From the Guidelines
Steroids can induce leukopenia, particularly with high-dose or prolonged therapy, due to their immunosuppressive effects on bone marrow function and white blood cell redistribution. This is a critical consideration in the management of patients on long-term steroid therapy, as evidenced by the British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults 1. The guidelines highlight the numerous side effects associated with prolonged steroid use, including increased infection risk, which can be partly attributed to leukopenia.
Key points to consider in the context of steroid-induced leukopenia include:
- The mechanism involves suppression of bone marrow function and redistribution of white blood cells away from the circulation
- Steroids primarily cause lymphopenia rather than neutropenia, though overall white cell counts can be affected
- The effect is typically dose-dependent and reversible upon dose reduction or discontinuation of the steroid
- Patients on long-term steroid therapy should have regular complete blood count monitoring to detect any significant changes in their white blood cell count
In clinical practice, the management of steroid-induced leukopenia may involve adjusting the steroid dosage, considering alternative treatments, or implementing infection prevention strategies depending on the severity and clinical context, as supported by the guidelines 1. It is essential to weigh the benefits of steroid therapy against the potential risks, including leukopenia, to optimize patient outcomes in terms of morbidity, mortality, and quality of life.
From the FDA Drug Label
Hematologic anemia, neutropenia (including febrile neutropenia)
Steroids, such as prednisone, can induce leukopenia, specifically neutropenia, which is a type of leukopenia characterized by a low neutrophil count. This is listed as a potential adverse reaction in the drug label. Key points to consider:
- Neutropenia is a direct adverse reaction associated with prednisone.
- Leukopenia is a broader term that encompasses various types of low white blood cell counts, including neutropenia.
- The drug label explicitly mentions neutropenia, including febrile neutropenia, as a potential adverse reaction 2.
From the Research
Steroids and Leukopenia
- There is no direct evidence to suggest that steroids induce leukopenia.
- In fact, studies have shown that corticosteroids can cause leukocytosis, which is an increase in the number of white blood cells 3, 4, 5.
- Leukopenia, on the other hand, is a decrease in the number of white blood cells, and it can be caused by various factors such as infection, drugs, malignancy, and immunoneutropenia 6.
- Steroids have been shown to have anti-inflammatory and immune-modulating properties, but they can also have side effects, including changes in white blood cell count 7.
- However, the available evidence suggests that steroids are more likely to cause an increase in white blood cell count (leukocytosis) rather than a decrease (leukopenia) 3, 4, 5.