From the Research
Introduction to Leukopenia
Leukopenia is a condition characterized by a decrease in the number of white blood cells, which can increase the risk of infections 1. The evaluation of leukopenia should be guided by the severity of the condition, duration, and clinical status of the patient.
Initial Lab Workup
The initial lab workup for a patient with leukopenia should include:
- A complete blood count (CBC) to determine the severity of leukopenia and to rule out other cytopenias 2
- A blood smear to evaluate the morphology of the white blood cells 2
- Automated total blood cell count to analyze the different leukocyte subpopulations 2
Differential Diagnosis
The differential diagnosis of leukopenia is vast and includes:
- Intrinsic causes such as impaired proliferation and maturation of myeloid progenitor cells in the bone marrow 1
- Extrinsic causes such as drugs, infections, and autoimmune disorders [(1,3)]
- Systemic diseases such as familial Mediterranean fever 4
- Benign reversible causes such as iron deficiency anemia 3
Further Evaluation
Further evaluation of leukopenia may include:
- Bone marrow examination, which is more frequently ordered in patients with neutropenia 3
- Flow-cytometry, which is useful in specific settings 5
- Autoimmune laboratory tests to evaluate for autoimmune disorders 3
- Molecular analysis to evaluate for genetic disorders 4
Treatment
Treatment of leukopenia is aimed at managing the underlying cause of the condition. In some cases, treatment with antibiotics may be necessary to prevent infections 1. The dosage and duration of treatment will depend on the underlying cause and the severity of the condition.
Caveats
It is essential to note that not all leukopenia is due to underlying cancer, and a thorough evaluation should be done to rule out other causes 5. Additionally, autoimmunity is a significant factor leading to isolated leukopenia, and autoimmune disorders should be considered in the differential diagnosis 3.