Leukopenia
The content of the article:
- Causes of leukopenia
- Forms
- Leukopenia symptoms
- Features of the course of leukopenia in children
- Diagnostics
- Leukopenia treatment
- Prevention
- Consequences and complications
- Forecast
Leukopenia is a syndrome characterized by a decrease in the number of different forms of leukocytes in the blood plasma. Leukopenia is said to be when the number of leukocytes in the blood becomes less than 4 × 10 9 / l.
Source: okeydoc.ru
Fluctuations in the content of leukocytes in the blood within the range from 4 to 9 × 10 9 / l are physiological and depend on many external and internal factors.
Leukopenia weakens the immune system, which makes the body susceptible to any infections, and reduces the body's regenerative capacity.
Causes of leukopenia
The development of leukopenia is based on the following etiopathogenic mechanisms:
- a decrease in the production of leukocytes in the hematopoietic organs - mature leukocytes are not formed due to the mass death of young proliferating bone marrow cells. Occurs under the influence of chemotherapy drugs or bone marrow radiation;
- failure in the circulation of leukocytes or their redistribution in the vascular bed - a change in the ratio between circulating and parietal leukocytes. A decrease in leukocytes freely circulating with the blood flow (lazy leukocyte syndrome, i.e., a sharp decrease in their motor activity) occurs due to an increase in the fraction of leukocytes adhered to the vessel wall. As a rule, the redistribution of leukocytes in the vascular bed is a temporary condition that occurs due to the action of endotoxins during stress, shock, inflammation, trauma, intense muscle work, blood loss;
- destruction and decrease in the life span of leukocytes - accelerated destruction of already existing mature leukocytes in the blood, hematopoietic organs, tissues, including the hypertrophied spleen. It arises under the influence of autoantibodies, agglutinogens, endo- and exotoxins, radiation.
Possible causes of leukopenia:
- a reaction to the use of a number of drugs (antidepressants, antibiotics, diuretics, analgesics, antihistamines, anti-inflammatory, antithyroid drugs, corticotropin and cortisone);
- long-term exposure to chemicals (pesticides, benzene);
- the action of ionizing radiation, X-rays, ultraviolet rays, microwave waves;
- long-term deficiency of vitamins B1 and B12, folic acid, copper, iron, selenium;
- the action of inorganic (salts of lead, arsenic, gold) and organic (benzene, tetraethyl lead, insecticides) substances;
- psycho-emotional upheavals, stressful conditions;
- large blood loss, trauma, burns;
- long-term radiation therapy, chemotherapy (myelotoxic leukopenia);
- infection with viruses (influenza, rubella, measles, hepatitis, Epstein-Barr viruses, cytomegalovirus), bacteria (tuberculosis, severe sepsis, brucellosis,), protozoa (malaria, leishmaniasis), fungi (histoplasmosis);
- genetic diseases (congenital leukopenia);
- anaphylactic shock;
- malignant neoplasms, including those affecting hematopoietic organs;
- radiation sickness;
- autoimmune diseases (thyroiditis, systemic lupus erythematosus);
- HIV infection and AIDS.
Forms
The forms of leukopenia differ from each other in etiology, pathogenesis, time of onset, duration and a number of other factors; one and the same leukopenia can simultaneously refer to several types.
Leukopenia is divided into two large groups:
- absolute - characterized by a uniform decrease in the amount of all types of white cells circulating in the blood;
- relative (redistributive, hemodilution) - a decrease in the percentage of certain types of leukocytes while maintaining their total number within the permissible values.
Depending on the content of which types of leukocytes is reduced, relative leukopenia is divided into the following subspecies:
- neutropenia;
- lymphopenia;
- monocytopenia;
- eosinopenia;
- basopenia.
If the concentration of neutrophils, eosinophils and basophils is reduced, they speak of agranulocytosis.
Leukopenia is also divided into physiological (constitutional harmless leukopenia) and pathological forms.
Pathological leukopenias are primary (congenital, hereditary) and secondary (acquired). The hereditary form of leukopenia is associated with genetic abnormalities (Kostman's neutropenia, hereditary neutropenia of the autosomal dominant type, chronic granulomatous disease, leukopenia with lazy leukocyte syndrome, cyclic neutropenia). The acquired form develops under the influence of factors that inhibit hematopoiesis.
Acute and chronic leukopenia is isolated downstream.
The division of leukopenia according to the severity of the disease occurs in accordance with the gradation of the indicator of the number of leukocytes in the blood:
- mild leukopenia - 1.5 × 10 9 / l, no complications;
- moderate leukopenia - 0.5-1 × 10 9 / l, there is a risk of complications;
- severe leukopenia - 0.5 × 10 9 / l and below, agranulocytosis with its inherent serious complications.
Leukopenia symptoms
With leukopenia, there are no pronounced specific signs.
Source: zlmed.ru
All the symptoms of leukopenia are associated with the addition of any infection:
- signs of physical exhaustion, weakness and malaise;
- increased heart rate, tachycardia, heart pain;
- dyspnea;
- headaches, dizziness;
- lack of appetite and weight loss;
- frequent episodes of fungal, viral, herpes infections;
- signs of damage to the liver, bone marrow, spleen, intestines;
- increased body temperature, spasmodic temperature;
- chills, increased sweating;
- joint pain;
- enlargement of the tonsils, lymph nodes;
- swelling of the oral mucosa, ulcerative necrotizing stomatitis;
- enlargement of the spleen and liver (hepatosplenomegaly);
- immunodeficiency.
An asymptomatic variant of the course of leukopenia is not excluded.
Features of the course of leukopenia in children
The level of leukocytes below 4.5 × 10 9 / l in a child is regarded as leukopenia. Leukopenia in older children is manifested by a sharp decrease in immunity. Such children often get sick, lag behind their peers in growth, and gain weight poorly. They have chronic recurrent lesions of the skin, mucous membranes, inflammatory processes take on a severe, ulcerative-cicatricial nature. Leukopenia in young children can be suspected on the basis of recurrent pseudofurunculosis.
In newborns, a special form of transient leukopenia may occur. It is caused by the mother's antibodies that penetrated the child's body during intrauterine development and caused a decrease in the level of granulocytes while maintaining the total number of leukocytes within the normal range. This condition does not need treatment and usually disappears on its own by the age of four.
Diagnostics
If leukopenia is suspected, a number of diagnostic tests are prescribed. A detailed laboratory blood test is of decisive importance, including counting the absolute number of blood neutrophils, counting erythrocytes and platelets, and determining the leukocyte formula.
Additional research:
- enzyme immunoassay for antibodies to infectious agents, determination of antileukocyte antibodies, autoantibodies;
- blood tests for antinuclear and antigranulocytic antibodies, rheumatoid factor;
- a blood test for immature blood cells;
- liver tests (bilirubin, transaminases, markers of viral hepatitis);
- a blood test for vitamin B12, folic acid and folate;
- puncture of bone marrow with myelogram - cytological examination of punctate, which allows for differential diagnosis and establish the mechanism of development of leukopenia;
- biopsy of enlarged lymph nodes;
- Ultrasound, X-ray, MRI of internal organs as needed.
Leukopenia treatment
There is no pathogenetic treatment for leukopenia. Leukopenia therapy begins with the elimination of the etiological factor that caused it, treatment is aimed at combating infectious complications, preventing infection, and treating the underlying disease that led to leukopenia.
To avoid infection, the following measures are taken:
- The patient is placed in a separate aseptic ward, where they are regularly cleaned with disinfectants and quartzised.
- The patient's contacts with others are excluded;
- Provides thorough care for the oral cavity, sanitation of mucous membranes and skin.
- Close control of food processing.
Treatment of leukopenia is carried out by two main groups of pharmacological drugs:
- drugs to stimulate blood formation and metabolism;
- hormonal drugs that activate the formation of neutrophils and monocytes in the bone marrow.
During the period of agranulocytosis and / or exacerbation of infectious processes, treatment with immunostimulating, antibacterial drugs, symptomatic and rehabilitation therapy (vitamin therapy, detoxification therapy, maintenance of cardiovascular activity) is carried out. Plasmapheresis is indicated in the presence of antibodies and circulating immune complexes in the blood.
Source: vekzhivu.com
An indication for the appointment of corticosteroid hormones may be a relapse of immune agranulocytosis. Radical treatment for special indications - bone marrow transplant. Chronic leukopenia of splenic origin is eliminated after splenectomy.
Prevention
Prevention of leukopenia includes:
- careful hematological control for the entire period of treatment with myelotoxic drugs;
- the use of medications with a leukopenic effect, on strict necessity with careful observance of the prescribed dosage;
- timely treatment of diseases that cause the development of leukopenia;
- compliance with hygiene standards.
Consequences and complications
In patients with a changed leukocyte count and a reduced number of leukocytes in the blood, the risk of oncological diseases, viral hepatitis and other infections increases several times.
Forecast
An unfavorable prognosis is observed with the development of severe septic complications. The mortality rate for complications of leukopenia arising in the course of the treatment of oncological diseases ranges from 4 to 30%.
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Anna Kozlova Medical journalist About the author
Education: Rostov State Medical University, specialty "General Medicine".
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
