Overview
In healthy adults, the blood leukocyte count is usually between 4 and 10 × 109/A liter (4,000 to 10,000 A cubic millimeters); in healthy adults, the absolute value of neutrophils (equal to the total number of leukocytes × the neutrophil percentage) is about 2.0 to 7.5 × 109/A liter (2,000 to 7,500/cubic millimeters). If the white blood cell count in the blood is consistently (multiple examinations) lower than 4×109/liter (4000/cubic millimeter) and the neutrophil percentage is normal or slightly lower, it is called leukopenia; if the absolute value of neutrophils is lower than 1.5×109/liter (1500/cubic millimeter), it is called agranulocytosis; only white blood cell counts lower than 2×109/liter (2000/cubic millimeters) and Only when the white blood cell count is less than 2×109/liter (2000/cubic millimeter) and the neutrophil count is extremely deficient or completely disappeared is it called agranulocytosis, when the absolute value of neutrophil count has been reduced to less than 0.5×109/liter (500/cubic millimeter).
Causes
There are many causes of leukopenia and granulocyte deficiency.
1. Drugs: chloramphenicol, sulfonamides, antipyretic and analgesic drugs, and some anticancer drugs.
2. Chemical substances: long-term contact with organic solvents, such as benzene, xylene and so on.
3. Radiation: long-term exposure to X-rays and other radiation.
4. Infections: typhoid fever, sepsis, hepatitis, etc., all of which may lead to leukopenia and granulocyte deficiency.
5. Other diseases: Some hematological and rheumatic diseases, such as aplastic anemia, acute leukemia and systemic lupus erythematosus, may lead to leukopenia and granulocyte deficiency.
Symptoms
Most patients with leukopenia have symptoms such as dizziness, fatigue, heaviness in both lower limbs, insomnia and dreaminess. Some are susceptible to infections such as colds, pneumonia and bronchitis; a few are asymptomatic and have no infections, which are only detected during tests. Therefore, blood leukocyte counts and categorical counts should be checked in patients with recurrent infections accompanied by malaise and dizziness. However, granulocytopenia and deficiency, especially acute, with a rapid and aggressive onset, accompanied by chills, high fever, headache, excessive sweating, and often pharyngitis, tonsillar abscesses, and perianal ulcers, are commonly caused by the patient’s allergy to medications (aminopyrine, pau d’arco, etc.) or to chemicals (certain cosmetics, etc.). In this case, the diagnosis can be confirmed by checking the white blood cell and classification counts, and effective treatment can be provided.
Tests
1. Blood picture
Red blood cell and platelet counts are mostly normal. Certain malignant tumors infiltrating the bone marrow and accidental acute radiation accidents may be accompanied by anemia and thrombocytopenia. The white blood cell count is <4×109/L, and the absolute value of neutrophil is <0.5×109/L in the case of granulocyte deficiency, and the lymphocyte or monocyte is relatively increased. Neutrophils often have toxic granules, vacuoles and other degeneration in the cytoplasm. In severe infections, leftward shifting of the nucleus or naïve cells are seen. Atypical lymphocytes and abnormal cells should be noted.
2. Bone marrow
The bone marrow picture varies according to the cause of the disease. In the early stage, there may be no obvious changes, or there may be a “maturation disorder” in which there are many young granulocytes and fewer mature granulocytes, or there may be a decrease in the granulocyte lineage in the extreme stage of the disease, with a gradual appearance of granulocytes in various stages of the disease in the recovery stage.
3. Bone marrow biopsy
Bone marrow biopsy is valuable for myelofibrosis, bone marrow metastatic cancer, lymphoma, etc. It can help to identify MDS. Bone marrow examination can help the differential diagnosis of MDS.
4. Bone marrow culture
In vitro CFU-GM colony culture can help to understand the bone marrow proliferative activity, bone marrow neutrophil reserve, and help to identify the direct toxic effects of drugs or immune factors inhibiting granulocyte production.
5. Adrenaline test
Helps to identify pseudo-granulocytopenia.
6. Anti-neutrophil antibody assay
Helps to identify immune granulocytopenia.
7. Other immunologic assays
Antinuclear antibody (ANA), rheumatoid factor (RF) titer measurement, immunoglobulin measurement.
8. Serum lysozyme measurement
Elevated lysozyme suggests that granulocytopenia or lack of granulocytes is due to excessive destruction, while normal or decreased lysozyme indicates decreased granulocyte production.
Diagnosis
Because of the large physiological variation of leukocytes, it is necessary to check the blood image repeatedly and regularly in order to determine whether there is leukopenia or not. Detailed history should be asked, especially the history of medication, chemical or radiation exposure, and infections:
1. Laboratory tests
In leukopenia, the peripheral blood leukocyte count is <4.0×109/L. In granulocytopenia, the absolute value of peripheral blood neutrophils is <2.0×109/L, the lymphocytes are relatively increased, the nuclei of granulocytes are shifted to the left or the nuclei are overfollicated, and there are often toxic particles in the cytoplasm and vacuoles, and other degenerations. Erythrocytes and platelets are generally normal. The bone marrow picture may show a “maturation disorder” with a high number of young granulocytes and a decrease in mature granulocytes, or compensatory hyperplasia.
In granulocyte deficiency, the absolute value of neutrophils in the peripheral blood is less than 0.5×109/L or even disappears. Granulocyte cytoplasm has toxic granules, vacuoles, and solidified nuclei. Lymphocytes are relatively increased. Sometimes monocytes are slightly increased. Erythrocytes and platelets are generally normal. Granulocytes in all stages of the bone marrow almost disappear. In the recovery stage of bone marrow, the early granulocytes increase, presenting a leukemia-like image, followed by the proliferation of granulocytes, close to the normal bone marrow image.
2. Other tests
The detection of positive signs (e.g., tumors, infections, hepatosplenomegaly) can help to find the cause of the disease. Bone marrow examination may be performed to observe the degree of granulocyte proliferation and to exclude other hematologic disorders.
Acute granulocyte deficiency often has a definite cause, and it is not difficult to confirm the diagnosis by combining clinical manifestations, blood and bone marrow changes.
Treatment
For patients with leukopenia, although they can engage in normal work or light work, they need to pay attention to rest, combine work and rest, and do not do heavy physical strength and work at high altitude and underwater to avoid accidents. Usually increase nutrition, appropriate exercise, pay attention to hygiene, prevent infection. For neutropenia and lack of patients, must be hospitalized, the conditions also need to be isolated or live in the laminar flow room, strictly prohibited from visiting the room, the patient after meals to mouthwash, brush your teeth, with disinfectant solution to clean the oral cavity, to keep the perineum, perianal clean, dry, the injection site should be strictly disinfected with iodine, alcohol, to prevent infection.
In addition, for patients with leukopenia and granulocyte deficiency, the cause of the disease must be sought. If it is caused by drugs (such as anticancer drugs, chloramphenicol, sulfonamides and antipyretic and analgesic drugs, etc.), chemical substances (such as benzene, xylene and organic solvents, etc.), radiation (X-rays, radioisotopes, etc.), it must be stopped from applying and contacting; if it is caused by infections (typhoid fever, septicemia, hepatitis, etc.) and other diseases (such as aplastic anemia, acute leukemia, systemic lupus erythematosus, etc.), it must be carried out. Targeted treatment.