Clinico-hematological characteristics in patients with kala azar. A study from north-west India.

Clinico-hematological features were analysed in 23 patients with kala azar. Fever and hepatosplenomegaly were the main presenting features. All patients were moderate to severely anemic (Hb 4.3-8.1 g/dl), 17 were leucopenic and 15 were thrombocytopenic. Bone marrow showed moderate to severe megaloblastosis in 11 cases, an increased number of plasma cells in 20 and megakaryocytic hyperplasia with abnormal morphology in 19 patients. Megakaryocyte numbers per smear were significantly increased (p = 0.01) in thrombocytopenic patients as compared to patients with normal platelet counts. Spleen size, Hb level, platelet count and number of plasma cells in the bone marrow were related to parasite load. In general the degree of parasitisation, spleen size and duration of illness correlated with some of the main hematological features. Thus splenic sequestration and ineffective hematopoiesis appear to be the main etiopathogenetic factors in the emergence of bone marrow changes and peripheral cytopenias.