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The image of hemophagocytosis is neither specific nor constant during macrophagic activation syndrome (MAS).The objective of our study was to search for new cytological criteria to optimize the diagnostic orientation.We have, thus, conducted a prospective evaluative monocentric study. Cases of suspected adult MAS presented to the hematology department of CHU la Rabta between June 2017 and January 2019, in order to perform a myelogram were included. Thirty five bone marrow smears were examined at diagnosis. A second reading of the bone marrow smears was performed in a blinded fashion to estimate the number of macrophages/1000 nucleated elements, the intensity of hemophagocytosis, the nature of the phagocytic elements as well as the presence of images of multiple phagocytosis were specified. The study revealed that none of these cytological parameters studied was predictive of the diagnosis. However, guidelines for myelogram reading in patients with suspected MAS have yet to be defined.