Lymphopenia is a transient or permanent decrease in the concentration of lymphocytic blood cells in the total volume of circulating blood, less than 1000 in 1 μl. Long-term lymphopenia can provoke activation of opportunistic infection and is a background pathological condition for the development of autoimmune and neoplastic diseases.
In terms of diagnostic activities, it is not so much the discovery of the fact of the decrease in lymphocytic cells that is important, as the imbalance in the lymphocytic subpopulation. To detect signs of lymphopenia, the leukocyte formula of peripheral blood must be determined when examining a general clinical analysis of circulating blood.
Causes of lymphopenia
There are a number of diseases in which congenital deficiency of lymphocyte cells is noted and absolute lymphopenia develops, including congenital immunodeficiency in newborns.
Lymphopenia in children can develop not only due to insufficient lymphocyte production, but also due to increased destruction of lymphocyte blood cells (mainly the T-lymphocyte group), which occurs in the Wiskott-Aldridge syndrome, which belongs to hereditary pathologies. A rare pathogenetic mechanism of lymphopenia is the inability of lymphocyte maturation from normal progenitor cells.
The largest category of patients with the acquired variant of lymphopenia are people who do not follow the rules of rational nutrition, in which there is a significant deficit in the protein component of the diet. A similar pathogenesis of lymphopenia is observed in autoimmune diseases, each of which is accompanied by a significant loss of proteins in the body.
Among infectious diseases accompanied by the development of the lymphopenic condition, it should be noted HIV infection and AIDS, as in the past decade there has been a significant increase in the incidence of these pathologies. The development of lymphopenia in this situation is caused by the destruction of most of the T-lymphocytes and the migration of decay products into the organs of the reticuloendothelial system.
Lymphopenia caused by impaired lymphocyte cell production is found in patients suffering from an organic pathology of the thymus, with both absolute and relative lymphopenia observed.
Increased destruction of lymphocytic cells is observed in people who take long-term medicines of the psoralen group, which are used in the complex therapy of psoriasis. And, of course, there is a separate etiopathogenetic category of lymphopenia, which is a consequence of radiation and cytostatic therapy, which are used in the treatment of cancer. This category of lymphopenic syndrome refers to iatrogenia.
There is one more category of patients who have not a decrease in lymphocytes, but an increase in the percentage of other blood cells of the leukocyte series, against which there is a false impression of a decrease in the lymphocyte cell count. In this situation, hematologists establish the conclusion "relative lymphocytopenia". This type of lymphopenic syndrome occurs with massive inflammation in the body of a purulent nature ( osteomyelitis of the bones, pulmonary abscess, empyema of the pleura, phlegmon ).
Reactive decrease of lymphocytic blood cells can be observed under stress conditions. This category includes lymphopenia in pregnancy, which in most cases does not need a medical correction, but this group of patients is subject to dynamic laboratory monitoring. After delivery, it is necessary to examine a newborn child for signs of lymphopenia, since this pathological condition can be transmitted by inheritance. The debut of the clinical manifestations of congenital absolute lymphopenia falls on the first day of the child's life and in this period there is a great risk of a lethal outcome of the disease.
Symptoms of Lymphopenia
Since lymphopenia is not an independent nosological unit, this pathological state of the body does not have its own pathognomonic clinical picture, but there is a wide range of clinical manifestations that are observed in most cases with a decrease in lymphocyte cells. Cellular immunodeficiency, manifested in a decrease in the production of lymphocytic cells, is manifested primarily in the hypoplasia of the tonsils of the lymph glotopharynx and underdevelopment of large groups of lymphatic collectors.
Like any pathology of peripheral blood, lymphopenia is accompanied by a change in the skin as a change in color (pallor, icterism), the presence of ulceration and erosion on the mucous membranes of various spreads. Patients who have even a slight but prolonged decrease in lymphocyte cells are classified as "often ill with respiratory illnesses of individuals," as this group of patients has an increased risk of developing infectious genesis diseases that occur in severe form with the presence of complications.
Treatment of lymphopenia
In a situation where lymphopenia is acquired, it is necessary to conduct adequate etiotropic therapy of the underlying disease, which is the primary cause of its development. In most situations, the elimination of background pathology is accompanied by an independent leveling of the manifestations of lymphopenia and normalization of the cellular composition of peripheral blood.
Pathogenetic orientation of therapy of lymphopenia consists in carrying out immunoglobulin therapy with a long course, which allows to eliminate lymphopenia of a chronic nature, and also to prevent the development of a recurrent infection. Parenteral administration of immunoglobulins G is used not only to suppress a severe inflammatory reaction in patients with immunodeficiency, but also to normalize the indices of lymphocytic cells. When the patient has all the signs of lymphopenia, the dose of immunoglobulin is calculated by the body weight of the patient and is 0.4 g per kg. Multiplicity of intravenous administration is 1 time in two weeks. Indication for the termination of parenteral immunoglobulin therapy is the development of severe life-threatening adverse reactions in the form of arterial hypotension, up to collapse, as well as a pronounced allergic reaction.
It should be taken into account that drug replacement therapy with the use of immunoglobulins in parenteral form does not have the proper effect with the present congenital lymphopenia. In this situation, the only pathogenetically justified method of treatment is the transplantation of the stem hemopoietic cell substrate.
? Lymphopenia - which doctor will help ? If you have or suspect a development of lymphopenia, you should immediately seek advice from such doctors as a pediatrician, hematologist, oncologist, immunologist and transplantologist.