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Lymphocytopenia +lim(p)-fO-+sIt-u-!pE-nE-u

by Mary Territo, MD

Lymphocytopenia is an abnormally low number of lymphocytes (a type of white blood cell) in the blood.

  • Many disorders can decrease the number of lymphocytes in the blood, but AIDS and undernutrition are the most common.

  • People may have no symptoms, or they may have fever and other symptoms of an infection.

  • A blood sample is used to make the diagnosis of lymphocytopenia, but a sample of bone marrow or lymph node may be needed to determine the cause.

  • Doctors treat the cause of lymphocytopenia.

  • Some people are given gamma globulin, and some benefit from stem cell transplantation.

Lymphocytes usually constitute 20 to 40% of all white blood cells in the bloodstream. The lymphocyte count is normally above 1,500 cells per microliter of blood in adults and above 3,000 cells per microliter of blood in children. A reduction in the number of lymphocytes may not cause a significant decrease in the total number of white blood cells.

Various disorders and conditions, including infection with human immunodeficiency virus (HIV)—the virus that causes AIDS, can decrease the number of lymphocytes in the blood. Autoimmune disorders such as systemic lupus erythematosus (lupus), rheumatoid arthritis, and myasthenia gravis may decrease the number of lymphocytes. Also, the number of lymphocytes can decrease briefly during starvation, times of severe stress, and during use of corticosteroids (such as prednisone), chemotherapy for cancer, and radiation therapy. Severe reduction in lymphocytes can occur in certain hereditary disorders (the hereditary immunodeficiency disorders—see see Overview of Immunodeficiency Disorders).

Did You Know...

  • AIDS and undernutrition are the most common causes of lymphocytopenia.

There are three types of lymphocytes: B lymphocytes (B cells), T lymphocytes (T cells), and natural killer cells (NK cells), all of which have important functions in the immune system. Too few B cells can lead to a decrease in the number of plasma cells and reduced antibody production. People who have too few T cells or too few NK cells have problems controlling certain infections, especially viral, fungal, and parasitic infections. Severe lymphocyte deficiencies can result in uncontrolled infections that can be fatal.

Symptoms and Diagnosis

Mild lymphocytopenia may cause no symptoms and is usually detected by chance when a complete blood count is done for other reasons. Drastically reduced numbers of lymphocytes lead to infections with bacteria, viruses, fungi, and parasites.

When the numbers of lymphocytes are drastically reduced, doctors usually do a blood test for human immunodeficiency virus (HIV) and other infections and sometimes take a sample of bone marrow to examine under a microscope (bone marrow examination). The number of specific types of lymphocytes (T cells, B cells, and NK cells) can also be determined in the blood. A decrease in certain types of lymphocytes may help doctors diagnose some diseases, such as AIDS or certain hereditary immunodeficiency disorders.

Treatment

Treatment depends mainly on the cause. Lymphocytopenia caused by a drug usually begins to resolve within days after a person stops taking the drug. If the lymphocytopenia is the result of AIDS, combination therapy with at least three antiviral agents of different classes can increase the number of T cells and improve survival.

Gamma globulin (a substance rich in antibodies) may be given to help prevent infections in people with too few B cells (who therefore have a deficiency of antibody production). People with a hereditary immunodeficiency may benefit from bone marrow (stem cell) transplantation. If an infection develops, a specific antibiotic, antifungal, antiviral, or antiparasitic drug directed against the infective organism is given.

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