The predominance of malignant diseases of the hematologic system in patients hospitalized in the hematology department may lead people to believe that there are more malignant diseases in the hematology department, but in fact, many of the patients concentrated in outpatient treatment are mostly benign diseases with simple leukopenia or thrombocytopenia. The following is a brief description of the common causes of leukopenia and the key points of diagnosis and treatment.
Leukopenia refers to an absolute peripheral blood leukocyte technique consistently below 4.0*109/L; in addition there are neutrophils and lymphocytes in peripheral blood leukocytes, where neutropenia is an absolute peripheral blood neutrophil count below 2.0*109/L in adults, below 1.8*109/L in children over 10 years of age, and below 1.5*109/L in those under 10 years of age. Severe cases below 0.5*109/L are called granulocyte deficiency, which will likely lead to life-threatening and serious infections and require urgent treatment.
[Etiology].
1. Decreased production: ionizing radiation, chemical drugs, etc. can lead to a decrease in leukocyte production, in our life commonly caused by leukocyte reduction drugs are: antipyretic and analgesic drugs (indomethacin, ibuprofen, etc.), but also include such pain relief, such as Sanliacin, Tylenol, symptomatic treatment of “cold” drugs. Other drugs include antibiotics (chloramphenicol, sulfonamides), antithyroid drugs (methyl/propylthiouracil, methimazole, etc.), hypotensive drugs (captopril, methyldopa, etc.), antipsychotics (chlorpromazine, tricyclic antidepressants, etc.), etc.
2, excessive destruction or depletion: if the patient has autoimmune disease can lead to leukocyte and neutrophil reduction, some hepatitis patients may also lead to leukocyte reduction due to immune factors; viral infection or severe bacterial infection, leukocytes or neutrophils in the blood and inflammation site consumption increased resulting in a decrease in peripheral blood counts.
3, distribution abnormalities: most of the leukocytes or neutrophils are attached to the wall of small blood vessels, resulting in reduced cell counts in the peripheral blood circulation, or most of the cells are retained in the spleen to reduce blood leukocytes and neutrophils, in this case, the actual total number of leukocytes and neutrophils in the patient’s body is not reduced, but only transferred from the blood circulation to other parts, while routine blood tests only count the leukocytes and neutrophils in the blood circulation.
Clinical manifestations
1. Mild leukocytopenia or neutropenia often does not present any specific symptoms.
The common sites of infection are the respiratory tract, gastrointestinal tract and genitourinary tract, which can be manifested as oral mucositis, gingivitis, throat and tonsillitis and other upper respiratory tract infections; abdominal pain and diarrhea or urinary system infection symptoms such as urinary frequency and pain.
3.Severe leukocytopenia or neutropenia, such as granulocyte deficiency can present with life-threatening serious infections, manifested as high fever, mucosal necrotizing ulcers and sepsis and septicemia, and even infectious shock.
4. Some patients may mainly present with non-specific symptoms such as fatigue, weakness, dizziness, and loss of appetite.
Examination and diagnosis
1.Ordinary blood tests can detect leukopenia and/or neutropenia, but because laboratory results are affected by a variety of factors, at least 2 or more results are needed to rule out errors in the test method and, if necessary, repeated tests at different medical units may be required.
2. There are multiple test results suggestive of leukopenia and/or neutropenia that can be diagnosed, but more importantly, the cause of the leukopenia needs to be clarified. Therefore, in addition to a detailed history of past illnesses and the specifics of the medications used, the following tests are needed.
1) tests related to autoimmune diseases: complete set of antinuclear antibodies, rheumatic set, etc.
2) Complete set of tests for hepatitis virus.
3) presence of hepatosplenomegaly.
4) bone marrow examination.
5) Other: such as thyroid function and other tests.
[Treatment].
Many patients with mild leukocytosis or neutropenia often do not require special treatment.
1. Etiological treatment, which is the key to treatment, should stop exposure to suspected drugs or other causative factors immediately. If it cannot be avoided based on the analysis of the trade-off between pros and cons, the condition should be closely monitored and promptly treated if there is progress.
2.Infection prevention and control, according to the patient’s specific situation, antibiotic treatment should be given.
3.Promote granulocyte production, apply B vitamins (vitamin B4, B6), Lixin and other drugs, also can use Chinese herbal medicine, but the efficacy is not exact. Recombinant human granulocyte colony-stimulating factor (rhG-CSF) has clear efficacy, can shorten the course of granulocyte deficiency, promote neutrophil proliferation and release, common side effects include fever, musculoskeletal pain, rash, etc. Some patients will have significantly higher white blood cells or even exceed the normal high limit after use, and will fall on their own after stopping the drug.
4. Some patients who have only mild leukocyte or neutropenia and cannot find a clear cause often do not need special treatment, but need to pay attention to avoid using drugs that may lead to leukopenia, exposure to the corresponding physicochemical factors, avoiding infection, and regular rechecking of blood routine.