What Is Lymphocytopenia?

Total lymphocytes in adults <1000 / l, children (under 2 years) <3000 / l.

Lymphopenia

Hereditary lymphocytopenia may be associated with hereditary immunodeficiency diseases (see Table 135-4 and Section 147), which cause ineffective hematopoietic lymphocytes due to abnormal stem cell quality and quantity. Other causes, such as Wiskott-Aldrich syndrome, can be caused by accelerated destruction of T cells. Patients with adenosine deaminase deficiency and purine nucleotide phosphorylase deficiency develop the same mechanism. Acquired lymphocytopenia is a syndrome accompanied by the loss of peripheral blood lymphocytes that are not secondary to a genetic disease. AIDS is the most common infectious disease with lymphopenia caused by the destruction of HIV-infected CD4 T cells. In some cases of acute viremia, lymphocytes may be accelerated by viral activation, or they may become trapped in the spleen or lymph nodes or migrate to the respiratory tract.

Overview of Lymphopenia

Total lymphocytes in adults <1000 / l, children (under 2 years) <3000 / l.

The number of lymphocytes in normal adults is 1000 ~ 4800 / l, and children (under 2 years old) are 3000 ~ 9500 / l. The normal low value at 6 years old is 1500 / l. About 65% of peripheral blood T cells are CD4 (helper) T cells. In most patients with lymphopenia, the absolute number of T cells is reduced, especially the number of CD4 cells. The average value of CD4 T cells in adult peripheral blood is 1100 / l (300 ~ 1300 / l). The absolute number of T cells is 600 / l (100 ~ 900 / l).

Lymphopenia etiology

Iatrogenic lymphocytopenia can be caused by cytotoxic chemotherapy, radiotherapy and lymphoglobulin injection. Long-term use of psoralen and ultrasound radiation in psoriasis patients can damage T cells. Glucocorticoids can induce cell damage and Causes a decrease in lymphocytes.

Autoimmune-related systemic diseases (such as SLE, rheumatoid arthritis, myasthenia gravis) can cause lymphopenia. Loss of protein enteropathy can be accompanied by lymphopenia.

Lymphopenia symptoms, signs and diagnosis

Lymphopenia usually does not cause symptoms and is usually found in the diagnosis of other diseases, especially in cases of recurrent viral, fungal or protozoal infections. Lymphopenia can be determined by lymphocyte count. Lymphocyte subpopulations can be determined by multi-parameter flow cytometry, which uses antigenic expression to classify and characterize cells.

Lymphopenia patients have repeated infections, often with unusual responses to benign infectious agents or with rare pathogen infections. The occurrence of pneumocystis carinii, cytomegalovirus, rubella or chickenpox pneumonia indicates the possibility of immunodeficiency Any type of pneumonia caused by the above infections can be fatal. Patients with this disease have a higher incidence of cancer or autoimmune diseases. The disappearance or shrinkage of tonsils or lymph nodes in patients indicates cellular immune deficiency. Skin abnormalities such as hair loss , Eczema, pus dermatosis, or telangiectasias; hematological lesions showing paleness, purpura, jaundice, or oral ulcers; and systemic lymphadenopathy and splenomegaly. These signs may indicate HIV disease.

As 80% of patients with primary immunodeficiency also have insufficient antibodies, antibody function tests and immunoglobulin levels are appropriate. Patients with a history of repeated infections should be tested for immunodeficiency, even if the initial screening test results are normal. These tests are detailed in Section 147. Extremely low neutrophil counts may indicate severe congenital neutropenia, periodic neutropenia, severe chronic neutropenia, bone marrow Diseases such as failure and the replacement of bone marrow by tumors or other hematopoietic cells. Knowledge of the clinical characteristics of immunodeficiency diseases will better explain the results of laboratory tests.

Lymphopenia treatment

Stress, taking steroids, chemotherapy or radiotherapy-related lymphopenia can often be improved after removing the drug or cause. Effective treatment of underlying diseases of lymphopenia (such as inflammation, infection and cancer) can often increase the number of white blood cells.

The ideal treatment for patients with HIV disease requires the identification and management of active infections in patients who show severe immunodeficiency, primary and secondary prevention to prevent the development of new or recurrent conditional infections, and management of primary HIV infections to delay Immune function decline. Drug therapy is designed to maximize clinical efficacy, prevent or minimize toxicity, and maintain comfort and function.