Splenic aspirate is the most sensitive method for parasitological diagnosis of Visceral Leishmaniasis (VL). Described since the early 20th century, its use declined due to complications, especially bleeding. In the 1980s, studies in India described splenic aspirate as highly sensitive (>90% positivity) and safe when using a new, less invasive technique and grading parasitism by direct slide analysis. In Brazil, the method has been used safely with high positivity since the 1990s. There are also reports of splenic aspirate use in diagnosing other diseases such as lymphomas. This study describes an experience with splenic puncture in Northeast Brazil. Patients were treated at two public hospitals. The procedure was authorized in all cases after explanation of risks and benefits and requested by attending physicians. Contraindications included spleen size less than 3 cm below the left costal margin, active bleeding, abnormal INR, or platelet count below 100,000/mm³. A total of 158 splenic punctures were performed for VL diagnosis and treatment follow-up; 32 were part of a clinical trial, including 20 pre-treatment and 16 post-treatment parasitism follow-ups. Patient age ranged from 3 to 40 years. No sedation or anesthesia was used. The technique involved inserting a thin injection needle (usually 21G) subcutaneously, creating a 1 mL vacuum using a 10 mL syringe. The needle was positioned at a 45–60° angle and inserted into the abdomen during respiratory pause to collect splenic material. Duration was 1–2 seconds. Local pressure was applied for 20 minutes, followed by 2 hours of bed rest. All patients remained hospitalized for more than 24 hours post-procedure. No bleeding episodes occurred in the 158 punctures. When parasitological confirmation of VL is required, splenic puncture represents an alternative to bone marrow aspirate, with higher positivity, safety, and the possibility of monitoring parasitism degree, important for assessing parasitic reduction in refractory or relapsing VL cases.
Silva et al. (Sun,) studied this question.