Differential Diagnosis for a White Count Less Than 2000 with Low Neutrophils and Lymphocytes
Single Most Likely Diagnosis
- Aplastic Anemia: This condition is characterized by the failure of the bone marrow to produce blood cells, leading to pancytopenia, which includes a low white blood cell count with decreased neutrophils and lymphocytes. It is a common cause of severe leukopenia.
Other Likely Diagnoses
- Viral Infections (e.g., HIV, EBV, CMV): Certain viral infections can suppress bone marrow function or directly affect blood cell production, leading to leukopenia with decreased neutrophils and lymphocytes.
- Chemotherapy or Radiation Therapy: These treatments can damage the bone marrow, resulting in decreased production of blood cells, including neutrophils and lymphocytes.
- Severe Bone Marrow Suppression due to Medications: Some medications, such as immunosuppressants or certain antibiotics, can cause bone marrow suppression, leading to low blood cell counts.
- Autoimmune Disorders (e.g., Lupus): Autoimmune diseases can lead to the destruction of blood cells, including neutrophils and lymphocytes, due to the production of autoantibodies.
Do Not Miss Diagnoses
- Severe Sepsis or Septic Shock: Although the white blood cell count can be elevated in sepsis, in some cases, especially in severe or prolonged sepsis, the count can be low due to consumption of neutrophils and lymphocytes. Missing this diagnosis can be fatal.
- Leukemia or Lymphoma: Certain types of leukemia or lymphoma can present with leukopenia due to bone marrow infiltration by malignant cells, which can suppress normal blood cell production.
- Disseminated Tuberculosis: TB can cause a decrease in blood cell counts, including neutrophils and lymphocytes, due to bone marrow involvement or severe infection.
Rare Diagnoses
- Congenital Neutropenias (e.g., Kostmann Syndrome): These are rare genetic disorders characterized by severe neutropenia, which can also affect lymphocyte counts.
- Idiopathic CD4+ Lymphocytopenia: A rare condition characterized by a low CD4+ T cell count without HIV infection or other known causes of immunodeficiency.
- Myelodysplastic Syndromes: A group of disorders caused by poorly formed or dysfunctional blood cells, which can lead to low blood cell counts, including neutrophils and lymphocytes.