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Lymphocytopenia

  1. Gastroepato
  2. Hematology
  3. Lymphocytopenia
  4. Granulocytopenia
  5. Generalized lymphadenopathy
  6. The blood
  7. Lymphomas
  8. Lymphocyte series

notes by dr Claudio Italiano 

It is difficult to evaluate the production and the lymphocyte circulation because both the B lymphocytes and the T lymphocytes are replicated in different locations such as lymph nodes, spleen, tonsils and bone marrow and migrate everywhere, having the ability to stay in circulation and spread to the tissues peripheral, making their count impossible. Nevertheless, a value between 2 and 4 X 10 9 / dL is considered normal, of which 20% of this quota consists of B lymphocytes and 70% of T lymphocytes. Thus, lymphocytopenia is defined as the lymphocyte count on peripheral blood below the levels of 1.5 x 10 9 / dL and becomes the very strict condition if the number drops to 0.7 x 10 9/dL.

Etiology and pathogenesis

Lymphocytopenia can derive from three types of alterations:
- The production of the lymphocytes themselves
- Circulation or redistribution
- Loss or destruction

In the first case, production is reduced if factors such as cachexia or protein malnutrition occur, with the risk of serious incidence of infections in the population; radiation and immunosuppressive drugs, such as alkylating agents and lymphocyte serum, may induce lymphocytopenia. There are still inherited conditions such as congenital immunodeficiencies, conditions in which the selective deficit of B lymphocytes (bone marrow derivated) or T (thymus-derived) lymphocytes is determined. How it can happen that the B or T line is compromised is not yet very clear. It is also possible that some viruses such as the famous AIDS or HIV virus, ie human immunodeficiency virus, can cause acquired immunodeficiency. In the case of HIV, they will be infected and affected by specific populations of T lymphocytes, the so-called CD4 + or T Helper, thus defined for their key role in the "help" of the defense immunological response, which consists in amplifying and coordinating the same .

The same applies to patients with Hodgkin's lymphoma, if not properly treated. In the following case, the redistribution of the lymphocytes is determined as a result of infectious facts, both bacterial infections, and during surgical interventions, traumas or hemorrhages.

This response is a function of high levels of endogenous glucocorticoids, produced by the adrenal gland, during stress, which causes the collapse of the number of circulating lymphocytes and, therefore, a lymphocytopenia of both T and B lymphocytes. Similarly, therapies with cortisone cause a shift of lymphocytes to the periphery, but at its suspension levels return to normal within a few days. Lymphopenia, classically, is determined in patients with widespread granulomatosis, for example patients with tuberculosis. In the last condition, the loss is determined by viral infections or by the presence of anti-lymphocyte antibodies, especially in patients with autoimmune or rheumatic diseases. Therefore, in these patients it would be advisable to check the immunological system, through the count of the CD4 + helper T and the cytotoxic-suppressor CD8 + T, by measuring the serum immunoglobulins and performing the skin tests to identify deficiencies. cell-mediated immunity.

Topics of Gastroepato

Cardiology

Dermatology

Diabetology

Hematology

Gastroenterology

Neurology

Nephrology
and Urology


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Psychiatry

Oncology
Clinical Sexology

Causes of lymphocytopenia

Abnormalities of lymphocyte production
Protein malnutrition
Radiation
Therapeutic immunosuppressive agents
Glucocorticoids
Cyclosporine
Congenital immunodeficiency states
Wiskott-Aldrich syndrome
Nezelof syndrome
Deficiency of adenosine deaminase
Viral infections
Hodgkin's disease
Multiple myeloma
Generalized granulomatous infections (eg from mycobacteria, fungi etc.)
Cytotoxic chemotherapy
Fludarabine
Cyclophosphamide
Reactions to drugs, ex. quinine
Alterations of lymphocyte circulation
Acute bacterial / fungal infections
Surgical interventions
traumas
hemorrhage
Glucocorticoid therapy
Viral infections
Destruction or loss of lymphocytes

HIV infections or other viruses
Destruction of mediated antibody lymphocytes
Enteropathy proteinodisperdente
Chronic ventricular failure
Drainage of the thoracic duct

Treatment

The treatment is highly specialized and must be entrusted to hematology centers. In general, the pathology underlying lymphocytopenia should be sought, not lymphocytopenia in itself. Patients with reduced dosage of immunoglobulins may benefit from supportive therapy with intravenous hyperimmune immunoglobulins to reduce the risk of infection. Excellent results are obtained with allogeneic bone marrow transplantation, obviously in targeted cases. In addition, fetal liver stem cells or thymic epithelial cells were used. People with adenosine deaminase deficiency are recently benefited by treatment with this enzyme and an adjuvant to which the enzyme is connected to make it act in vivo.

Hematology