What does a low white blood cell count indicate?
White blood cells are several different types of cells, each with its own task. Neutrophils are responsible for fighting bacteria, lymphocytes are responsible for the antiviral and immune response, monocytes, eosinophils and basophils perform narrower functions. Therefore, the doctor looks not only at the total number, but also at the leukocyte formula: a decrease due to neutrophils and due to lymphocytes means completely different things. The risk of infections directly depends on the absolute number of neutrophils: with a moderate decrease it remains almost unchanged, with a deep decrease it increases significantly.
- Neutropenia is a decrease in neutrophils, the main clinical landmark
- Lymphopenia - decrease in lymphocytes
- Isolated leukopenia with normal other sprouts
- Pancytopenia - decrease in all blood cells
- Benign ethnic neutropenia as a normal variant
Reasons
The most common and harmless cause is a recent viral infection: white blood cells decrease for one to two weeks and then recover. The second large group is drugs: some antibiotics, anticonvulsants, thyreostatics, painkillers and cytostatics can suppress the bone marrow or destroy neutrophils. Persistent leukopenia occurs with autoimmune diseases, an enlarged spleen, deficiency of vitamin B12 and folic acid, severe infections and bone marrow diseases. Some healthy people have low neutrophils - a congenital feature without the risk of infections.
- Viral infections, including influenza, hepatitis, HIV
- Medicines: cytostatics, a number of antibiotics, thyreostatics, anticonvulsants
- Chemotherapy and radiation therapy
- Autoimmune diseases: systemic lupus erythematosus, rheumatoid arthritis
- Enlarged spleen in liver disease
- Deficiency of vitamin B12, folic acid, copper
- Bone marrow diseases and leukemias
- Hereditary and benign forms of neutropenia
Symptoms and dangers
Leukopenia itself does not feel anything: it is found in the analysis. Manifestations occur when protection against infections is reduced. Characterized by frequent sore throats, stomatitis and mouth ulcers, inflammation of the gums, ulcers on the skin, and lingering colds. The peculiarity of infections with deep neutropenia is that the classic signs of inflammation are weakly expressed: little pus, inexpressive redness, but high temperature and rapid deterioration of the condition. That is why fever with neutropenia is considered an emergency and is not treated independently.
- Recurrent sore throats and stomatitis
- Mouth ulcers and gum inflammation
- Pustular skin lesions
- Protracted respiratory infections
- Increased temperature without obvious focus
- Weakness and sweating
Survey
The first step is to repeat a complete blood count with leukocyte count after one to two weeks to distinguish between a temporary decrease after infection and a persistent one. The doctor asks in detail about medications taken, recent illnesses, contacts and symptoms. Further examination depends on the picture: if an infectious cause is suspected, viral hepatitis and HIV are checked, for systemic complaints, rheumatological markers are checked, if several blood cells decrease and lymph nodes are enlarged, they are referred to a hematologist for a bone marrow examination.
- Repeated general blood test with formula in dynamics
- Assessment of medications taken
- C-reactive protein and markers of infection
- Tests for HIV and viral hepatitis
- Vitamin B12 and folic acid
- Abdominal ultrasound to evaluate the spleen and liver
- Rheumatological tests for systemic symptoms
- Bone marrow puncture according to the decision of a hematologist
Treatment and prevention of infections
They treat not the number, but the cause. If the drug is to blame, the doctor decides whether to discontinue or replace it - you cannot stop the prescribed therapy yourself. Vitamin deficiency is replenished, autoimmune disease is treated together with a rheumatologist. In case of deep neutropenia, most often during chemotherapy, drugs that stimulate the formation of neutrophils are used, and in case of fever, broad-spectrum antibiotics are immediately started in the hospital. In everyday life, with persistent neutropenia, simple precautions and timely vaccination, which are agreed upon with your doctor, are important.
- Cancellation or replacement of the drug only by doctor’s decision
- Replenishment of vitamin B12 and folic acid deficiency
- Treatment of the underlying disease
- Stimulators of granulocytopoiesis in severe neutropenia
- Immediate treatment if fever
- Careful hand and oral hygiene
- Avoiding contact with people with infections
- Processed food and clean water
