Bone Marrow Aspiration Procedure Research Articles

Evaluation of lidocaine infiltration efficiency for pain relief during bone marrow aspiration in children with cancer

Background: Bone marrow aspiration (BMA) is a painful procedure often requested in paediatric haematology and oncology. The role of local anaesthesia during BMA is matter of debate. This study assessed pain induced by BMA in children who received standard analgesic premedication with or without additional subcutaneous administration of local anaesthesia. Methods: This non-randomised prospective study included 100 patients (age range 5-21 years) who underwent BMA for the diagnosis or treatment of malignancy in a paediatric oncology unit between March 2009 and October 2010. Patients received standard premedication with topical anaesthesia, inhaled nitrous oxide, anxiolytics and analgesics, which was combined or not with administration of local anaesthesia (lidocaine). The children, nurses and doctors all graded procedural pain using a visual analogue scale (VAS). Data were statistically analysed, with each procedure serving as a statistical unit. Results: For 100 BMA procedures performed during the study period, the mean pain rating by children was 2.2, with 38 subjects reporting no pain. Use of lidocaine (19%) induced a mean pain score of 1.6, with 11 patients (57.9%) reporting no pain. Without lidocaine, the mean score was 2.3, and only 27 children (33.3%) reported no pain. Patients undergoing BMA for the first time more frequently graded pain as “0” (p=0.008). Ratings by patients and caregivers correlated poorly; 29.6% of nurses and 34.7% of doctors underestimated procedural pain. Conclusions: Our findings do not clearly demonstrate that addition of local anaesthetic to standard premedication reduces BMA-induced pain. Nevertheless, we provide valuable information on VAS scoring during BMA with standard premedication

Applications of Nitrous Oxide for Procedural Sedation in the Pediatric Population

The objective of this review was to provide a general descriptive account of the physical properties, end-organ effects, therapeutic applications, and delivery techniques of nitrous oxide (N2O) as used in the arena of procedural sedation. A computerized bibliographic search regarding the applications of nitrous for provision of sedation and analgesia during procedures with an emphasis on the pediatric population was performed. The end-organ effects of N2O have been well described in the operating room setting. Aside from its effects on the central nervous system of sedation and analgesia, N2O may alter intracerebral dynamics and alter cerebral blood flow and intracranial pressure especially in patients with altered intracranial compliance. Effects on ventilation include a dose-related depression of ventilatory function and control of upper airway patency. These effects are generally limited in the absence of comorbid diseases and potentiated by other sedative and analgesic agents. The more clinically significant respiratory effect of N2O on ventilatory function is a dose-dependent depression of the ventilatory response to hypoxemia. Hemodynamic effects include a mild direct depressant effect on myocardial function, which in the absence of comorbid cardiac disease is generally compensated by stimulation of the sympathetic nervous system. Nitrous oxide may potentially aggravate pulmonary hypertension. Additional physiologic effects on neurologic and hematologic function may result in inactivation of the enzyme, methionine synthetase. Recent concern has also been raised regarding the potential effects of N2O on immune function and its relationship to perioperative surgical site infections. Given differences in the solubility, N2O will diffuse into and significantly expand gas-filled cavities. Chronic exposure of health care works to N2O is also a concern. Although there are limited data in the literature to clearly substantiate concerns regarding the reproductive toxicity of occupational exposure to N2O, appropriate scavenging and use of other techniques are mandatory. Nitrous oxide has been shown to be effective for a variety of minor surgical procedures such as venipuncture, intravenous cannula placement, lumbar puncture, bone marrow aspiration, laceration repair, dental care, and minor dermatologic procedures. It is generally as effective as midazolam, with several studies demonstrating it to be more effective. However, its utility is not as great in severely painful procedures such as fracture reduction. Demonstrated advantages to parenteral sedation include a more rapid onset and a shorter recovery time with the majority of patients preferring it to over other agents or agreeing to its use for subsequent procedures. The literature also suggests increased success rates with simple procedures such as intravenous cannula placement when compared with placebo. In general, life-threatening adverse events have not been reported. Most common adverse effects include dysphoria and vomiting. For more painful procedures, combination with another agent may be used, and in all cases, topical or infiltrative local anesthesia is recommended. In general, N2O is a useful adjunct for procedural sedation. Given the variety of procedures performed in the pediatric patient, ongoing research is required to identify the most appropriate and effective use of this agent. This may be particularly relevant when evaluating its use for procedures associated with significant pain. In these scenarios, the combination of N2O with other agents needs to be evaluated. Given the potential for adverse effects, strict adherence to published guidelines regarding procedural sedation and monitoring is suggested.

Prospective Randomized Crossover Evaluation of Three Anesthetic Regimens for Painful Procedures in Children with Cancer

To identify the most effective sedation regimen for bone marrow aspiration and lumbar puncture procedures with a prospective trial of 3 combinations of sedation/analgesia. In this double-blind crossover study, we randomly assigned 162 children with acute lymphoblastic leukemia or lymphoblastic lymphoma to receive fentanyl 1 mcg/kg, fentanyl 0.5 mcg/kg, or placebo, in addition to propofol and topical anesthetic for 355 procedures. We found no significant differences among the 3 regimens in the frequency of pain (pain score > 0) or severe pain (pain score ≥ 5) during recovery, or a >20% increase in hemodynamic/respiratory variables during anesthesia. Treatment with fentanyl 1 mcg/kg was associated with a lower frequency of movement during procedure compared with treatment with fentanyl 0.5 mcg/kg (P = .0476) or treatment with placebo (P = .0545). The placebo group required longer time to recover (median, 18 minutes) compared with the fentanyl 0.5 mcg/kg group (median, 9 minutes) (median difference 2.0, P = .007) and the fentanyl 1 mcg/kg (median 8 minutes), (median difference 2.0, P = .15). The placebo group also required larger total dose of propofol (median 5 mg/kg) compared with that of the fentanyl 1 mcg/kg group (median, 3.5 mg/kg) and the fentanyl 0.5 mcg/kg group (median 3.5 mg/kg) (median differences 1.5, P < .00005, in both comparisons). The addition of fentanyl 1 mcg/kg to propofol for brief painful procedures reduces movement, propofol dose, and recovery time.

High Quality Bone Marrow Core Biopsy and Aspiration (BMBX) Procedures Can Be Performed by a Nurse Led Team Using the OnControl Battery Powered Bone Marrow Biopsy System

Abstract 4743 Background:BMBX procedures are traditionally performed by physicians, NPs, or PAs using a manual method. It is uncommon for nurses to perform these procedures, and even more rare for nurses to perform them using non-traditional techniques, such as the battery-powered system (OnControl, Vidacare, Shavano, TX). In this study, we report our nurse-led BMBX team experience using OnControl to collect diagnostic BMBX samples. Patient care and safety, team satisfaction, and specimen quality were evaluated. Methods:A team of nurses trained to perform BMBX procedures on sedated and non-sedated patients completed 94 procedures using OnControl and established SOPs. All nurses completed a questionnaire aimed at assessing the patient experience during and after the procedure and overall nurse satisfaction with OnControl. Specimen quality was graded by 3 physicians and compared to 25 specimens obtained by the same nursing team using traditional methods. Bone core specimens were graded based on core length and the presence/absence of artifacts. Biopsies had to be >1 cm or >1.5 cm to qualify good or excellent, respectively. Aspirates were similarly evaluated taking into account the presence/absence of spicules on stained smears.Results: Patient Care & Safety:The majority (86.2%) of patients who underwent a BMBX procedure during the study were outpatients, and minimal sedation was used in 94.7%. Most patients (76.6%) had a prior BMBX using the traditional method. In 94 patients evaluated, pre-procedure pain was 0 (0-10 scale) in 72 (76.5%) while 21 (22.3%) reported pain up to 5 just before the procedure (avg=2). The post-procedure pain score in the same patients was 0 in 78 (83%) and up to 4 in six (6%) (avg=1). No patients had post-procedure bleeding or complications requiring medical care. Seventy patients were reached 24 hrs post-procedure: 33 (47%) reported no pain and 37 (53%) reported pain up to 8 (avg=2.5). Nurse BMBX Team Satisfaction:Team members reported 100% satisfaction with the process of inserting the OnControl biopsy needle through soft tissues and acquiring a core biopsy. The nurses reported having satisfactory control of the depth of needle through the cortex and into the medullary space using the needle guide 95% of the time. Team members were satisfied with the ease of obtaining an aspirate 93% of the time. Nearly all (95%) nurses felt improved ergonomics using the battery-powered driver compared to the manual method. The nurses reported that OnControl was easy to use, with 83% of them obtaining a core biopsy on their first attempt. All nurses indicated they would use OnControl over the manual method if given the choice. Specimen Quality:H&E-stained bone core biopsy slides and W-G-stained aspirate smears from 83/94 specimens collected using OnControl were reviewed and graded. All but two (2.4%) of the bone core specimens were adequate for diagnosis. Of adequate samples, 45.8% were excellent, 12% good, and 39.8% fair. Aspiration artifact was seen in 18/83 (21.6%) of cores, and that artifact was the reason for a downgrade to fair quality in 17/18 (94%). Extra aspirate material for research was collected in 7/18 with fair quality bone core biopsies. Similar grading applied to 25 core biopsy samples collected using the manual method revealed 44% of cores to be excellent, 20% good, 32% fair, and 4% poor. The average core length using OnControl and the traditional method was 1.6 cm and 1.7 cm, respectively. Five of 83 (6%) aspirates obtained using OnControl were poor quality due to lack of bone marrow cells. Of the remaining aspirates, 54.2% were excellent, 20.5% good, and 19.2% fair. Factors related to bedside technique caused a downgrade in 10/16 samples graded as fair and 5/17 samples graded as good. Aspirates obtained by the standard method were graded as 52% excellent, 28% good, 12% fair, and 8% poor. Conclusions:Trained nurses can safely and effectively perform BMBX procedures using traditional methods as well as novel techniques such as the OnControl battery-powered driver system. In the hands of experienced individuals, OnControl can consistently yield high-quality BMBX specimens. Aspiration artifact was the most common flaw found in bone cores obtained with OnControl, but it was usually focal and did not hinder interpretation. When artifact associated with technical aspects out of the control of the BMBX operator was excluded, the OnControl needle produced good-excellent aspirate in 87% of patients. Disclosures:No relevant conflicts of interest to declare.

Soluble Transferrin Receptor - A Marker For Iron Deficiency; A Review

Parameters for measuring iron deficiency have been established for decades and have served clinicians in the management of this nutritional disorder. The bone marrow still remains the gold standard in the final diagnosis of iron deficiency. However, researchers have been able to identify the dominating role of the transferrin transferrin receptor complex in the internalization of iron, subsequent to its transport and utilization. The serum transferrin are shed into the blood and its level has been found to correlate with the level of iron stores and thereby the degree of erythropoietic activity. The aim of this literature review is to explore the physical properties of the serum transferrin receptor and its usefulness in the detection of iron deficiency. Literature on the subject was researched using manual library search, articles in journals, internet search such as pubmed, medscape and as well as conference abstracts. Serum transferrin receptor was found to be a reliable marker in the detection of iron deficiency in early pregnancy and other conditions such as patients with chronic renal failure undergoing haemodialysis. Many of the parameters currently being used as markers for iron deficiency have draw backs especially in anaemia that is complicated with other conditions. It has been shown that the concentration of serum transferrin receptors are unaffected by the acute phase reaction seen in many inflammatory conditions. The serum transferrin receptor concentration has been found to correlate well with bone marrow iron stores and red cell indices. However the serum transferrin receptor has not yet been in clinical use in Nigeria and has been mainly in the realms of experiment despite the obvious advantages it presents over the bone marrow aspiration procedure. The procedure for the determination of the serum transferrin receptor concentration is quite easy to understand, the introduction of its estimation into clinical practice will enhance early diagnosis and management of iron deficiency and other related conditions. Key words: Iron deficiency anaemia, soluble transferrin, serum ferritin

Risk Factors Concerning Sternal Bone Marrow Aspiration and Patient Safety in Japan

Several reports have described adverse events resulting from sternal bone marrow aspiration procedures. We hypothesized about inevitable lacerations to the ascending aorta that occur from structural abnormalities in the needle passage. We evaluated dimensions in the thorax related to the sternal bone marrow aspiration, using a chest CT scan on a display terminal. Patients Among the 3,848 patients who visited our institution and underwent a chest CT scan between September 1, 2007 and December 31, 2008, a total of 153 subjects showing no particular chest CT findings were enrolled. Significant variation was observed in the distance from the sternum to the ascending aorta, from a minimum of 4.2 to a maximum of 47.6 mm (median 23.6) in men and a minimum of 5.2 to a maximum of 38.4 mm (median 21.3) in women. There were three men (3.6%) and women (4.3%) each having a distance within 10 mm. Our findings showed for the first time that an anterior chest approach to sternal bone marrow aspiration involves an inevitable risk of laceration of the ascending aorta, when the needle tip penetrates the sternum. Our analysis of dimension also suggested that the sternal marrow aspiration procedure involved a greater risk among older subjects of short stature.

The Analgesic Effect of Magnetic Acupressure During Bone Marrow Aspiration and Biopsy Procedure in Cancer Patients: A Randomized, Blinded, Placebo Controlled Trial.

Abstract 71 Introduction:Bone marrow aspiration and biopsy (BMAB) is one of the most frequently performed and painful procedures in cancer patients. Magnetic acupressure has been used to reduce pain in patients in China. Our study was designed to study the efficacy of magnetic acupressure in reducing pain in cancer patients undergoing BMAB. Patients and Methods:Patients eligible for this IRB approved study had cancer, had a BMAB planned, and had not previously had acupuncture or acupressure. They were stratified by the number of prior BMAB they had experienced and randomly assigned to receive either magnetic acupressure at large intestine 4 point or at a non-acupuncture point (placebo) located in the proximal fourth interosseus space of the hand. All BMAB procedures were done by one operator (JS) and all acupressure was performed by one experienced operator (TB). All patients as well as the BMAB operator and data collector were blinded to treatment assignment. A visual analog score (VAS) was used to measure the patient's baseline pre-BMAB pain and the pain associated with the BMAB procedure. The acupressure operator was blinded to baseline pain scores and the pain associated with the BMAB by having the patient complete a form which was seen only by an independent data collector. The differences in VAS associated with the BMAB in the real versus placebo acupressure cohorts were compared to determine the analgesic efficacy of magnetic acupressure. Results:From 5/08 to 6/09, 77 cancer patients (47 male, 63 Caucasian, with a median age: 56 yrs, range: 21-80) undergoing BMAB at the Johns Hopkins Kimmel Sidney Comprehensive Cancer Center were enrolled in the study. Thirty-seven patients were randomized to the intervention arm and 40 to the control arm. Thirty-one patients (84%) in the intervention arm and 30 patients (75%) in the control arm had more than 1 BMAB prior to this study (p=0.34). Gender, analgesic or anxiolytic medications intake within 12 hours of BMAB and the pain score before BMAB were well balanced between two arms. The primary outcome was patient rated VAS pain score (0 to 10) during BMAB assessed after the procedure. Only one patient (2.7%) in the intervention arm experienced severe pain (VAS≥7) compared to 8 patients (20%) in the control arm (p=0.03, two- tailed Fisher's exact test). Using a multivariate logistic regression analysis to adjust for the number of BMAB patients had prior to this study, the odds of patients experiencing severe pain during BMAB procedure was 8.4 times (95% CI: 0.98-71.9) higher in the control arm versus the intervention arm. Forty-five percent of patients in each arm requested acupressure for future BMABs. No significant side effects or discomforts related to acupressure were reported by patients in either arm. Conclusions:These results suggest that magnetic acupressure significantly reduces the proportion of patients experiencing severe pain during BMAB. As acupressure requires minimal training and expense and was not associated with adverse events, it could be readily incorporated as a treatment option in this patient population. A larger, multi-centered, randomized, placebo controlled trial is planned to confirm these observations. Disclosures:No relevant conflicts of interest to declare.

Umbilical Cord Wharton's Jelly: A New Potential Cell Source of Mesenchymal Stromal Cells for Bone Tissue Engineering

Although bone marrow-derived mesenchymal stromal cells (BMSCs) are a main cell source for tissue-engineered bone (TEB), the clinical use of BMSCs is restricted due to the invasive bone marrow aspiration procedure and the decline in available number of mesenchymal stromal cells (MSCs) and differentiation potential with increasing age. Umbilical cord-derived MSCs (UCMSCs) are likely to be a promising alternative cell source for TEB due to their higher availability and potential to proliferate and differentiate. To assess this possibility, we studied bone morphogenetic protein 2 (BMP2)-induced osteogenic differentiation and activation of signaling pathways in UCMSCs and BMSCs. UCMSCs showed a phenotype and differentiation potential similar to that of BMSCs. After 14 days of BMP2 treatment, the overall expression of several osteogenic-specific phenotypes (type I collagen, osteopontin, and osteocalcin) was similar for UCMSCs and BMSCs. The signaling pathway by which BMP2 induced differentiation of both cell types involved the membrane receptor-initiated signals including SMADs, P38, and extracellular regulated kinase. The similar characteristics of BMP2-induced osteogenic differentiation of UCMSCs and BMSCs in vitro would support the use of UCMSCs in TEB.

Retrospective study on CT findings of the sternal bone after bone marrow aspiration procedure in hematological patients

Retrospective study on CT findings of the sternal bone after bone marrow aspiration procedure in hematological patients

Safe and effective sedation and analgesia for bone marrow aspiration procedures in children with alfentanil, remifentanil and combinations with midazolam

Invasive procedures such as bone marrow aspiration in children may be painful and cause anxiety. We investigated the efficacy and safety of remifentanil (R) alfentanil (A), remifentanil-midazolam (RM), and alfentanil-midazolam (AM) combinations in providing analgesia and sedation for bone marrow aspiration. Eighty children undergoing a diagnostic bone marrow aspiration whose ages ranged from 5-16 years (mean 9.20 +/- 3.00 years) were enrolled in this study. The patients were randomly assigned to one of 4 treatment groups. Vital signs, sedation and pain scores, somatic responses (sweating and tears) were recorded before, during bone marrow aspiration and after 5 and 15 min of the procedure. There were no statistical differences between sedation and the CHEOPS scores of the four groups during and after the procedures. The VAS scores were significantly higher for group A compared with groups R and RM during the procedure (P < 0.008). There were no differences between the VAS scores in group AM compared with groups R and RM (P > 0.008). There were also no statistical differences among the VAS scores of four groups after the procedure (P > 0.008). All patients had adequate sedation and analgesia. None of the patients in the study had deep sedation, hypotension, bradycardia, hypoxemia, or respiratory depression. Remifentanil, alfentanil, remifentanil-midazolam, and alfentanil-midazolam combinations are effective in children and can be used safely in bone marrow aspiration which is a brief but painful procedure performed in the pediatric patient group.

The usage of remifentanil and alfentanil in alleviating pain and anxiety during bone marrow aspiration in pediatric patients

Aims: To investigate the efficacy and safety of remifentanil and alfentanil compared with local anesthesia in providing analgesia and sedation during bone marrow aspiration procedures. Methods: Seventy-four children who underwent a diagnostic bone marrow aspiration were included in this study. Patients were assigned to one of 3 treatment groups (remifentanil, alfentanil and local anesthesia). Vital signs, sedation, pain scores, and somatic responses were recorded during and after bone marrow aspiration procedure. Results: There were no statistical differences between pain scores of the remifentanil group and the alfentanil group. Pain scores were significantly higher in the local anesthesia group compared with the other groups. None of the patients in the study had deep sedation, hypotension, bradycardia, hypoxemia, or respiratory depression. Conclusions: Remifentanil and alfentanil are effective in children and can be used safely in bone marrow aspiration procedure.

Mesenchymal stem cells: will they have a role in the clinic?

In addition to hematopoietic stem cells (HSC), human post natal bone marrow contains another stem cell capable of giving rise to multiple mesenchymal cell lineages. Termed mesenchymal stem cells (MSCs) based on their capacity for multi-lineage differentiation, these cells can easily be obtained following a simple bone marrow aspiration procedure and subsequently expanded in culture through as many as 50 population doublings. This extensive capacity for expansion in vitro at clinical scale has recently facilitated the development of clinical trials designed to assess the safety, feasibility, and efficacy of transplanting MSC for a variety of pathological conditions. This review focuses on the background and rationale for performing clinical studies of MSC transplantation and will discuss the potential role that MSC may play in the correction or modification of human diseases.

A Randomized, Placebo-Controlled Study of Outpatient Premedication for Bone Marrow Biopsy in Adults with Lymphoma

The outpatient bone marrow biopsy and aspiration (BMBA) procedure performed with local anesthetic is often poorly tolerated in adults. This prospective, randomized, placebo-controlled, double-blind trial was designed to determine whether oral (p.o.) lorazepam and hydromorphone reduces pain and anxiety during BMBA. Eligible patients had lymphoma, had no prior BMBA, and were ≥ 18 years old. Since patients had bilateral BMBA, each served as their own control. Patients were stratified by anxiety level using the Spielberger Trait Anxiety Scale and randomized to: A) placebo for the first BMBA and 2 mg lorazepam and 2 mg hydromorphone p.o. for the contralateral BMBA, or B) placebo for both BMBAS. Changes in pain and anxiety experienced between the first and second BMBA were measured by the Visual Analogue Scale (VAS) and the Spielberger State Anxiety Scale at the time of the BMBA and 24 hours later. Twenty-seven patients were enrolled and 25 were evaluable; there were 17 males and eight females. The median age was 57 years (range, 28-79 years). Overall, BMBA was reported as painful in both arms, with a median VAS pain score after the second BMBA of 3.9 (scale, 0-10) for arm A and 5.8 for arm B (P = 0.21). There was no difference in the change in pain, anxiety, or recalled anxiety between treatment arms (all P values > 0.05). The difference in the change in recalled pain was of borderline significance (P = 0.07) and consistent with benzodiazepine-induced anterograde amnesia.

Approach--Avoidance and Distress in Children Undergoing Preparation for Painful Medical Procedures

We report the development of an observational scale of children's behavioral responses to preparation for diagnostic bone marrow aspiration procedures, the Behavioral Approach – Avoidance and Distress Scale (BAADS). This scale measures the dimensional constructs of approach–avoidance and behavioral distress. Data obtained on 43 pediatric cancer patients indicated moderate to high internal consistency. Significant correlations were obtained between observers' data and independent global ratings provided by the activity specialist preparing the child. Behavioral distress during preparation predicted both distress during the bone marrow procedure and distress during early hospitalization. High approach during preparation was related to low distress during the aspiration procedure as well as during early hospitalization.

Play Behaviors of Children Undergoing Bone Marrow Aspiration

A play intervention that focused on the bone marrow aspiration (BMA) procedure was carried out with 15 children who had a diagnosis of leukemia. Each play session was tape recorded. Examination of the process and the content of the play sessions revealed certain commonalities in the children's play behavior. The children tended to play out the BMA as an event in which minimal or no verbal interaction occurred between the child and the adults who were present during the procedure. In addition, inaccuracies in or absence of content related to the procedure was noted. The children's patterns of play were similar to those reported in the literature on play therapy.

Yield of bone marrow culture in the diagnosis of infectious diseases in patients with acquired immunodeficiency syndrome.

The yield in cultures of bone marrow aspirations or biopsies was determined in 50 patients with acquired immunodeficiency syndrome. Most patients were febrile and had no identifiable source of infection. Concurrent stool, urine, and blood samples were also cultured. The bone marrow aspiration and biopsy procedures produced no complications and enabled a microbiological diagnosis to be made in 42% of the cases. Granuloma formation was not seen in any of the infected bone marrow specimens despite the fact that mycobacteria were seen in abundance in some. Bone marrow culture is a valuable low-morbidity invasive procedure in the evaluation of febrile patients with acquired immunodeficiency syndrome.

A teaching device for simulating the bone marrow aspiration procedure.

A simple, inexpensive device for in vitro instruction in marrow aspiration has been created. It consists of a small plastic container having artificial bone marrow, i.e. , a mixture of a Congo red solution and homogenized food particles. In addition, a disposable hypodermic needle has been modified to resemble the size and contour of a commercially available marrow needle. Puncturing the lid of the container simulates the resistance encountered in vivo in penetrating the bony cortex to enter the medullary cavity. Aspiration and subsequent preparation, staining and appearance of smears of the homogenate mimic the usual clinical procedures. It is hoped that this device, by familiarizing a novice with the methodology prior to its clinical employment, will result in greater expertise by the operator and perhaps minimize hazard to the patient.

TO DETERMINE THE FREQUENCY OF VISCERAL LEISHMANIASIS IN PERIPHERAL CYTOPENIC PATIENT IN PATHOLOGY DEPARTMENT HAYATABAD MEDICAL COMPLEX.

BACKGROUND: Visceral Leishmaniasis is a chronic disease and was first described in 1903, byLIESHMAN and DONOVAN. The disease is common in tropical and sub tropical areas of the worldwith various hematological manifestations. It is characterized by fever, visceromegaly, weight loss,pancytopenia and hypergammaglobulenemia. The disease is silent killer, invariably killing almost alluntreated patients, but curable with hematological improvement within 4-6 weeks of treatment.OBJECTIVE: To determine the frequency of Visceral Leishmaniasis in patints with cytopenias .MATERIAL AND METHODS: A descriptive study conducted in Pathology department, HayatabadMedical Complex, Hayatabad from September 1, 2012 to August 31, 2013. This study comprises of 126patients, subjected to complete blood counts. Diagnosis were confirmed by finding Amastigote( L/Dbody) from bonemarrow aspirate. All the patients who were referred to pathology Department of thehospital for bone marrow examination, with the results of peripheral blood using automatedHaematology analyzer, Sysmex KX 21 showing cytopenia were included in the study. Consent wastaken from the patient for bone-marrow aspiration procedure. After consent detailed history, physicalexamination was done.Laboratory investigations i.e. full blood count, which includes hemoglobin estimation, white blood cell,red blood, and platelet count.Bone marrow cytology (Giemsa stain) was recorded on the designed profroma.Posterior superior iliac spine (PSIS) was used as the site for aspiration in adults and children over 2years of ageRESULT: Descriptive case series study of 126 patients of peripheral cytopenia. In which 77 (61.1%)patients were males and 49 (38.9%) were female with male to female ratio of 1.57: 1 It was also foundin this study that visceral leishmaniasis was present in 29 (23%) of cases and the male: female were 1.6:1. Result of the automated hematology analyzer of peripheral cytopenic patients in visceralleishmaniasis show that all of the patients were having total leukocyte count less than 4000/cmm(100%). The hemoglobin level wass less than lOgm/dl in 26 cases (87.7%) and more than lOgm/dl inthree cases (10.3%). In case of platelets count, 27 cases (93.1%) were having platelets count less than150000/cmm.CONCLUSION: Incidence of visceral leishmaniasis is highier in children age group 1-10 years, alsomales are more prone than females. Leukopenia is recorded in all (100%) of the cases, followed bythrombocytopenia (93.1%) and anemia (Hb &lt;10gm %) 87.7% cases.KEY WORD: Visceral Leishmaniasis, Kala Azar, Amastigote (L/D body)