Introduction: Visceral leishmaniosis, kala-azar, or black fever is a fatal disease caused by protozoan parasites of the genus Leishmania. Serological testing is more frequently used in endemic areas. The recombinant kinesin antigen (rK39) is a useful antigen in enzyme-linked immunosorbent assay (ELISA), also available in strip format as a rapid test, but the best way for the diagnosis of visceral leishmaniosis is histopathologic demonstration of the parasite by aspiration or biopsy of affected organs (usually, bone marrow or spleen aspirations). Case Presentation: Here, wepresent the case of a 5-year-old girl with fever, weight loss, weakness and massive hepatosplenomegaly. In lab data, pancytopenia was observed. ELISA rapid test was negative for leishmaniosis. Bone marrow aspiration showed amastigotes within macrophages and outside cells. Conclusions: The aim of this report was to emphasize that bone marrow aspiration is an accurate method for the diagnosis of visceral leishmaniosis.

Background: Bone marrow necrosis (BMN) is a rare and ominous complication of wide variety of diseases including hematologic malignancy. This study was perform to identify frequency and the underlying associated diseases of marrow necrosis.Methods: About 850 bone marrow trephine biopsies related to living patients at the Pathology Department of Urmia Imam Hospital between March 1998 and January 2008, were retrospectively reviewed. The reviews include clinical and laboratory findings from files of the patients.Results: Eight cases of bone marrow necrosis were found. Frequency was 0.94 percent. Ages of the patients were between 18 and 85 years, and four of them were female. Prominent symptoms of the patients were bone pain, fever, fatigue, and jaundice. The most common laboratory findings were anemia, cytopenia, elevated lactate dehydrogenase (LDH), and alkaline phosphatase (ALP). Underlying diseases of bone marrow necrosis in our patients includes systemic lupus erythematosus, multiple myeloma, metastatic gastric cancer, acute myeloid leukemia (M4), hairy cell leukemia, lymphoma, chronic myeloid leukemia and sepsis.Conclusion: Our findings suggest that the conditions associated with BMN are varied and malignancy remains common. In cases presented with pyrexia, bone pain, pancytopenia, elevated LDH and ALK, marrow necrosis must be thought. Although prognosis is very bad, supplementary therapy, in addition to the underlying disease must be performed.

Background and Objectives: Bone marrow necrosis (BMN) is a rare and ominous complication of wide variety of diseases including hematologic malignancy. This study was performed to identify frequency and the underlying associated diseases of marrow necrosis.Materials and Methods: In this descriptive study, totally 850 bone marrow trephine biopsies related to living patients at the Pathology Department of Urmia Imam Hospital from March 1998 to January 2008, were retrospectively reviewed. The reviews included clinical and laboratory findings from files of the patients.Results: Eight cases of bone marrow necrosis were found. Frequency was 0.94 percent. Ages of the patients were between 18 and 85 years, and four of them were female. Prominent symptoms of the patients were bone pain, fever, fatigue, and jaundice. The most common laboratory findingswere anemia, cytopenia, elevated lactate dehydrogenase (LDH), and alkaline phosphatase (ALP). Underlying diseases of bone marrow necrosis in our patients includes systemic lupus erythematosus, multiple myeloma, metastatic gastric cancer, acute myeloid leukemia (M4), hairy cell leukemia, lymphoma, chronic myeloid leukemia and sepsis.Conclusion: Our findings suggest that the conditions associated with BMN are varied and malignancy remains common. In cases presented with pyrexia, bone pain, pancytopenia, elevated LDH and ALK, marrow necrosis must be thought. Although prognosis is very bad, supplementary therapy, in addition to the underlying disease must be performed.

Myeloid sarcoma of female breast is a rare presentation of acute myeloid leukemia (AML). The tumor mass may precede or occur concurrently with AML, CML, myeloproliferative disorders, and/or myelodysplastic syndromes. Histologically, it looks like a large cell lymphoma and can be misdiagnosed. A case referred as a suspected case of large cell lymphoma. Initial morphological study with conventional H and E staining showed diffuse infiltration of pleomorphic large blast cells with occasional mature cells showing eosinophilic cytoplasmic granules. Immunohistochemical study was done on paraffin material for this suspected case of myeloid sarcoma and tumor cell reaction with myeloperoxidase was positive. The histological diagnosis was finalized as myeloid sarcoma. Initial bone marrow aspiration showed less than 20% myeloid blasts but after three weeks the marrow aspiration showed 30% of myeloid blasts. Flow cytometry was also performed and proved the diagnosis of acute myeloid leukemia. It is concluded that in conditions of an unusual case of pleomorphic large cell lymphoma, myeloid sarcoma may be a possibility.

BACKGROUND: Kala-azar is a multisystem infection of the reticuloendothelial system. Various hematologic abnormalities have been described in kala-azar including hemophagocytic syndrome (HPS).METHODS: We reviewed bone marrow aspirate smears from 18 documented cases of kala-azar complicated by HPS.RESULTS: The bone marrow smears were hypercellular with erythroid hyperplasia. Megaloblastic changes, foamy macrophages, activated macrophages with cytoplasmic vacuoles and elongated cytoplasmic process, intra- and extracellular amastigotes, cytoplasmic fragments (blue bodies), plasma cells with inclusions and hemophagocytic cells were seen. Leishman bodies (amastigotes) were also found in some hemophagocytic cells.CONCLUSION: Kala-azar should be considered as an etiology of HPS, particularly in endemic areas.

Background: Ketofol is usually using as a sedative drug during painful procedures now. That Provides sedation, analgesia and rapid recovery. The aim of this study was to compare the efficacy, respiratory and hemodynamic profiles, and side effects of two various combination of ketamine and propofol in patients undergoing bone marrow aspiration (BMA) and lumbar puncture (LP).Materials and Methods: This randomized, double blinded study was designed to compare the quality of analgesia and side effects of intravenous ketofol in sixty boys and girls. In this study Patients received a slow bolus injection of a solution containing combination of equal amount of propofol and ketamine (1: 1) (Group I) or two parts of propofol plus one part of ketamine (2: 1) (Group II). Subsequent slow bolus injects to a predetermined sedation level using Ramsay Sedation Scale. Vital signs, oxygen saturation (SpO2) and incidence of any side effects were recorded.Results: Ketofol was used in 49 surgical procedures in children with a median age of 5 years (1 to 10 years old). In this study there was an increase postoperative nausea, psychomimetic side effects, and increase recovery time with the largest ketamine dosage (Group I). (P-value<0.001) Conclusion: The adjunctive use of smaller dose of ketamine in ketofol combination minimizes the psychomimetic side effects and shortens the recovery time. A large number of patients are required to evaluate and validate these findings.

Background & Objective: Chronic lymphocytic leukemia (CLL) is one of the most common types of leukemia in adults with various signs, symptoms, and types of progression. In this study, we have investigated the frequency and correlation of laboratory findings including peripheral blood smear, bone marrow aspiration and biopsy, and cellular immunophenotyping in CLL patients.Methods: In this cross-sectional and retrospective study, the laboratory information of all 161 patients with definite diagnoses of CLL was extracted, and the frequency and correlation between different laboratory data were analyzed by descriptive statistics methods and Jamovi software version 2022.Results: Demographic factors such as age and gender, and laboratory factors such as anemia, thrombocytopenia, white blood cell count, percentage of lymphocytes, and patterns of bone marrow involvement were evaluated for 161 patients. There was a significant relationship between the bone marrow iron storage and the percentage of FMC7 marker expression with the percentage of atypical lymphocytes in the peripheral blood.Conclusion: Chronic lymphocytic leukemia, a prevalent form of leukemia associated with substantial mortality and morbidity, can be detected through a range of diagnostic techniques. Analyzing the results of these diagnostic tests and examining the prevalence of these indicators in patients afflicted with the condition can prove highly beneficial for prompt disease diagnosis, and prognosis determination among affected individuals.

Background & objective: Introduction: First detection of any solid tumour as metastatic deposits in bone marrow directs clinicians to start searching for the primary tumour. Detection of bone marrow metastasis determines the stage of the malignancy, prognosis, mode of treatment, chemotherapeutic response and follow-up in case of relapse. The aim of the current study was to analyse the clinico-haematological presentation and morphological pattern of infiltration of solid tumours detected first as metastatic deposits on bone marrow examination. Methods: Three-year retrospective analysis of MGG-stained bone marrow aspiration smears and touch imprints of the bone marrow biopsy and Hematoxylin and Eosin (H&E) stained histopathological sections of biopsies was performed at the Department of Pathology at a tertiary care institute (January 2014 to December 2016). The morphological pattern of metastatic deposits and haematological profiles of the patients were analysed. Exclusion criterion was the presence of hematolymphoid malignancies. Results: In 22 cases, bone marrow was the first site of detection of metastasis. The age of the patients ranged from 3 years and 10 months to 82 years, with equal gender predilection. Overall, 16 cases had cytopenias, 9 cases each had leucocytosis and leukoerythroblastic presentation. The metastasis was from Ewing’ s sarcoma, prostate carcinoma, gastric adenocarcinoma invasive duct carcinoma breast, gallbladder carcinoma, lacrimal duct carcinoma and invasive papillary urothelial carcinoma. Conclusions: Bone marrow examination is a cheap and reliable investigation to detect metastasis in an unsuspecting case. Bilateral trephine biopsies are recommended to increase the efficacy of detecting bone marrow metastasis.

Background: Invasive procedures such as bone marrow aspiration in children with oncologic malignancies are painful and may produce anxiety for both patients and their parents. Various pharrnacologic treatments have been used to sedate children undergoing bone marrow aspiration. This prospective randomized study was designed to compare the effectiveness of these combinations, as well as their associated hemodynamic and respiratory side-effects and recovery in pediatric patients undergoing bone marrow aspiration.Methods: Fifty children with oncologic malignancies whose ages ranged between 2- 12 years were emolled in this study. Patients were randomly assigned either to the Propofol- Alfentanyl group or the Midazolam- Ketamine group for analgesia and sedation during bone marrow aspiration in the operating room. Time to induce sedation, sedation score and recovery time were recorded.Results: There were no statistical differences between groups in weight, age, sex and duration of procedures. Procedures were completed with satisfactory sedation levels in all patients in the study groups according to the modified Ramsay score. Induction and recovery times in the Propofol- Alfentanyl group were significantly shorter than in the Midazolam- Ketamine group (p<0.001).fter Midazolam- Ketamine sedation, a statistically significant increase in systolic blood pressure and heart rate were seen, however the opposite was observed after Propofol- Alfentanyl sedation. Other side effects, such as nausea and vomiting, agitation myoclonus and aspiration, were not seen in our patients.Conclusion: Both Propofol- Alfentanyl and Midazalam-Ketamine combinations can be used safely and effectively for sedation and analgesia during bone marrow aspiration in the pediatric patient group.