Lymphopenia

Lymphocytopenia is absolute lymphocyte values ??<1000 / ul (adults) and <3000 / ul before (children <2 years). This results in the increased risk of opportunistic infections and malignant and autoimmune diseases. Shows the blood lymphocytopenia, further investigations to clarify an immunological defect and an analysis of lymphocyte subpopulations are necessary. Treatment depends on the underlying disease.

The normal lymphocyte value in adults is 1000-4800 / ul and in children <2 years 3000-9500 / ul. At the age of 6 years, the lower limit of normal is 1500 / ul. In the peripheral blood are both B and T cells. Approximately 75% of lymphocytes are T cells and 25% B cells. Since the lymphocytes make up only about 20-40% of all leukocytes lymphopenia may go undetected if a differential blood count is performed.

Lymphocytopenia is absolute lymphocyte values ??<1000 / ul (adults) and <3000 / ul before (children <2 years). This results in the increased risk of opportunistic infections and malignant and autoimmune diseases. Shows the blood lymphocytopenia, further investigations to clarify an immunological defect and an analysis of lymphocyte subpopulations are necessary. Treatment depends on the underlying disease. The normal lymphocyte value in adults is 1000-4800 / ul and in children <2 years 3000-9500 / ul. At the age of 6 years, the lower limit of normal is 1500 / ul. In the peripheral blood are both B and T cells. Approximately 75% of lymphocytes are T cells and 25% B cells. Since the lymphocytes make up only about 20-40% of all leukocytes lymphopenia may go undetected if a differential blood count is performed. Clinical calculator: Absolute lymphocyte count Nearly 65% ??of T-lymphocytes in the peripheral blood are CD4 + - (helper) cells. For most patients with lymphopenia an absolute reduction in T cells is present, particularly the CD4 + T cells. The number of CD4 + T cells in the blood is in adults average of 1100 / ul (300-1300 / ul). The average value of the other major T-cell subset, the CD8 (suppressor) T-cells is 600 / ul (100 to 900 / ul). Etiology lymphopenia may be Acquired Hereditary Acquired lymphocytopenia Acquired lymphocytopenia can use a series of other diseases associated (see Table: Causes of lymphocytopenias). The most common causes are protein malnutrition AIDS and certain other virus infections, the world's most common cause of acquired lymphopenia is a protein malnutrition. The most common infectious disease that has a lymphopenia results in AIDS. Here, CD4 + T cells are destroyed by infection with HIV. The presence of lymphopenia may also be a sign of inadequate lymphopoiesis, which is caused by a degeneration of the thymus or other lymphoid tissue. In acute, by HIV or other viruses induced viremia often an increased destruction of lymphocytes through the active infection with the virus takes place. Also lymphocytes may remain in the spleen or lymph nodes, or migrate in the respiratory tract. Iatrogenic lymphocytopenia is caused by cytotoxic chemotherapy, radiation therapy or the administration of anti-lymphocyte globulin (or other lymphocyte antibody). Through long-term treatment with psoralen and UV-A radiation in psoriasis, T cells can be destroyed. Glucocorticoids can cause the destruction of lymphocytes. Lymphocytopenia can also be associated with autoimmune diseases such as SLE, rheumatoid arthritis, myasthenia gravis and exudative enteropathy associated sein.Angeborene lymphopenia The causes of congenital lymphopenia (see Table: Causes of lymphocytopenias) are usually heavy combined immunodeficiency Wiskott-Aldrich syndrome you can with inherited immunodeficiency syndromes (immunodeficiency disease) and other diseases may be associated, leading to a disturbed lymphopoiesis. Other hereditary diseases (eg. As Wiskott-Aldrich syndrome, Adenosindesaminasemangel, Purinnukleosidphosphorylasemangel) may be associated with an accelerated destruction of T-cells. In many diseases an antibody deficiency is present. Causes of lymphocytopenias mechanism examples Acquired AIDS Other infectious diseases such as hepatitis, influenza, tuberculosis, typhoid fever and sepsis malnutrition in alcoholism, protein malnutrition Iatrogenic after cytotoxic chemotherapy, corticosteroids, high-dose psoralen / UV-A radiation, immunosuppressive therapy, radiation therapy or ductus thoracicus Drainage Systemic diseases with (auto) immune defects (z. B. aplastic anemia, Hodgkin's disease, myasthenia gravis, exudative enteropathy, rheumatoid arthritis, renal failure, sarcoidosis, SLE, burns) Innate Aplasia lymphopoietic stem cells ataxia telangiectasia cartilage-hair hypoplasia syndrome idiopathic CD4 + T lymphocytopenia immunodeficiency with thymoma severe combined immunodeficiency with defect of the interleukin-2 receptor (?-chain), with ADA or PNP deficiency or unknown cause Wiskott Aldrich syndrome ADA = adenosine deaminase; PNP = purine nucleoside phosphorylase. Symptoms and complaints The lymphopenia in itself does not generally lead to symptoms. However, the findings an associated disorder may include: missing or reduced tonsils or lymph nodes, which suggests cellular immunodeficiency skin lesions (for example, alopecia, eczema, pyoderma, telangiectasia.) Signs of a hematological disorder (e.g., pallor, petechiae, jaundice. mouth ulcers) Generalized lymphadenopathy and splenomegaly, which may indicate HIV infection in patients with recurrent infections occur lymphocytopenias, some with atypical pathogens on. Pneumonia with Pneumocystis jirovecii, cytomegalovirus, rubella and varicella often fatal. Lymphocytopenia also represents a risk factor for the development of cancer and autoimmune diseases. Diagnosis Clinical suspicion (repeated or unusual infections) blood count with differential blood count of lymphocyte subpopulations and immunoglobulin levels in patients who develop repeated to viral, fungal or parasitic infections is that suspected lymphocytopenia; usually it is accidentally discovered in the blood. Pneumonia with P. jirovecii, cytomegalovirus, rubella and varicella indicate an immunodeficiency. In patients with lymphopenia lymphocyte subpopulations should be determined. To evaluate the antibody formation, immunoglobulin levels should be measured. Occurred, should be carried out a full examination of all laboratory values ??for screening immunodeficiency (examination of patients with suspected immune deficiency) are required, even if the screening tests have failed normal for a patient to recurrent infections. Treatment Treatment of associated infections treating the underlying disease Occasionally i.v. Maybe immunoglobulin blood-forming stem cell transplantation The acquired lymphocytopenias lets lymphopenia after usual when the underlying cause is eliminated or the underlying disease is successfully treated. I.v. Administration of immunoglobulins is indicated if the patient has a chronic IgG deficiency, lymphocytopenia and recurrent infections. Hematopoietic stem cell transplantation may be curative in congenital immune deficiencies and should therefore be considered with this type diseases (hematopoietic stem cell transplantation) in all patients. Summary lymphopenia is usually caused by AIDS or malnutrition, but can also be congenital or caused by various infections, drug or autoimmune diseases. Patients have recurrent infections caused by viruses, fungi or parasites. The lymphocyte subpopulations and immunoglobulin levels should be determined. Treatment is directed generally to the cause; occasionally is an i.v. Immunoglobulin administration or, in patients with congenital immunodeficiency, a stem cell transplant of benefit.

Health Life Media Team

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