Blood Cellular Hematological Changes in Patients with Visceral Leishmaniasis Attending Kimalel Sub-County Hospital, Baringo County, Kenya

Abstract

Blood cellular changes in visceral leishmaniasis (VL) are common. This study sought to find a balanced view between the significance of the blood cellular changes and their clinical utility in diagnosis of VL. The VL disease causes various hematologic manifestations in humans. Usually, anaemia, leucopenia, and thrombocytopenia are most common. VL disease affects people of all age groups that are exposed to infected sand flies and is characterized by fever, hepatomegaly, splenomegaly, weight loss, and enlarged lymph nodes. However, other common tropical illnesses manifest with similar clinical features. The study dealt with two presumptions: that the diagnosis of VL was not based on symptoms and signs alone; and that the existing definitive procedures of diagnosis were invasive and necessitated safe laboratory options. Due to these challenges, blood cellular parameter changes were used as a unique indicator for VL and to reduce Turnaround Time (TAT) and subsequent management. To achieve its objective of determining the unique blood cellular changes that can be used to aid in early diagnosis of visceral leishmaniasis, a descriptive cross-sectional study was undertaken at Kimalel Sub-County Hospital Baringo County, Kenya. A total of seventy-four (74) splenic aspirates and whole blood samples were collected for analysis. Splenic aspirates stained with Giemsa stain were examined for Leishmania donovani (LD) bodies. AcT10 Coulter Counter hematology analyzer was used to run complete blood cell count. Peripheral blood films were stained with Giemsa and examined for cell morphology, characterization and variations using a Daly cell counter. Amastigotes were microscopically identified in splenic aspirates smears. The study results revealed a decrease in Hb: 3.8-9.8g/dl, RBCs: 1.19-3.85 for males and Hb of 3.6-10.2g/dl, RBCs: 1.13-3.83 for females. There was also a decrease in WBCs: 0.6-3.3,neutrophils:29-71,lymphocytes:26-70,monocytes:0-5,platelets 21-225 for males and 0.6-3.0 Neutrophils: 32-73,lymphocytes:24-66,monocytes:0.5,platelets: 19-405 for females. RBC indices were reduced (except MCV which was normal in all cases) with decrease also in white blood cells and Platelets counts using automated electronic cell counter. The differential count and microscopic examination showed a complete absence of eosinophils. All cells were affected but eosinophils were mostly affected in the study. The study demonstrated that there were no unique blood cellular changes which could inform early diagnosis or detection of visceral leishmaniasis. More research should be conducted on various test methodologies to ascertain the simplest, cheap and appropriate laboratory diagnosis for VL.