pancytopenia and marked bone marrow eosinopenia were the most common findings. The finding of marked bone marrow eosinopenia is a significant clue for the diagnosis of visceral leishmaniasis in patients who present with splenomegaly associated with cytopenias. This finding is particularly valuable in non-endemic areas.

Hematological alteration among visceral leishmaniasis patients attending in Western Tigrai, Ethiopia, 2018/2019: A cross-sectional study

“…The present study showed that anemia, leucopenia, neutropenia, lymphopenia, thrombocytopenia, and pancytopenia were the most common hematological problem present in VL patients. These findings are in line with studies reported from Yemen [14], Nepal [9], India [15], Iran [12,13], Sudan [16,17], Gonder, Ethiopia [18].…”

“…In present study significantly decreased mean Hgb, RBC, HCT and RBC indices values was reported in VL patients compared to control groups, similar to report in Sudan [17]. The 96% anemia observed in VL patients in this study, is consistent with studies done in Iran (97.1%) [12] ,Yemen (100%) [14] India (100%) [7], Sudan (100%) [16],and Gondar, Ethiopia (94.4%) [18]. However, the prevalence of anemia in this study was higher than other studies done in Nepal (90%) [9] and Iran (87.3%) [13].…”

“…Also eosinopenia was observed in VL patients in this study. The result of this study is in line with pervious study conducted in India [4,10], Yemen [14], and Sudan [16].The suggested mechanism for development of this leucopenia is due to hypersplenism [1].…”

“…Total white blood cell count and neutrophil count of VL patients significantly decreased compared to controls , similar with the study conducted in Sudan [17].The prevalence of leucopenia in this study was 95% which is similar with a study done in Gonder, Ethiopia (95.4%) [18]. The prevalence of leucopenia in this study was higher than studies done in Yemen (87%) [14], Nepal (67.5%) [9], India (83.3%) [7], Iran (67.6%) [13].The cause of leucopenia is may be due to delayed presentation to hospital which was attributing to hypersplenism causing leucopenia. Neutropenia was the most common abnormality seen in 92% in this study, which was similar with a study done in Gonder (90.1%) [18], but which was higher than studies in Yemen (73.5%) [20] and Sudan (88%) [16].This increases of neutropenia may be due to destroyed premature white blood cell (especially Neutrophils) by the parasite [4].…”

“…Similarly the prevalence of Lymphopenia in this study was 73%, which was higher than in studies done in Yemen (53.2%) [14] and Gonder ,Ethiopia (37.9%) [18].The prevalence of Lymphopenia in this study was lower than study done in Sudan (94%) [16]. Also eosinopenia was observed in VL patients in this study.…”