Lymphopenia: What is it? Classification, Symptoms, Causes, Diagnosis, Treatment and Prognosis

Also known as lymphocytopenia, it is a term used to describe the state in which a certain type of blood cell called a lymphocyte is lacking.

Lymphocytes are one of three types of white blood cells (known as leukocytes ) that are found in the blood.

Leukocytes function as part of our body’s first-line immune defense against disease-causing pathogens, such as bacteria, viruses and parasites.

It is a condition that implies a decrease in the level of serum lymphocytes. Lymphocytes are essential in the part of immunity or in the protection of the body against infections. Many conditions are associated with lymphopenia. Others who suffer from this condition are asymptomatic or do not present any signs or symptoms.

Lymphocytes are essential in the body because they generally make up approximately 20% to 40% of the white blood cells in our serum.

The normal level of lymphocytes is higher than 1,500 cells per microliter in adults, while for children the normal level is approximately 3,000 cells per microliter.

Below these levels, depending on the corresponding age group, Lymphopenia will be considered. There should also be a significant decrease in the level before it is considered that way.

Lymphopenia ranks and classification

There are three types of Lymphopenia and, in most cases, it is divided according to the type of lymphocytes decreased. A direct term is used when all types of lymphocytes are decreasing.

Lymphopenia T: Specifically, T lymphocytes are affected mainly by HIV or AIDS. This is related to the deficiency of T. The condition usually develops in case of HIV attack.

On the other hand, this condition could be idiopathic, which is a rare heterogeneous disorder. In this condition, the T cells fall below 300 cells per microliter.

Lymphopenia B: This is basically caused by some type of immunodeficiency. It is related to B lymphocyte deficiency. Causes humoral immunodeficiency.

The cause of this condition is the regular intake of medications that suppress the body’s immune system.

Lymphopenia NK:  Few numbers of natural killer cells are observed. This is perceived as the rarest form of Lymphopenia. In this type, the body develops killer cells.

symptom

Lymphopenia can be defined as a health situation in which the level of lymphocytes decreases abnormally. The decrease in these white blood cells creates a serious loss of immunity in the body.

It is widely accepted that white blood cells are responsible for the development of the immune system in the body. Patients with this disorder usually do not show any clear symptoms.

Therefore, acute observation with modern diagnosis is very important. In most cases, patients feel loss of muscle power. They also experience repeated attacks of infections that include viruses, fungi or bacteria due to the lack of immunity in the body.

The symptoms of Lymphopenia depend to a large extent on the underlying problem. Similarly, the symptoms may vary from one patient to another due to the drug-genesis, the etiology of the disease and the general health of the patient.

Clinically, some commonly observed symptoms are:

  • Splenomegaly
  • Immune system compromised
  • High frequency of infection.
  • Longer duration of infection.
  • Tonsillitis .
  • Swollen lymph nodes around the tonsils and abdominal area.
  • Swelling around the joints.
  • Eruptions
  • Generalized glimpse.
  • Fatigue.
  • Repeated infections

Causes

In most cases, lymphopenia ends when the infection resolves. Patients who have an idiopathic disorder may experience a low but stable CD4 + cell count. Lymphocytic deficiency (lymphopenia) can occur in several malignancies.

  • Malignant cancers such as lymphoma , leukemia, etc.
  • Immune system disorders such as autoimmune disease or HIV infection.
  • Chemotherapy or antiviral therapy.
  • Deep tissue injury.

Lymphopenia can be caused by many conditions, including infection and side effects of medications.

Occasionally, the condition can only affect lymphocytes. In others, it may be the result of a depletion of all white blood cells.

Lymphopenia is usually caused by an infection, including the common cold, and will usually recover on its own once the infection has disappeared.

In cases where the cause is idiopathic (of unknown origin), it may suggest a more serious underlying condition.

For example, when treatment for viral hepatitis includes Peginterferon and Ribavirin, it can cause the suppression of only neutrophils ( neutropenia ) or only lymphocytes (Lymphopenia) in some people. In others, it can affect the entire range of white blood cells (leukopenia).

Lymphopenia is more associated with conditions that affect the bone marrow, including:

  • Viral infections that temporarily impair the function of the bone marrow.
  • Congenital disorders that involve decreased bone marrow function.
  • Cancer or other diseases that damage the bone marrow.
  • Autoimmune disorders that destroy white blood cells or cells of the bone marrow.
  • Acute infections that kill white blood cells faster than they can occur.
  • Medications, such as antibiotics, that can destroy white blood cells.

Diseases or conditions related to Lymphopenia.

The diseases and conditions most commonly associated with Lymphopenia can be broadly described as pathogenic (related to infection), cytotoxic (toxic to cells), congenital (caused by genetic defects) or nutritional.

They include:

  • Aplastic anemia (a rare condition in which the body stops producing blood cells).
  • Chemotherapy.
  • VIH.
  • Hypersplenism (the premature destruction of blood cells by the spleen).
  • Leukemia (a type of blood cancer).
  • Lupus (an autoimmune disorder).
  • Malnutrition and vitamin deficiencies.
  • Myelodysplastic syndromes (a group of disorders that interrupt the production of blood cells).
  • Rheumatoid arthritis (another autoimmune disorder).
  • Radiation therapy
  • Tuberculosis.

Although the condition is mostly caused by infection or recent infection, it is also possible that the body is not able to produce enough lymphocytes.

There is also the possibility that a person’s lymph nodes catch the necessary amount of lymphocytes.

To explain it better, the condition is associated with the following factors:

Intake of certain medications

Those who are taking immunosuppressants such as corticosteroids are affected by the condition.

Underlying conditions

Those who have HIV or AIDS are likely to have this condition, since they must take a series of medications that can affect the immune system.

Those who suffer from arthritis and iatrogenic conditions are also victims of Lymphopenia.

Malnutrition and stress

These can have an effect by decreasing a person’s immune system.

Chemotherapy and radiotherapy

This form of therapy will suppress the immune system, thereby affecting the normal levels of the blood components. These agents can severely compromise the person’s immunity.

Radiation can also suppress the immune system, especially when high levels of it are applied.

Malignities

Those who suffer from bone marrow cancer, such as leukemia or Hodgkin’s disease , may suffer from Lymphopenia.

Diagnosis

Several diagnostic methods are available to identify Lymphopenia. However, medical experts always prefer to count blood cells to control a greater or lesser number of lymphocytes.

This selection depends to a large extent on the accuracy of the count. The age of the patient is considered a determining factor in this procedure.

When the lymphocyte level of an adult is below 1,500 cells per microliter, then it is positive for Lymphopenia.

When a child has a lymphocyte level of less than 3,000 cells per microliter, then it is positive for Lymphopenia.

Collecting the patient’s medical history is also helpful in completing the diagnosis.

A low white blood cell count is most often found when your doctor orders a test for a condition you are already experiencing. A low count is rarely an unexpected finding.

In some cases, the type of affected white blood cell may be sufficient to indicate a diagnosis. At other times, you may need additional tests to reconstruct a cause.

A very low white blood cell count makes you more at risk of infection. If this happens, you may need to take special precautions to prevent illness.

This includes avoiding other people who may be sick, washing your hands regularly and meticulously, or even wearing a mask if you are in a confined space (like a plane) with other people.

Treatment

Lymphopenia disappears when the causal factor or the disease that caused it is eliminated. Intravenous immunoglobulin is indicated if the patient is chronically deficient in IgG, lymphopenia and recurrent infections.

Hematopoietic stem cell transplantation can be successfully applied in patients with congenital immunodeficiency.

The treatment for Lymphopenia aims to increase or reach normal levels of lymphocytes. The treatment will also depend on the cause of the disease.

The following treatments are recommended for those who suffer from Lymphopenia:

Gamma globulin: This is a substance rich in antibodies that can help prevent infections. Those who have low lymphocytes can reach the normal count of lymphocytes when they administer it.

Bone marrow transplant: This is a very expensive form of treatment, but in fact it is effective especially for those who have problems with their bone marrow.

This can alter the problem of immunodeficiency and also provide a good or better prognosis to people with malignant tumors of the bone marrow.

Treat the infection: When it is known that a person suffers an infection, they must be provided congruent medications. Provide specific antibiotics, antiviral agents, antifungal medications and antiparasitic agents to directly target the disease process that causes Lymphopenia.

Forecast

Those who suffer from lymphopenia have a dependent prognosis. This condition can appear and disappear; especially when a person is in treatment for cancer.

Those who take medications that are immunosuppressants are likely to recover easily from the condition when they stop taking the medications.

But when it comes to patients who have chronic conditions such as HIV or AIDS, they may have this condition as a fluctuating condition.

It is also expected that those with terminal conditions have a poor prognosis, since they may have chronic problems with their immune system.

Note: Understanding Lymphocytes and Lymphopenia

White blood cells are important for humans. These are considerably valuable in maintaining the immune system in the body. However, the level of white blood cells increases or decreases depending on a person’s health conditions.

Lymphopenia, also known as lymphopenia, is a condition in which the level of lymphocytes drops in the blood. Basically, these are white blood cells and are responsible for numerous functions, including the maintenance of immunity in the body.

The vast majority of the cells in our blood are erythrocytes (red blood cells) that are responsible for transporting oxygen throughout the body. This is followed by thrombocytes (platelets) and leukocytes.

Leukocytes are produced in the bone marrow and circulate freely in the bloodstream as part of the immune system. Lymphocytes account for the largest proportion of these cells, ranging from 25 to 45 percent.

The lymphocytes can be divided into three subsets:

  • Natural killer cells (NK): which serve as the first line of defense for the immune system.
  • T-cells: that are produced in response to a specific pathogen.
  • B cells: that produce antibodies that help other cells to identify and neutralize pathogens.

As such, lymphopenia can be identified by the type of affected lymphocyte.

For example, HIV specifically targets CD4 T cells for infection, resulting in massive losses of that specific cell.

The loss of B cells is more associated with immunosuppressive drugs (such as those used for organ recipients), whereas NK depletion is usually a rare situation.

Trauma

Patients with reduced humoral immunity, which can be quantified by measuring immunoglobulin levels, often show bacterial infections of the respiratory tract, skin, and urinary tract.

Severe T cell depletion can lead to many unusual opportunistic infections, which include causes of viruses, fungi and pneumonia .

Instead of neutropenia, patients afflicted with lymphopenia may be concerned about the symptoms of infection or a flu with incredibly low grade characteristics.

Other symptoms of Lymphopenia:

Lymphopenia itself is usually asymptomatic. However, the signs of associated diseases, absence or reduction of tonsils or lymph nodes indicate cellular immunodeficiency.

The most frequent symptoms of lymphopenia are skin diseases such as alopecia, eczema, pyoderma, telangiectasia; signs of hematological diseases, such as pallor, petechiae, jaundice , ulceration of the oral mucosa; generalized lymphadenopathy and splenomegaly, which may indicate the presence of HIV infection.

In patients with lymphopenia, recurrent infections or infections caused by rare organisms, such as proven Pneumocystis (ex P. Carinii), cytomegalovirus, rubella, varicella with pneumonia and lymphopenia, are common, which implies the presence of immunodeficiency.

In patients with lymphopenia, it is necessary to count the lymphocyte subpopulations and determine the level of immunoglobulins. Patients with recurrent infections should undergo a complete laboratory examination to assess immunodeficiency, even if the initial screening tests are normal.

Other causes of Lymphopenia:

Congenital lymphopenia is manifested in congenital immunodeficiency diseases and diseases in which there is an alteration in the production of lymphocytes.

In some hereditary diseases, such as Wiskott-Aldrich syndrome, there is a deficiency of adenosine deaminase, purine nucleoside phosphorylase, there is a greater destruction of T lymphocytes. With many hereditary diseases there is also a deficit of antibodies.

Acquired lymphopenia occurs with a large number of different diseases. Throughout the world, the most common cause of lymphopenia is insufficient protein nutrition.

The most common infectious disease that causes Lymphopenia is AIDS, in which CD4 T cells infected with HIV are destroyed.

Lymphopenia may be a consequence of impaired lymphocyte production caused by damage to the structure of the thymus or lymph nodes.

In acute viremia caused by HIV or other viruses, lymphocytes can undergo accelerated destruction caused by an active infectious process, captured by the spleen or lymph nodes or migrate to the respiratory tract.

Long-term therapy of psoriasis with psoralen and ultraviolet radiation can destroy T cells.

The iatrogenic lymphopenia is caused by cytotoxic chemotherapy, radiotherapy or administration of antilymphocyte immunoglobulin.

Glucocorticoids can induce the destruction of lymphocytes.

Lymphopenia can occur in autoimmune diseases, such as SLE, rheumatoid arthritis , myasthenia gravis, enteropathy, accompanied by protein loss.

Ultimately, most of the causes of Lymphopenia are:

  • Aplasia of lymphopoietic stem cells.
  • Ataxia-telangiectasia.
  • Idiopathic CD4 + T-lymphopenia.
  • Immunodeficiency in thymoma.
  • Severe combined immunodeficiency associated with an abnormality of the interleukin 2 chain and receptor, ADA or PNP deficiency, or unknown etiology.
  • Wiskott-Aldrich syndrome Infectious diseases, including AIDS, hepatitis, influenza, tuberculosis , typhoid fever, sepsis .
  • Insufficient protein nutrition or zinc deficiency.
  • Yatrogenic after the application of cytotoxic chemotherapy, glucocorticoids, high doses of psoralen and ultraviolet radiation, immunosuppressive therapy, radiation or drainage of the thoracic duct.
  • Systemic diseases with autoimmune components: aplastic anemia, Hodgkin’s lymphoma, myasthenia gravis, enteropathy due to protein loss, rheumatoid arthritis, SLE, thermal trauma.
  • ADA – adenosine desaminasa; PNP – purinucleoside phosphorylase.
List of medications that may cause lymphopenia:

Brentuximab Vedotin:

  • Symptoms and common effects: decrease in white blood cells, anemia, peripheral sensory neuropathy, fatigue, nausea, fever, rash, diarrhea and pain.

Decitabina:

  • Symptoms and common effects: anemia, decrease in white blood cells and platelets, fatigue, fever, nausea, cough, constipation, diarrhea. And it can cause diabetes.

Dexmethylphenidata Hcl:

  • Symptoms and common effects: anemia, decrease in white blood cells and platelets, fatigue, fever, nausea, cough, constipation, diarrhea and sugar.

Erythromycin mesylate:

  • Symptoms and common effects: decrease in white blood cells, anemia, weakness, fatigue, hair loss, nervous disease, nausea and constipation.

Interferon Beta-1B:

  • Symptoms and common effects: decrease in white blood cells, reaction at the injection site, weakness, complex of flu-like symptoms, headache and pain.

Ofatumumab:

  • Symptoms and common effects: decrease in white blood cells, pneumonia , fever, cough, diarrhea, anemia, fatigue, difficulty breathing, skin rash, nausea, vomiting, lung inflammation and upper respiratory tract infections.

Pertuzumab:

  • Common symptoms and effects: diarrhea, hair loss, decreased white blood cells, upset stomach, fatigue, rash, nerve damage.

pomalidomide:

  • Symptoms and common effects: fatigue, weakness, decreased white blood cells, anemia, constipation, nausea, diarrhea, shortness of breath, upper respiratory tract infections, back pain and fever.

Sulfasalazina:

  • Symptoms and common effects: Nausea, indigestion, rash, headache, abdominal pain, vomiting, fever, dizziness, ulcers in the mouth, itching, abnormal liver function tests, decreased white blood cells and decreased platelets.

Valganciclovir:

  • Symptoms and common effects : diarrhea, fever, nausea, tremor, anemia, rejection of grafts, decrease in white blood cells and platelet count, vomiting.

Who can I contact if I think I have Lymphopenia?

    • Hematologist.
    • Infectionist