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The photo shows the materials used to perform aspirate punctures of bone marrow: Ethyl alcohol, Betadyne, cotton, adhesive tape, xylocaine 2%, disposable syringes (5 mL for anesthetic infiltration and 20 mL for aspirate puncture of bone marrow), sterile gloves and Osgood-type 25X12 and 30X12 needles with an obliterator

Region in the sternum appropriate
for aspirate puncture of
bone marrow

A sternum aspirate puncture

 

Region in the anterosuperior iliac crest appropriate for aspirate puncture of bone marrow.


Medullar material being drawn during aspirate puncture of anterosuperior iliac spinal crest.

Medullar sample on a slide immediately after sample collection.


The two left slides show thin medullar smears without granules in patients with Visceral leishmaniasis under the macroscopic aspect.

Global Cellularity of medullar sample in patient with Visceral Leishmaniasis. Note the diminished cellularity.


This picture shows that the M/E ratio (Myeloid/Erythroid ratio) is inverted.



The relative granulocytic hipocellularity and consequent erythroblastic hipercellularity are evident here.

This field shows the increase of the number of neutrophile Promyelocites. Note that segmented neutrophils are not visualized

 

In black, the maximun and minimum parameters of the elements of the neutrophil series. In red, the average value of 100 patients studied. The increased numbers of neutrophil promyelocytes and the percentual deficit of segmented neutrophils are evident.


In black, the maximun and minimum parameters of the erythroblastic series. In red, the average value of 100 patients studied. The increased number of ortho-chromatic erythroblasts are evident.


Here we notice the predominance of small erythroblasts (microerythroblasts), which are, almost in totallity, ortho-chromatic erythroblasts.

In the lower central part of the image, we can see an erythroblast with a clover-shaped nucleus.

 

Another clover-shaped erythroblast, with a not very well delimited nucleus.


Field showing limphocytosis.

 

Isolated plasmocyte with two amastigote forms of Leishmania donovani and naked nucleus.


Small plasmocyte nest with several amastigote forms of Leishmania donovani.

 

Plasmocyte nest. Considerable number of Leishmania donovani. See also bi-nucleated plasmocyte.

 

A case of Visceral Leishmaniasis with tetra-nucleated plasmocyte.

 

Mott cell. Considerable number of Leishmania donovani in the upper central field.

 

Macrophages with several amastigote forms of phagocytosed Leishmania donovani.

 

Two macrophages with several amastigote forms of phagocytosed Leishmania donovani.


Two extra-cellular isolated amastigote forms.

Several extra-cellular amastigote forms

 

Several extra-cellular forms of Leishmania donovani with highly visible nucleus and kinetoplast.

Macrophage (ruptured) with numerous Leishmania donovani forms.


Isolated macrophage with several phagocytosed forms. It gives the false impression of projecting two cytoplasmatic "arms" to engulf a loose amastigote form.

 

Macrophage with numerous Leishmania donovani forms.

 

Same photo as beside at a higher magnification

 

Very large macrophage nest with an impressive number of Leishmania donovani amastigote forms.


Same photo as beside at a higher magnification

The reproduction or use of these photos is strictly prohibited without the author's permission. All rights reserved.

 


Final Observations:

The presence of the above alterations lead us to search for protozoary in the bone marrow smears, especially in those cases where there was the diagnostic possibility of Visceral Leishmaniasis. However, even if all these alterations are found in the same suspected case, a diagnosis of Visceral Leishmaniasis cannot be determined until after the Leishmania donovani are actually found. Most of the alterations cited above have been previously described, and can be found in the international medical literature.

Our sincerest thanks to the medical staff and patients of the Infectious and Parasitic Service of Clinical Hospital of the University of São Paulo School of Medicine where most of this data was gathered.

Photo Gallery: The magnifications used were 400X, 630X and 1000X.

About the author: Nivaldo Medeiros, MD Former Director of the Hematology and Cytology Service of the Central Laboratory of the University of São Paulo School of Medicine. Former Assistant Physician of the Department of Clinical Pathology (Hematology Service) at the Cancer Hospital of São Paulo.

Please address correspondence to:

1140 Key Route Blvd
Albany, CA
USA
94706

Other Websites from the same author: Atlas of Hematology
, Cellular Similarity and Morphologic Similarities
E-mail: nivas@earthlink.net




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