Low white blood cells are not necessarily a sign of leukemia. This is because leukemia typically presents with abnormally high white blood cells and can be accompanied by anemia or thrombocytopenia. Of course, there are also leukemias with low white blood cells, and this type of leukemia requires a bone marrow aspiration to further confirm the diagnosis. Low blood white blood cells can also be seen in many other conditions, such as rheumatic immune diseases: rheumatoid arthritis, systemic lupus erythematosus or dry syndrome, all of which can present with low white blood cells. In addition, chronic aplastic anemia can also present with low white blood cells and can be accompanied by anemia and thrombocytopenia. Finally, other diseases, such as megaloblastic anemia and myelodysplastic syndrome, can also present with low white blood cells. Therefore, the presence of low white blood cells should not be the first consideration for the diagnosis of leukemia.