Lymphocytes, which themselves are divided into a variety of forms with different tasks, represent a subgroup of leukocytes. With few exceptions, they are part of the acquired immune system, and their relative share in the total number of leukocytes is usually 25 to 45 percent of leukocytes. If the relative proportion or the absolute number falls below a certain value, lymphopenia is present.
What is lymphopenia?
According to Topbbacolleges, lymphopenia is a pathologically low absolute or relative number of lymphocytes in the blood. Lymphopenia actually embodies lymphocytopenia. Lymphocytes, which represent a subgroup of leukocytes, the white blood cells, can themselves be subdivided into a large number of different cell types with different tasks in the acquired immune system.
In principle, lymphopenia can be divided into an absolute and a relative form. Absolute lymphopenia is present when the number of lymphocytes falls below 1000 cells per microliter of blood. In a relative lymphopenia, the proportion of lymphocytes within the group of leukocytes is less than 15 percent or, according to other authors, less than 25 percent.
A uniformly defined and binding guideline value does not exist. Normally, the relative proportion of lymphocytes is around 20 to 40 percent of the total number of leukocytes. Absolute lymphopenia is more meaningful in terms of its physiological effect because the relative value depends on the total number of leukocytes.
If, for example, the absolute number of lymphocytes is in the normal range and the absolute number of the remaining leukocytes is pathologically increased, arithmetically, lymphopenia could be derived from this, although there is an increase in leukocytes, i.e. leukocytosis.
Causes
Lymphopenia can arise due to a wide variety of causal complexes. Lymphopenia is not always caused by a specific disease. For example, specific infections can cause a large increase in granulocytes, so that a large increase in the number of leukocytes results in relative lymphopenia.
Absolute lymphopenia can be caused by a variety of different viral and autoimmune diseases such as HIV, measles and yellow fever as well as multiple sclerosis (MS), celiac disease, Hodgkin’s disease or rheumatoid arthritis. HIV infection is the most common cause of infection-related lymphopenia worldwide.
Lymphopenia is also typically caused by various forms of leukemia. In many cases, the decrease in lymphocytes is caused by the undesirable side effects of drugs such as immunosuppressants, cytostatics or glucocorticoids (cortisone preparations).
Protein malnutrition, prevalent in some developing countries, is the most common cause of lymphopenia worldwide. In rare cases, it is a congenital immunodeficiency that causes a reduced number of lymphocytes from birth.
Symptoms, Ailments & Signs
Lymphopenia is not accompanied by typical complaints or symptoms, but is initially quite inconspicuous. This is also the reason why the disease is often only discovered during a blood test for other reasons.
Associated symptoms, signs, and signs are usually consistent with the causative disease unless the lymphopenia is due to other causes. For example, emerging symptoms of a hematological disease such as eczema, dilated capillaries with bleeding, and other signs are not triggered by the lymphopenia but by the causative hematological disease.
Diagnosis & course of disease
Absolute or relative lymphopenia can be diagnosed in the laboratory using the blood count. Due to the lack of specific symptoms, however, the examination usually does not take place because no cause can be identified. The disease is often only discovered by chance during an examination for other reasons.
The situation only changes when the patient complains of frequently recurring infections. The suspicion of congenital or acquired immunodeficiency can then fall. In these cases, a blood test can provide information on the absolute quantity and the relative distribution of the different leukocytes and thus also the lymphocytes.
The course of the disease, which is usually a side effect of an underlying disease, depends on the course of the underlying disease. Lymphopenia can therefore develop in completely different ways. The progressive forms therefore cover a very different spectrum, ranging from harmless to serious – such as MS or leukemia.
Complications
In most cases, the lymphopenia does not lead to characteristic or special symptoms that only speak for this disease. For this reason, it is only recognized relatively late, so that the patient is treated too late. It can usually only be diagnosed with a blood test.
Those affected can suffer from various types of bleeding that occur for no particular reason. This does not always lead to restrictions or other complications. Only rarely does the bleeding or swelling lead to pain or other limitations in the patient’s everyday life. Furthermore, those affected often suffer from infections and inflammation. However, the further course of lymphopenia depends very much on the underlying disease that caused it, so that a general course of the disease cannot usually be predicted.
Treatment of the disease is primarily aimed at the underlying disease. It is also not possible to universally predict whether complications will arise. In many cases, however, the symptoms can be reduced by transplantation of stem cells, so that the patient’s life expectancy is not reduced.
When should you go to the doctor?
If fever, malaise, and other signs of lymphopenia are noticed, seek medical advice. The affected persons should consult the doctor immediately and have the symptoms clarified, especially if symptoms such as jaundice, bleeding or skin changes occur. Inflammation, eczema and dilated capillaries must always be examined by a doctor, as they may be due to a serious illness. Lymphopenia usually develops insidiously and only causes clear symptoms at a late stage.
That is why you should see a doctor at the first sign of illness. Risk groups include cancer patients, as well as people suffering from pneumonia or another bacterial or viral disease. Anyone who has ever had rubella or severe inflammation should speak to their family doctor if there are signs of lymphopenia. He can diagnose the disease and, if necessary, call in various specialists, such as dermatologists for possible skin problems, internists for organ diseases and neurologists as well as physiotherapists for neurological and physical complaints.
Treatment & Therapy
Efficient treatment of lymphopenia aims at treating the underlying disease. This presupposes that the underlying disease has been reliably diagnosed and can be effectively treated. In the case of lymphopenia caused by side effects of drugs, it may be sufficient to substitute the drug with other drugs with alternative active ingredients.
If a congenital immunodeficiency leads to a chronic lack of immunoglobulins and frequent infections are the result, intravenous administration of gamma globulins with antibody properties may be indicated. If the infusion with gamma globulins does not have the desired effect, the last resort is haematopoietic stem cell transplantation. Lymphopenia caused by protein malnutrition could be treated and cured very easily by eating protein-rich foods.
Outlook & Forecast
The prognosis of lymphopenia depends on the underlying disease. If it is a viral disease, it can be cured in many cases. Medical therapy treats the present condition and often completely cures it within a few weeks or months. At the same time, the number of leukocytes normalizes independently. With a chronic viral disease, the prognosis worsens. Long-term therapy is used here, in which the symptoms are alleviated. However, no recovery is expected.
In the existing malnutrition, the affected person can independently achieve sufficient change. Changing the food supply changes the conditions within the organism. The organism is automatically brought into balance by the production of leukocytes. If the change in diet is successfully implemented throughout life, permanent freedom from symptoms can be documented.
In particularly severe cases, the patient needs a stem cell transplant. This is the last treatment option for some of those affected. The organism is already significantly weakened and other treatment methods have not been successful. Transplantation is associated with various risks and side effects. Nevertheless, it can bring about the desired changes in the case of a chronic deficiency or congenital immune deficiency. Despite everything, the patient must optimize his lifestyle and align it with the needs of the organism in order to achieve permanent freedom from symptoms. Otherwise, the symptoms will return.
Prevention
There are no direct preventive measures that could prevent the occurrence of lymphopenia, because the disease usually occurs as a side effect of another underlying disease. However, simple preventive measures exist for the two leading causes of lymphopenia worldwide.
On the one hand, there is the diet-related form caused by chronic protein deficiency and the lymphopenia caused by HIV infection. In the former case, fortifying the diet with protein would have a preventive effect, and in the latter case, effective protection against HIV infection could be considered preventive.
Aftercare
Since the symptoms are not clear, lymphopenia is often recognized late. The treatment is therefore only given after the late diagnosis. Since both the disease and the treatment are relatively complex, aftercare is aimed at trying to find a good way of dealing with the situation. Those affected are more susceptible to inflammation and infections and have to adapt their everyday life to the disease. This can lead to psychological upsets, which should sometimes be clarified by a psychologist. Therapy or contact with other sufferers can help to better accept the disease. This can increase well-being despite the fact that the treatment is still ongoing.
A general course of the lymphopenia can usually not be predicted, as this depends on the underlying disease. In order to be able to treat lymphopenia, the underlying disease must first be identified and combated. Whether the treatment will lead to complications or discomfort can only be estimated on a case-by-case basis. In most cases, the symptoms can be reduced by transplanting stem cells. The lifespan of sick people is then not reduced.
You can do that yourself
In the case of lymphopenia, the patient’s options for self-help are relatively severely limited. First and foremost, the underlying disease of the patient must be treated, whereby a general statement about the means of self-help is neither possible nor useful.
However, if the lymphopenia is caused by certain medications, these medications should be changed or discontinued. A change in medication should only be made after consultation with a doctor in order to avoid complications. Often, however, lymphopenia can only be treated by transplanting stem cells. In this case, there are no opportunities for self-help for those affected.
In general, those affected should take it easy with this disease in order to avoid further infections or illnesses. Unnecessary efforts should be avoided. If the lymphopenia leads to psychological problems, talking to parents or friends is very helpful. Contact with other people affected by lymphopenia can also often have a positive effect on the course of the disease, since this leads to an exchange of information. These can appear helpful in everyday life and improve the quality of life of those affected.