Correlação entre as manifestações hematológicas na medula óssea e no sangue periférico de pacientes com leishmaniose visceral

Abstract

Visceral leishmaniasis (VL) or Kala Azar is a zoonosis with wide distribution, reaching about 88 countries with 500,000 new cases per year. In Piauí, the Institute of Tropical Diseases NatanPortela-IDTNP located in Teresina is the referral hospital for the disease. Objectives: This study sought to identify the hematologic changes and the occurrence of possible correlations between the bone marrow and the peripheral blood of patients with visceral leishmaniasis, in order to contribute to the definition of new medical and therapeutic pipelines. Material and methods: quantitative study was carried out in 62 patients diagnosed with transverse LV, in the period October 2007 to January 2008, in IDTNP. After anamnesis were requested laboratory tests (CBC, RIFI, bone marrow smears eous) for attestation of pathology. After confirmation of the disease, interviewed the patient or his legal guardian, on the objectives of the survey, requesting the signature of informed consent. For data analysis were elaborated specific tables in Microsoft excel, with subsequent statistical analysis by Biostat 5.3 and 20 SPSS. Results: patients came from three States: Piaui with 37 (59.7), with 22 (35.5) and Stop with 3 (4.8) (p 0.0001). The age ranged from 10 months to 70 years, being 18 (29.1) female and 44 (70.9) male (p 0.0005). The positivity was established through one of three laboratory methods (RIFI, MO and culture), and 41 (66.1) (p 0.0001) were positive in the three methods used. Hematologic analyses performed on blood smears and Cell dyn, demonstrated that, on white series, 162 (1.6) patient presented Leukocytosis, 1262 (19.4) were within the parameters considered normal and 4962 (79.0) had leukopenia. As the count specifies, it was observed that: 4 (6.4) had levels considered normal neutrophil and 58 (93.6) with neutropenia; lymphocytes: 6 (9.7) presented Lymphocytosis, 36 (58.1) lymphopenia and 20 (32.2) normal. The lymphocyte atypia was observed in 17 (27.4) (p 0.0001) patients and reached different levels: sharp: 317 (17.6) patients moderate: 1317 (76.5) and discreet: 117 (5.9). In the Red series, only 1 (1.6) patient had normal levels of red blood cells, hemoglobin and hematocrit; the remaining 61 (98.4) presented low levels, with hipocromia, anisocytosis, microcytosis and macrocytosis in varying degrees. It was noted even the occurrence of a patient with poikilocytosis, with refers, two policromatofilia and one with 8 of eritroblastos. In platelet series noted that 38 (61.3) patients had thrombocytopenia and 24 (38.7) levels were normal. Bone marrow aspirates were performed on all survey respondents for diagnostic purposes. In just 15 (24.0) not found the parasite (leishmania sp.), either by direct search, is the culture in appropriate media. Reading was held in 40 (65.0) (p 0.0234) blades of bone marrow smear, where he noted that three were normocelulares and normoplasiamegacariocítica. As for global cellularity 21 (52.5) patients were hypocellular, 13 (32.5) normocelular and 6 (15.0) hypercellular, while megacariocítica series, 28 (70.0) showed hypoplasia, 8 (20.0) normoplasia and 4 (10.0) enlarged. In the mielóideeritróide relationship, the occurrence of inversion in 7 (17.5) cases (p 0.0001). Values less than 21 were recorded on 10 (25.0) patients, while 18 (45.0) were within the reference range (21 to 41) and 5 (12.5), were above this value (41). Conclusion: the research demonstrated that the hematological changes are common in patients with visceral leishmaniasis and involve a complex and multifactorial pancytopenia. Anemia hypochromic microcytic and type is and although there are positive correlations between the changes in the bone marrow and peripheral blood, in this study, statistical significance was not observed among these correlations.