Association between clinical outcomes, peripheral blood and cytomorphologic features of bone marrow in visceral leishmaniasis

Maria Aline Ferreira De Cerqueira; Alaíde Maria Rodrigues Pinheiro; Dorcas Lamounier Costa; Carlos Henrique Nery Costa

doi:10.1016/j.htct.2023.10.006

Association between clinical outcomes, peripheral blood and cytomorphologic features of bone marrow in visceral leishmaniasis

Hematol Transfus Cell Ther. 2024 Jan 23:S2531-1379(23)02601-9. doi: 10.1016/j.htct.2023.10.006. Online ahead of print.

Authors

Maria Aline Ferreira De Cerqueira¹, Alaíde Maria Rodrigues Pinheiro², Dorcas Lamounier Costa³, Carlos Henrique Nery Costa³

Affiliations

¹ Centro de Hematologia e Hemoterapia do Piauí (HEMOPI), Teresina, PI, Brazil. Electronic address: alinecerqueira@yahoo.com.br.
² Instituto de Doenças Tropicais Nathan Portella (IDTNP), Teresina, Brazil.
³ Instituto de Doenças Tropicais Nathan Portella (IDTNP), Teresina, Brazil; Universidade Federal do Piauí (UFPI). Teresina, PI, Brazil.

PMID: 38272737
DOI: 10.1016/j.htct.2023.10.006

Abstract

Introduction: An intracellular parasite of mononuclear phagocytes, mainly distributed in the bone marrow and the spleen, causes visceral leishmaniasis. Complete blood count (CBC) reveals the poorly understood pathogenesis of anemia, leukopenia and thrombocytopenia. Our study aimed to compare the CBC with bone marrow cytomorphological features and their association with clinical outcomes to clarify this relevant issue.

Methods: The CBC and bone marrow of 118 patients were described by two hematologists and compared to check their association with each other and mortality.

Results: Peripheral cytopenias were common findings, particularly anemia, as seen in almost all patients. No relationship was found between values of hemoglobin, neutrophils and platelet count with fatal outcomes. The bone marrow was normocellular in 61.9% of the cases. Dysplasia figures were frequent and 49.1% of the samples had dysgranulopoiesis. Additionally, erythroid hyperplasia was found in 72% of the patients with severe anemia. Patients with reduced bone marrow cellularity, erythroid hypercellularity and dyserythropoiesis seem to have a riskier disease.

Conclusion: The study results suggest that the bone marrow of patients with visceral leishmaniasis manifests a reactional pattern to the inflammatory event, thereby modulating cytokines and other colony growth factors. This compensatory response may be dysplastic and ineffective and generate peripheral cytopenias of varying intensity. Further studies are needed to clarify the signaling pathways involved, which may be used as therapeutic tools in the future.

Keywords: Bone marrow; Complete blood count; Visceral leishmaniasis.