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Lymphocytopenia

Introduction

Synonyms and keywords: Lymphocytopenia; lymphopenia; lymphocyte count low (peripheral blood)

Overview

Overview

Lymphocytopenia, or lymphopenia, is the condition of having an abnormally low level of lymphocytes in the blood. Lymphocytes are a white blood cell with important functions in the immune system. The opposite is lymphocytosis, which refers to an excessive level of lymphocytes.

References

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Historical Perspective

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Overview

Historical Perspective

References

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:

Classification

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Overview

Classification

References

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:

Pathophysiology

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Overview

Pathophysiology

References

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:

Causes

Overview

Common causes of lymphocytopenia include side effects of drugs that cause platelet changes. Additional common causes include congenital and acquired hematological conditions.

Causes

Common Causes

Causes by Organ System

Cardiovascular No underlying causes
Chemical/Poisoning Dimethyl fumarate
Dental No underlying causes
Dermatologic Aplasia cutis congenital, Cartilage hair hypoplasia
Drug Side Effect Aclarubicin, Alefacept, Alemtuzumab, Bendamustine, Blinatumomab, Cabozantinib, Chemotherapy, Chloramphenicol, Cladribine, Corticosteroids, Dinutuximab, Doxorubicin, Elotuzumab, Eribulin, Everolimus, Exemestane, Fludarabine, Idarubicin, Idelalisib, Ixabepilone, Legionella pneumophila, Linezolid, Lorcaserin, Olaparib, Olsalazine, Omacetaxine mepesuccinate, Oxaliplatin, Pamidronate, Pazopanib, Pentostatin, Rituximab, Saxagliptin, Sorafenib, Sunitinib malate, Temsirolimus, Vinblastine
Ear Nose Throat No underlying causes
Endocrine No underlying causes
Environmental No underlying causes
Gastroenterologic Intestinal lymphangiectasis
Genetic Mckusick type metaphyseal chondrodysplasia, Purine nucleoside phosphorylase (pnp) deficiency
Hematologic Adenosine deaminase deficiency, Antithymocyte globulin, Aplastic anemia, Common variable hypogammaglobulinaemia, De vaal syndrome, Hodgkin’s disease, Human granulocytic ehrlichiosis, Human monocytotropic ehrlichiosis, Interferon beta, Legionella pneumophila, Leukemia, Lymphangiectasis, Pancytopenia, Schimke immunoosseous dysplasia, Waldmann disease, Wiskott-aldrich syndrome
Iatrogenic Chemotherapy, Radiation therapy
Infectious Disease Acute viral nasopharyngitis, Aids, Epstein-barr virus, chronic, Hiv-1 disease, Human granulocytic ehrlichiosis, Human monocytotropic ehrlichiosis, Influenza, Tuberculosis, Typhoid fever, Viral hepatitis
Musculoskeletal/Orthopedic Myelodysplastic syndrome
Neurologic Ataxia telangiectasia
Nutritional/Metabolic Malnutrition
Obstetric/Gynecologic No underlying causes
Oncologic Leukemia, Myelodysplastic syndrome
Ophthalmologic Reticular dysgenesis
Overdose/Toxicity No underlying causes
Psychiatric Stress
Pulmonary Sarcoidosis, Severe acute respiratory syndrome, Tuberculosis, Typhoid fever,
Renal/Electrolyte Spondyloepiphyseal dysplasia — nephrotic syndrome
Rheumatology/Immunology/Allergy Nezelof syndrome, Sarcoidosis, Systemic lupus erythematosus, Wiskott-aldrich syndrome
Sexual Aids, Hiv-1 disease, Viral hepatitis
Trauma Excessive physical exercise, Stress
Urologic No underlying causes
Miscellaneous No underlying causes

Causes in Alphabetical Order

References

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Luke Rusowicz-Orazem, B.S.

Differentiating Lymphocytopenia from other Diseases

Overview

Differentiating Lymphocytopenia from other Diseases

Lymphocytopenia can be caused by various types of chemotherapy, such as with cytotoxic agents or immunosuppressive drugs. Some malignancies in the bone marrow also cause lymphocytopenia.

People exposed to large doses of radiation, such as those involved with Chernobyl, can have severe lymphocytopenia.

A decreased number of certain types of lymphocytes, notably T cells, is a characteristic of AIDS.

Idiopathic CD4+ lymphocytopenia is the condition of having an abnormally low level of CD4+ T-cells. It has no known cause[1] and is not associated with AIDS or any known infectious agent such as HIV or HTLV.[2] It is associated with higher risks of opportunistic infections and cancer.[3]

Lymphocytopenia may be present as part of a pancytopenia, when the total numbers of all types of blood cells are reduced. This can occur in marrow failure.

Lymphocytopenia, but not idiopathic CD4+ lymphocytopenia, is associated with corticosteroid use, infections with HIV and other viral, bacterial, and fungal agents, Hodgkin’s disease, leukemia, malnutrition, systemic lupus erythematosus,[4] high stress levels, whole body radiation, rheumatoid arthritis, and iatrogenic conditions.

In alphabetical order. [5] [6]

References

  1. ↑ D K Smith, J J Neal, and S D Holmberg. “Unexplained opportunistic infections and CD4+ T-lymphocytopenia without HIV infection. An investigation of cases in the United States”. The New England Journal of Medicine. 328 (6): 429–431. PMID 8093633.
  2. ↑ D D Ho, Y Cao, T Zhu, C Farthing, N Wang, G Gu, R T Schooley, and E S Daar (1993-02-11). “Idiopathic CD4+ T-lymphocytopenia — immunodeficiency without evidence of HIV infection”. The New England Journal of Medicine. 328 (6): 386–392. PMID 8093634.
  3. ↑ Thomas J Spira, Bonnie M Jones, Janet Nicholson, Renu B Lal, Thomas Rowe, Alison C Mawle, Carl B Lauter, Jonas A Shulman, and Roberta A Monson (1993-02-11). “Idiopathic CD4+ T-Lymphocytopenia — An Analysis of Five Patients with Unexplained Opportunistic Infections”. The New England Journal of Medicine. 328 (6): 386–392. PMID 8093635.
  4. ↑ W L Ng, C M Chu, A K L Wu, V C C Cheng, K Y Yuen. “Lymphopenia at presentation is associated with increased risk of infections in patients with systemic lupus erythematosus”. Quarterly Journal of Medicine. 99 (1): 37–47. doi:10.1093/qjmed/hci155.
  5. ↑ Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
  6. ↑ Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Epidemiology and Demographics

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Overview

Epidemiology and Demographics

References

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:

Risk Factors

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Overview

Risk Factors

References

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:

Screening

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Overview

Screening

References

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:

Natural History, Complications and Prognosis

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Overview

Natural History

Complications

Prognosis

Lymphocytopenia that is caused by infections tends to resolve once the infection has cleared. Patients with idiopathic CD4+ lymphocytopenia may have either abnormally low but stable CD4+ cell counts, or abnormally low and progressively falling CD4+ cell counts; the latter condition is terminal.

References

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Diagnosis

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings | Chest X Ray | CT | MRI | Other Imaging Findings | Other Diagnostic Studies

Treatment

Treatment

Medical Therapy | Surgery | Primary Prevention | Secondary Prevention

Case Studies

Case Studies

Case #1

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]