Clinicohematological Profile of Visceral Leishmaniasis in the Pediatric Population

Background Visceral leishmaniasis (VL) is a major public health problem worldwide. In addition to the clinical manifestations, varied hematological abnormalities have also been observed. We aim to study morphology both in peripheral smear and bone marrow aspirates (BMAs) along with clinicohematological correlation in the pediatric age group. Materials and Methods: A retrospective analysis of clinicohematological findings of 47 pediatric patients (0-18 years) diagnosed with leishmaniasis on BMAs from 2006 to 2017 was undertaken. All the results were tabulated and compared for evaluation. Results: From the 47 VL patients, the following abnormalities were noted. Pancytopenia 44.7 (21/47), bicytopenia 42.5 (20/47), anemia 10.6 (5/47), leukopenia 81 (38/47), and thrombocytopenia 53.2 (25/47). On peripheral smear, shift to left (48.3), nucleated red blood cells (19.4), toxic granules (6.7), and Leishmania donovani (LD) bodies (5.7) were noted. About 5.7 were seen. Bone marrow examination revealed erythroid hyperplasia in 44.6 of cases showing normoblastic (88.8), megaloblastic (4.4), and mixed (10.6) reactions. Dyserythropoiesis (15.5), drug-induced karyorrhexis (2.1), dysmyelopoiesis (17), giant stabs and metamyelocytes (6.3), coarse granulation (2.1), intrahistiocytic organisms (100), increased plasma cells (3.4), granulomas (25.5), parasitophorous vacuoles (25.5), nonhistiocytic intracellular organisms (15), intracellular granule-like organism (8.5), hemophagocytosis (8.5), Reed-Sternberg-like cells (2.1). Conclusion: BMA findings such as increased plasma cells, granulomas, hemophagocytosis, and granule-like organisms are important clues for suspecting leishmaniasis and further searching for LD bodies in patients with fever and splenomegaly. Keywords: Bone marrow, leishmaniasis, pediatric