Clinical features:
(1) visiting, living or history of living in a region endemic for visceral leishmaniasis
(2) development of hematologic abnormalities with changes in the bone marrow (see below)
(3) exclusion of other causes of myelodyplasia
(4) often small numbers of parasites that may require diligence to identify
(5) improvement following specific treatment for leishmaniasis
where:
• Exclusion of other causes may be difficult in an elderly adult due to the frequency of myelodysplasia in that age group.
• The disorder is easier to recognize when it involves children or adolescents.
• Immunostaining or a molecular technique may be more sensitive methods of detecting the parasites. Alternatively looking for amastigotes in the spleen may be diagnostic.
Yarali et al associated myelodysplastic changes with elevated serum levels of tumor necrosis factor alpha (TNF-alpha).
Hematologic changes in visceral leishmaniasis may include:
(1) unexplained pancytopenia in the peripheral blood
(2) dyserythropoiesis
(3) ineffective erythopoiesis (erythroid hyperplasia with low peripheral reticulocyte count)
(4) hemophagocytosis
(5) generalized hyperplasia in the bone marrow
(6) increased iron in the bone marrow
(7) dysplastic changes in megakaryocytes
(8) dysplastic changes in myelopoiesis
(9) increased marrow fibrosis
(10) increased lymphocytes and plasma cells in the bone marrow
