Leukopenia is a very common clinical problem that many people find during a physical exam, but also before surgery or during other treatments.
To understand why leukopenia occurs, we first need to understand what leukocytes are used for.
First of all, leukocytes is a collective term for a large group of cells, including neutrophils, eosinophils, basophils, lymphocytes, and monocytes, each of which has a complex role.
Because neutrophils make up the majority of white blood cells, the clinical meaning of leukopenia generally refers to neutropenia.
The main job of neutrophils is to engulf and kill pathogenic microorganisms. Wherever there is an invasion of foreign enemies or internal disturbances in the body, neutrophils will pounce on them.
That’s right, neutrophils are like people’s warriors, wherever there is a border disaster, natural disaster or turmoil, people’s warriors will jump on it, no matter how big the sacrifice is.
When you see the “pus” (the corpse of a white blood cell), it is perhaps not difficult to imagine the complexity and magnificence of this process.
Decreased white blood cells do not necessarily mean decreased immunity
Whether a decrease in white blood cells means that humans are less immune and more susceptible to disease depends on whether the decrease in white blood cells is physiological or pathological.
Normally, a peripheral blood leukocyte count below 4.0×109/L is called leukopenia, but doctors are not so simple in their understanding and judgment.
The body’s leukocytes are distributed in three main parts: bone marrow, blood vessels and tissues, which are actually the three stages of leukocyte life.
The bone marrow is where the leukocytes are generated, differentiated, matured and stored.
Half of the leukocytes in the blood vessels are mobile, while half are attached to the vessel walls and remain relatively motionless. More than you can imagine, only 0.3%.
The white blood cells are just passing through the blood vessels, just like soldiers in a transport train. Since this mobile part is extremely variable, the number we assay does not always accurately represent the total number of leukocytes in the body, just as the flow of people on the street does not represent the total population of the city.
There are fewer people on the street, so maybe everyone stays in the building, and this is called pseudo-leukopenia. We can give certain stimuli, such as adrenaline experiments. It is like setting off fireworks and dancing with lions in the street, and the flow of people in the street will immediately increase.
Of course not all such stimulation is necessary, and we can often tell by experience that the total population is not small. This physiological decrease in white blood cells does not necessarily indicate a decrease in immune function.
Why do white blood cells decrease? There are many reasons
We commonly see pathological leukopenia as a result of suppression of the bone marrow during chemotherapy drugs or radiation therapy. Other common medications such as antipyretics and antibiotics can almost always cause leukopenia.
In addition, infection, immunity, and genetics are also common causes of leukopenia. Of course there are many patients for whom no specific cause can be found.
Too few white blood cells can increase the risk of infection
Although a physiological decrease in white blood cell data in routine blood tests does not necessarily mean that the body is less immune, if the number of white blood cells is too low, the body is at increased risk of infection.
There are three types of leukocyte counts according to
Mild reduction: ≥1.0×109/L
Moderate decrease: (0.5~1.0)x109/L
Severe decrease: <0.5x109/L
If it is a mild decrease, there is no need to worry at all, the risk of infection is not much different from that of a healthy person, rather the excessive fear of leukopenia is more harmful to health.
If the decrease is severe, the risk increases considerably, and in medical terms it is called granulocyte deficiency, which is one of the medical emergencies.
If it is moderately reduced, it is somewhere in between, and the risk of infection varies from person to person. Most patients clinically have a leukopenia of around 2.0×109/L, which is mild, but are often frightened by their doctors or themselves as if they were severely reduced or even immunodeficient, which is not necessary.
In short, for our leukopenia, first to determine whether it is really reduced, and then second to determine the cause of the reduction, and third to assess the severity.
Can leukopenia be cured by taking medication?
In fact, if the cause of leukopenia is clearly identified, such as medication, then immediate discontinuation of the medication and removal of the cause is the most important and best treatment.
There are many so-called “leukostimulants”, such as berberamine, lithium carbonate, B vitamins, and leucovorin, as well as countless Chinese herbal medicines (gum, spleen and blood, ginseng, astragalus, etc.).
The reason is that with all these medicines, their efficacy is not certain. Therefore, for chronic, stable leukopenia without infection, regular monitoring of the blood picture is sufficient.
Taking medication to “raise white” is only a psychological comfort. In the process of taking your medication, if you are worried and anxious to know the effect, you will find that your white blood cells go up and down, so you will naturally think that the medication is good and bad, and you will feel happy and sad.
In reality, this is just a natural fluctuation in white blood cell counts, just like pedestrians on the street, the population of the city does not change.
The only effective treatment is the “whitening shot”
Of course, there are definitely effective white-boosting drugs, and they are the injectable hematopoietic growth factors (GM-CSF and G-CSF) (commonly known as “white-boosting injections”).
Reliable clinical trials have shown that “white boosting injection” for severe or infected neutropenia can significantly shorten the time to normalization of neutrophils and cure of infection, and reduce the length of hospitalization and hospitalization costs, with a high efficacy-price ratio.
It is often used for granulocyte deficiency caused by radiotherapy and other drugs, which can significantly shorten the time to normalization of granulocytes and reduce the incidence of infection.
However, for chronic granulocytopenia without infection, there is not enough information to show that it helps patients, and the cost is high, so it is not recommended for routine use. Therefore, “leukapheresis” is the only effective and last resort.
In conclusion, the vast majority of chronic leukopenia does not require medication, and there is no medication available to treat it if one wants to; high-risk leukopenia (severe reduction or severe infection) requires hospitalization, and the only effective leuke-boosting agent is the leuke-boosting injection.