Bone Marrow Aspiration Findings in Kala-Azar

To describe the bone marrow aspiration cytologic findings in visceral leishmaniasis. Bone marrow aspiration of 204 documented cases of kala-azar were reviewed in order to find aspiration clues other than typical intrahistiocytic and free Leishman-Donovan bodies. Aspiration findings were divided into different groups of common, uncommon as well as atypical/unusual findings. Common findings were granulomas, intrahistiocytic and free typical organisms, plasma cells with or without inclusions, eosinophilia, free floating cytoplasmic bodies with or without Leishman bodies, granular bodies and erythroid hyperplasia. Uncommon findings were: intracellular (non-histiocytic) organisms, hemophagocytosis, plasma cells with abnormal crystalline inclusions, leukemic blasts and necrosis. Atypical/unusual findings were: spore-like organisms, regular or irregular shape of aggregates of organisms (flower-like, ball-like, rosette-like, doughnut-like and platelet-like), intracytoplasmic granule-like organisms (kinetoplast only), pseudo-Pelger Huet, increased vessels, fibroblasts, Reed-Sternberg-like cells, multinucleated giant cells, tart cells and foamy cells. Knowledge of common, uncommon and unusual/atypical bone marrow aspiration findings of kala-azar may help arrive at a correct diagnosis; avoid unnecessary workups, such as sophisticated molecular techniques; and avoid fatal outcomes in untreated or non-diagnosed cases.