Diagnostic value of bone marrow cell morphology in visceral leishmaniasis-associated hemophagocytic syndrome:Two case reports

BACKGROUND Visceral leishmaniasis related-hemophagocytic lymphohistiocytosis(VL-HLH)is a hemophagocytic syndrome caused by Leishmania infection.VL-HLH is rare,especially in nonendemic areas where the disease is severe,and mortality rates are high.The key to diagnosing VL-HLH is to find the pathogen;therefore,the Leishmania must be accurately identified for timely clinical treatment.CASE SUMMARY We retrospectively analyzed the clinical data,laboratory examination results,and bone marrow cell morphology of two children with VL-HLH diagnosed via bone marrow cell morphology at Kunming Children’s Hospital of Yunnan,China.Both cases suspected of having malignant tumors at other hospitals and who were unresponsive to treatment were transferred to Kunming Children’s Hospital.They are Han Chinese girls,one was 2 years old and the other one is 9 mo old.They had repeated fevers,pancytopenia,hepatosplenomegaly,hypertriglyceridemia,and hypofibrinogenemia over a long period and met the HLH-2004 criteria.Their HLH genetic test results were negative.Both children underwent chemotherapy as per the HLH-2004 chemotherapy regimen,but it was ineffective and accompanied by serious infections.We found Leishmania amastigotes in their bone marrow via morphological examination of their bone marrow cells,which showed hemophagocytic cells;thus,the children were diagnosed with VL-HLH.After being transferred to a specialty hospital for treatment,the condition was well-controlled.CONCLUSION Morphological examination of bone marrow cells plays an important role in diagnosing VL-HLH.When clinically diagnosing secondary HLH,VL-HLH should be considered in addition to common pathogens,especially in patients for whom HLH-2004 chemotherapy regimens are ineffective.For infants and young children,bone marrow cytology examinations should be performed several times and as early as possible to find the pathogens to reduce potential misdiagnoses.

Special IgD-λtype multiple myeloma based on bone marrow cell morphology:A case report

We aimed to explore the changes of laboratory indexes of IgD-λtype multiple myeloma with special cell morphology,and to improve the cognition of IgD-λtype MM.To explore the changes of laboratory indexes of IgD-λtype 1 multiple myeloma with special cell morphology,and to improve the cognition of IgD-λtype MM.The morphology of bone marrow cells,immunofixation electrophoresis,serum free light chain(sFLC)and other detection indexes of a patient with IgD-λtype MM treated in Handan Central Hospital in December 2020 were analyzed.The patient bone marrow smears showed 62%of abnormal cells-which were distributed in clusters and resembled lymphoma and metastatic cancer cells.The Flowcytometry indicates that the cell is a plasma cell tumor.Immunoglobulin IgG,IgA and IgM were all lower than the normal range.There is a monoclonal light chainλcomponent in immunofixation electrophoresis.The serum free light chainλwas 2700.00 mg/L,light chain k/λis 0.0023,the high of serum calcium,LDH,β2 microglobulin.IgD-λtype MM is a rare type of MM.The age of onset is young,the invasiveness is strong,the prognosis is poor,the clinical manifestation is complex,and it is easy to be misdiagnosed or missed.The analysis of the clinical symptoms and laboratory characteristics of the disease plays a positive role in the diagnosis,treatment and prognosis of the disease.