What is leukopenia

Leukopenia means a low white blood cell count, which is a decrease in disease-fighting white blood cells (leukocytes) in your blood (<4,000 white blood cell/mm³). Leukopenia is almost always related to a decrease in a certain type of white blood cell called the neutrophil.

Leukopenia definition of low white blood cell count varies from one medical practice to another. In general, for adults a count lower than 4,000 white blood cells per microliter of blood is considered a low white blood cell count. For children, that threshold varies with age.

Some people who are otherwise healthy have white cell counts that are lower than what’s usually considered normal, but which are normal for them.

Is leukopenia cancer?

It depends. Leukopenia means a low white blood cell count (<4,000 white blood cell/mm³).

Leukopenia (low white blood cell count) usually is caused by:

• Viral infections that temporarily disrupt the work of bone marrow
• Certain disorders present at birth (congenital) that involve diminished bone marrow function
• Cancer or other diseases that damage bone marrow
• Autoimmune disorders that destroy white blood cells or bone marrow cells
• Severe infections that use up white blood cells faster than they can be produced
• Medications, such as antibiotics, that destroy white blood cells
• Sarcoidosis (collections of inflammatory cells in the body)

Specific causes of leukopenia (low white blood cell count) include:

• Aplastic anemia
• Chemotherapy
• HIV/AIDS
• Hypersplenism (an abnormality of the spleen causing blood cell destruction)
• Kostmann’s syndrome (a congenital disorder involving low production of neutrophils)
• Leukemia
• Lupus
• Malnutrition and vitamin deficiencies
• Myelodysplastic syndromes
• Myelokathexis (a congenital disorder involving failure of neutrophils to enter the bloodstream)
• Radiation therapy
• Rheumatoid arthritis and other autoimmune disorders
• Tuberculosis (and other infectious diseases)

Leukopenia vs Neutropenia

Neutropenia occurs when you have too few neutrophils, a type of white blood cells. While all white blood cells help your body fight infections, neutrophils are important for fighting certain infections, especially those caused by bacteria. Leukopenia is sometimes used interchangeably with neutropenia.

You probably won’t know that you have neutropenia. People often only find out when they’ve had blood tests done for other reasons.

A single blood test showing low levels of neutrophils doesn’t necessarily mean you have neutropenia. These levels can vary from day to day, so if a blood test shows you have neutropenia, it needs to be repeated for confirmation.

Neutropenia can make you more vulnerable to infections. When neutropenia is severe, even the normal bacteria from your mouth and digestive tract can cause serious illness.

Numerous factors may cause neutropenia through destruction, decreased production or abnormal storage of neutrophils.

Cancer and cancer treatments

Cancer chemotherapy is a common cause of neutropenia. In addition to killing cancer cells, chemotherapy can also destroy neutrophils and other healthy cells.

• Leukemia
• Chemotherapy
• Radiation therapy

Drugs

• Medications used to treat overactive thyroid, such as methimazole (Tapazole) and propylthiouracil
• Certain antibiotics, including vancomycin (Vancocin), penicillin G and oxacillin
• Antiviral drugs, such as ganciclovir (Cytovene) and valganciclovir (Valcyte)
• Anti-inflammatory medication for conditions such as ulcerative colitis or rheumatoid arthritis, including sulfasalazine (Azulfidine)
• Some antipsychotic medications, such as clozapine (Clozaril, Fazaclo, others) and chlorpromazine
• Drugs used to treat irregular heart rhythms, including quinidine and procainamide
• Levamisole — a veterinary drug that’s not approved for human use in the United States, but may be mixed in with cocaine

Infections

• Chickenpox
• Epstein-Barr
• Hepatitis A
• Hepatitis B
• Hepatitis C
• HIV/AIDS
• Measles
• Salmonella infection
• Sepsis (an overwhelming bloodstream infection)

Autoimmune diseases

• Granulomatosis with polyangiitis (formerly called Wegener’s granulomatosis)
• Lupus
• Rheumatoid arthritis

Bone marrow disorders

• Aplastic anemia
• Myelodysplastic syndromes
• Myelofibrosis

Additional causes

• Conditions present at birth, such as Kostmann’s syndrome (a disorder involving low production of neutrophils)
• Unknown reasons, called chronic idiopathic neutropenia
• Vitamin deficiencies
• Abnormalities of the spleen

People can have neutropenia without an increased risk of infection. This is known as benign neutropenia.

Leukopenia causes

White blood cells are manufactured in your bone marrow — the spongy tissue inside some of your larger bones. Leukopenia (low white blood cell count) usually is caused by:

• Viral infections that temporarily disrupt the work of bone marrow
• Certain disorders present at birth (congenital) that involve diminished bone marrow function
• Cancer or other diseases that damage bone marrow
• Autoimmune disorders that destroy white blood cells or bone marrow cells
• Severe infections that use up white blood cells faster than they can be produced
• Medications, such as antibiotics, that destroy white blood cells
• Sarcoidosis (collections of inflammatory cells in the body)

Specific causes of leukopenia (low white blood cell count) include:

• Aplastic anemia
• Chemotherapy
• HIV/AIDS
• Hypersplenism (an abnormality of the spleen causing blood cell destruction)
• Kostmann’s syndrome (a congenital disorder involving low production of neutrophils)
• Leukemia
• Lupus
• Malnutrition and vitamin deficiencies
• Myelodysplastic syndromes
• Myelokathexis (a congenital disorder involving failure of neutrophils to enter the bloodstream)
• Radiation therapy
• Rheumatoid arthritis and other autoimmune disorders
• Tuberculosis (and other infectious diseases)

Infections during cancer treatment can be life threatening and require urgent medical attention. Be sure to talk with your doctor or nurse before taking medicine—even aspirin, acetaminophen (such as Tylenol®), or ibuprofen (such as Advil®) for a fever. These medicines can lower a fever but may also mask or hide signs of a more serious problem.

Some types of cancer and treatments such as chemotherapy may increase your risk of infection. This is because they lower the number of white blood cells, the cells that help your body to fight infection. During chemotherapy, there will be times in your treatment cycle when the number of white blood cells (called neutrophils) is particularly low and you are at increased risk of infection. Stress, poor nutrition, and not enough sleep can also weaken the immune system, making infection more likely.

You will have blood tests to check for neutropenia. Medicine may sometimes be given to help prevent infection or to increase the number of white blood cells.

Leukopenia symptoms

Leukopenia or neutropenia doesn’t cause obvious symptoms, so it alone probably won’t prompt you to go to your doctor. Leukopenia or neutropenia is usually discovered when blood tests are done for other reasons.

Talk to your doctor about what your test results mean. A finding of leukopenia or neutropenia combined with the results from other tests might indicate the cause of your condition. Your doctor also may need to repeat the blood test to confirm your results or order additional tests to find out what’s causing your leukopenia or neutropenia.

An infection is the invasion and growth of germs in the body, such as bacteria, viruses, yeast, or other fungi. An infection can begin anywhere in the body, may spread throughout the body, and can cause one or more of these signs:

• Fever of 100.4 °F (38 °C) or higher or chills
• Cough or sore throat
• Diarrhea
• Ear pain, headache or sinus pain, or a stiff or sore neck
• Skin rash
• Sores or white coating in your mouth or on your tongue
• Swelling or redness, especially where a catheter enters your body
• Urine that is bloody or cloudy, or pain when you urinate

If you’ve been diagnosed with leukopenia or neutropenia, call your doctor right away if you develop signs of an infection, which may include:

• Fever above 100.4 degrees F (38 degrees C)
• Chills and sweats
• A new or worsening cough
• Shortness of breath
• A mouth sore
• A sore throat
• Any changes in urination
• A stiff neck
• Diarrhea
• Vomiting
• Redness or swelling around any area where skin is broken or cut
• New vaginal discharge
• New pain

If you have leukopenia or neutropenia, your doctor may recommend measures to lessen your risk of infection, such as staying up to date on vaccinations, washing your hands regularly and thoroughly, wearing a face mask, and avoiding large crowds and anyone with a cold or other contagious illness.

Leukopenia treatment

Leukopenia treatment involves treating the underlying cause of the leukopenia.

In cancer chemotherapy, the timing of the drop in neutrophil levels is based on the type or dose of chemotherapy. Neutrophil counts generally start to drop about a week after each round of chemotherapy begins. Neutrophil levels reach a low point about 7 to 14 days after treatment. This is called the nadir. At this point, you are most likely to develop an infection. Your neutrophil count then starts to rise again. This is because your bone marrow restarts normal production of neutrophils. But it may take 3 to 4 weeks to reach a normal level again.

Granulocyte colony stimulating factor (G-CSF) and granulocyte-macrophage colony stimulating factor (GM-CSF) have been available since the early 1990s to raise neutrophil counts, and shorten the duration of neutropenia during anticancer treatment, particularly chemotherapy, by stimulating the bone marrow to produce neutrophils. However, side effects include diarrhoea, weakness, a flu-like syndrome, and rarely more serious complications such as clotting disorders and capillary leak syndrome. Granulocyte colony stimulating factor (G-CSF) and granulocyte-macrophage colony stimulating factor (GM-CSF) must be given by injection, and this may lead to local reactions at the site of administration, and repeated injections may not be desired by patients. Depot formulations are available but expensive.

The likelihood of infection may be reduced by the pre-emptive use of antibiotics, chosen to cover the most likely pathogens, and the time period of greatest risk for infection. The most serious bacterial infections are likely to arise from gram-negative organisms, but as the duration and degree of immunocompromise increase, significant infections can arise from other sources too. Typical antibiotics used for prophylaxis include the fluoroquinolones, and cotrimoxazole. These are given orally, but commonly incur patient-related risks of gut disturbance, allergy, etc and more general risks related to the development of antibiotic resistance in populations.

Ways to prevent infection

Your health care team will talk with you about these and other ways to prevent infection:

• Wash your hands often and well. Use soap and warm water to wash your hands well, especially after using the bathroom and before eating. Have people around you wash their hands well too.
• Stay extra clean. If you have a catheter, keep the area around it clean and dry. Clean your teeth well and check your mouth for sores or other signs of an infection each day. If you get a scrape or cut, clean it well. Let your doctor or nurse know if your bottom is sore or bleeds, as this could increase your risk of infection.
• Avoid germs. Stay away from people who are sick or have a cold. Avoid crowds and people who have just had a live vaccine, such as one for chicken pox, polio, or measles. Follow food safety guidelines; make sure the meat, fish, and eggs you eat are well cooked. Keep hot foods hot and cold foods cold. You may be advised to eat only fruits and vegetables that can be peeled, or to wash all raw fruits and vegetables very well.
• Get plenty of rest.
• Eat a well-balanced diet.
• Avoid contact with people who are sick.
• Do not share food, cups, utensils, toothbrushes, or makeup.
• Shower or bathe daily.
• Apply lotion to prevent dry and cracked skin.
• Be careful using sharp objects, such as scissors or knives. To avoid cuts, consider using an electric shaver and a blunt nail file instead of nail clippers.
• Do not eat raw foods, including meats, shellfish, and eggs. And wash raw fruits and vegetables. Learn more about food safety.
• Do not change cat litter or handle animal waste.
• Use gloves during gardening and housework, especially while cleaning.
• Clean your teeth and gums with a soft toothbrush. Use a mouthwash to prevent infections if your doctor or dentist recommends it.