Low lymphocytes or lymphopenia, a common condition that should be investigated as soon as possible.

Low lymphocytes or lymphopenia: main symptoms and causes

The feedback from low lymphocytes (lymphopenia or lymphocytopenia) is less common than lymphocytosis. The causes of low lymphocytes it can be abnormalities of bone marrow function, tumors, numerous drugs, the presence of an acute inflammatory state or infections, especially viral ones. THE symptoms of lymphopenia they are generally weakness (asthenia), malaise, ease of getting sick and becoming infected. Very often, however, there is no specific symptom associated with lymphocytopenia.

What are lymphocytes?

What are lymphocytes? THE lymphocytes I'm a type of white blood cells (leukocytes  or in English WBC, that is white blood cells), and I'm very important cells, necessary for the defense of our organism from attacks by foreign agents or organisms such as bacteria, viruses, parasites and fungi.

Lymphocytes are leukocytes mononuclear agranulocytes, since in contrast to granulocytes they have a rounded nucleus they have few or no granules in the cytoplasm.

Absolute lymphocytes are divided into some subtypes, classified according to function and type of action against pathogens. After i neutrophil granulocytes, the lymphocytes represent the type of leukocyte more numerous.

There leukocyte formula, that does not is none other than the Percentage determination of the various cell types of leukocytes present in the peripheral smear of our blood, it is in fact mainly composed of lymphocytes and granulocytes, the latter mostly of the neutrophilic type. 

The main categories of lymphocytes are:

  1. THE B lymphocytes, ie the plasma cells, are the lymphocytes responsible for the production of antibodies and the activation of T lymphocytes. They are called B from the initial of the place where they mature, the Bone Marrow (bone marrow).
  2. THE T lymphocytes, which are named after the initial of the body district where they mature, that is the Thymus. The T lymphocytes in turn They are divided into:
    1. T Helper (Th) lymphocytes, are the CD4 lymphocytes, essential for the activation and modulation of the immune response of the other lymphocytes, 
    2. cytotoxic T lymphocytes (Tc), or activated lymphocytes, are the CD8 lymphocytes, which have a direct action against bacteria, viruses and other hostile agents to the organism. 
  3. THE regulatory T lymphocytes, also called suppressor T lymphocytes, they are involved in the self-regulation of the immune response.
  4. THE NK lymphocytes, called more simply Natural Killer lymphocytes, Natural Killer cells or NK cell, they are cells with a high cytotoxic potential.

Low lymphocytes - Lymphopenia values

Thing wants to say have low lymphocytes? What are the values of lymphocytes below the normal range? The number of normal lymphocytes in our body is in the range between 1,000 and 4,800 lymphocytes / ml in adults, while normal values in children are 3,000-9,000 lymphocytes / ml.

For low lymphocyte values (lymphopenia) are therefore intended values gods lymphocytes less than 1.5 * 10 ^ 9 / l, i.e. less than 1.5 billion lymphocytes per liter of blood.

In some laboratories this number is expressed as 1,500 lymphocytes / mm3 or ml, i.e. values less than four thousand lymphocytes per cubic millimeter or milliliter of blood.

As for thepediatric age, we therefore speak of low lymphocytes in children below 3.0* 10 ^ 9 / l, i.e. less than 3.0 billion lymphocytes per liter of blood, and less than 3,000 lymphocytes / ml or mm3.

Low lymphocytes or lymphopenia, a common condition that should be investigated as soon as possible.

In the image a lymphocyte, with a rounded nucleus and cytoplasm free from granules.

Low Lymphocytes Causes - Lymphopenia Causes

What are the main causes of lymphocytopenia (i.e. the causes of low lymphocytes in the blood)?

The main ones causes of low lymphocytes I'm:

  • Blood tumors, which damage the bone marrow and impair the production of blood cells:
    • Leukemia: they are distinguished on the basis of the type of cells affected (myeloid leukemias and lymphatic or lymphoid leukemias), as well as the speed of expression (acute and chronic leukemias). Acute lymphocytic leukemia (or acute lymphoblastic leukemia, ALL) and chronic lymphocytic leukemia (chronic lymphoblastic leukemia, CLL) are the two main types of leukemia that affect the production of lymphocytes. Although on blood tests at many stages of these diseases show themselves  high lymphocytes, in fact, most lymphocytes are nonfunctioning or immature (blasts).
    •  Lymphomas: they are a kind of solid leukemia, with the disease mainly affecting the organs of the immune system such as lymph nodes, spleen and intestinal immunological stations. They are divided into Hodigkin's lymphoma (also called malignant lymphogranuloma or lymphosarcoma) or Non-Hodgkin's lymphoma (NHL).
    • Myelodysplasia: myelodysplasia, more correctly defined myelodysplastic syndrome it is a blood disease caused by damage to one or more stamina cells present inside the bone marrow. Damaged stem cells therefore fail to produce adequate amounts of functioning blood cells, resulting in a shortage of white blood cells, red blood cells and / or platelets. There are various types of myelodysplastic syndromes. In a certain percentage of cases, myelodysplastic syndromes develop into a more aggressive form of haematological disease, the acute myeloid leukemia. Although the type of white blood cell most affected are granulocytes, with consequent finding of low neutrophilic granulocytes and leukopenia, we often witness, especially in the advanced stages, the appearance of lymphocytopenia.
  • Neoplasms: the presence of cancer that damages the bone marrow directly (by proximity) or distantly (with metastases) can lead to bone marrow hypoplasia or aplasia, with low white blood cells (leukopenia) and low blood lymphocytes (lymphopenia), anemia (low red blood cells) and thrombocytopenia (low platelets).
  • Myelofibrosis: progressive replacement of the bone marrow with fibrotic material. In addition to idiopathic myelofibrosis, sometimes a myelofibrosis pattern represents the final stage of diseases such as leukemias, lymphomas and other cancers. It is characterized by bone marrow hypoproduction, with low leukocytes in the blood, lymphopenia and neutropenia, associated with anemia and thrombocytopenia (low platelets).
  • Acquired or congenital disorders which compromise bone marrow hematopoiesis, decreasing its productivity, and leading to the finding of reduced lymphocytes, often also with low erythrocytes and reduction of platelets. For example
    • Sex-linked agammaglobulinemia (Bruton's disease) rare pathology in which due to an alteration of the X chromosome, the B lymphocytes are reduced or absent, and consequently the production of antibodies (immunoglobulins) is also strongly deficient.
    • Autosomal recessive agammaglobulinemia: deficiency of B lymphocytes and antibodies, with susceptibility to infections, especially respiratory and intestinal.
    • Aplastic anemia: hypoproduction of all types of circulating cells by the marrow, causing a condition of pancytopenia. It can be genetic or acquired.
    • Paroxysmal nocturnal hemoglobinuria: is an acquired hematopoietic cell disease characterized by haemolytic anemia, bone marrow failure and frequent thrombotic episodes of the great vessels.
  • Congenital absence of the thymus.
  • Medicines that damage circulating lymphocytes:
    • Antibiotics, such as minocycline (Minocin), trimethoprim-sulfamethoxazole (Bactrim) sulfasalazine (Salazopyrin)
    • Antipsychotics, such as clozapine (Leponex)
    • Antidepressants such as bupropion (Wellbutrin)
    • Antiepileptics such as valproic acid (Depakin)
    • Antithyroid drugs like tapazole
    • Monoclonal antibodies such as Rituximab (Mabther
  • Medicines or therapies which interfere with the hematopoietic function of the bone marrow
    • chemotherapy: all chemotherapy drugs they can cause neutropenia and lymphopenia, as well as low eosinophils and low basophils.
    • chronic therapy with corticosteroids.
    • immunosuppressants: azathioprine, methotrexate, cyclosporine, everolimus, tacrolimus: these are all drugs that depress the immune system and can cause lymphopenia.
    • Radiation or radiation therapy: irradiation with ionizing rays at the medullary or neighboring level can result in a reduced functionality of the latter. Even in cases of nuclear disasters, such as Chernobyl or Fukushima, the very high concentration of radiation present in the surrounding area has increased the incidence of blood diseases, with bone marrow hypoproduction and even fatal.
  • Autoimmune Diseases which reduce bone marrow production of blood cells
    • Arthritis rheumatoid
    • Autoimmune hyperthyroidism (e.g. Graves' disease)
    • Systemic lupus erythematosus
    • Myasthenia gravis
    • Sarcoidosis
  • Infections which determine a broad cell consumption and destruction blood, including leukocytes;
    • Malaria
    • HIV: Human Immunodeficiency Virus, is the virus that causes the justly feared Acquired Immunodeficiency Syndrome, or AIDS.
    • Dengue: hemorrhagic fever, characterized by fever and hemorrhagic manifestations
  • Infections (especially acute viral infections) that alter the bone marrow function:
    • HIV: the HIV virus damages both the circulating cells and the bone marrow directly.
    • Hepatitis B: HBV infection can inhibit proper bone marrow hematopoiesis, resulting in a drop in white blood cells.
    • CMV infection: cytomegalovirus can impair bone marrow production
    • EBV infection: Epstein Barr Virus also behaves like CMV.
    • Tuberculosis: especially if with vertebral or medullary localization (miliary tuberculosis).
    • Sepsis: Although infections normally cause an increase in white blood cells (leukocytosis), a severe infection can also be characterized by low lymphocytes and neutrophils (see the old sepsis criteria).
    • Parasitic or protozoal diseases
  • GVHD: Graft Versus Host Disease, graft versus host disease, is a form of rejection after transplantation of
  • Hypersplenism: Entrapment and / or premature destruction of circulating blood cells within the spleen, which appears enlarged and hypertrophic. Enlarged spleen is common in blood disorders such as leukemia, lymphoma, myelodysplasias and lymphoproliferative syndromes, but also in diseases such as liver cirrhosis. The finding of a low number of circulating blood cells in the presence of an enlarged spleen is therefore frequent and often does not resolve once the underlying disease is cured.
  • Vitamin deficiencies, such as that of folate and vitamin B12 (cyanocobalamin): the lack of these substances essential for the growth of circulating blood cells often causes a reduction of lymphocytes, with simultaneous megaloblastic anemia.
  • Deficiencies of trace elements: the lack of substances such as zinc and copper can lead to a reduction in lymphocytes.
  • Stress, with production of cortisol and reduction of immune defenses.

Low lymphocytes in pregnancy

What does a match of low lymphocytes in pregnancy? what does it mean? Are there any health risks for the baby? are there effective remedies?

Low levels of lymphocytes in pregnancy on blood tests may be a simple result of a temporary fluctuation in lymphocyte levels, which will normalize at the next check. Lower than normal lymphocytes in pregnancy may be the result of the increase in overall body fluids that occurs during gestation, which leads to hemodilution with a slight drop in the concentration of all cells and substances in the bloodstream.

In any case, the finding of a reduction in lymphocyte counts in pregnancy should be investigated promptly, especially if it is accompanied by alterations of other blood cells, with the presence of low lymphocytes and high neutrophils, elevated monocytes or hypereosinophilia. In particular, the finding of a low number of lymphocytes and high neutrophils in pregnancy can suggest the presence of a bacterial infection, which must be promptly investigated and treated.

Low Lymphocytes Symptoms - Lymphocytopenia Symptoms

What are the symptoms of low lymphocytes?

The lack of white blood cells and in particular of lymphocytes exposes to the risk of viral and bacterial infections, in addition to reducing immune surveillance also towards other types of pathologies such as neoplasms. The main symptoms of lymphopenia I'm:

  • weight loss (weight loss)
  • asthenia (tiredness and weakness in common daily activities)
  • increased susceptibility to infections, resulting in frequent infections
  • bone pains
  • fever, sometimes mild and concentrated at night
  • profuse sweating, especially at night
  • frequent bleeding, even spontaneous
  • pale skin, lips and nails
  • Jaundice (yellow skin) and high bilirubin: in case of liver disease or paroxysmal nocturnal hemoglobinuria, hyperbilirubinemia manifests itself with the accumulation of bilirubin on the skin tissues, with the appearance of yellow / green color of the skin
  • Abdominal pain
  • Hepatomegaly: enlarged liver
  • Splenomegaly: enlarged spleen
  • Ascites: presence of fluid in the abdomen (peritoneal cavity)
  • Headache: headache.
  • Frequent bleeding, especially gum bleeding or epistaxis (nosebleeds).
  • Renal failure: finding of high creatinine following overload of the lysis products of red blood cells and defective white blood cells in the kidneys.

When to worry in the presence of reduced lymphocytes? Without a doubt one lymphopenia, especially if associated with other alterations of theblood count, must be investigated by contacting your own doctor that he will be able to suggest exams is investigations more appropriate.


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