What does an elevated lymphocyte count with a decreased granulocyte (white blood cell) count indicate?

From the Guidelines

Elevated lymphocyte count with a decreased granulocyte count is a strong indicator of an underlying condition such as viral infections, autoimmune disorders, or certain types of leukemia, and requires immediate medical evaluation to determine the cause and appropriate treatment. This blood profile can be seen in several conditions including viral infections (particularly HIV, hepatitis, cytomegalovirus, and Epstein-Barr virus), certain autoimmune disorders like lupus, some types of leukemia (especially chronic lymphocytic leukemia), and bone marrow disorders, as noted in guidelines for chronic lymphocytic leukemia diagnosis and treatment 1. Some key points to consider in the evaluation of this condition include:

• Viral infections are the most common cause, as the body produces more lymphocytes to fight the virus while viral suppression may reduce granulocyte production
• Certain autoimmune disorders like lupus can also cause this blood profile
• Leukemia, especially chronic lymphocytic leukemia, is another possible cause, with studies showing high complete remission rates from treatments like 2-chloro-2’-deoxyadenosine in previously treated patients 1
• Additional tests, such as a complete blood count with differential, specific viral tests, bone marrow examination, or autoimmune panels, may be necessary to determine the underlying cause
• Treatment targets the underlying condition rather than the blood count abnormality itself, and no specific medication is recommended without knowing the cause
• Low granulocytes can increase the risk of bacterial infections, so good hygiene practices and avoiding sick contacts may be advisable while the cause is being investigated.

From the Research

Elevated Lymphocyte Count with Decreased Granulocyte Count

• An elevated lymphocyte count with a decreased granulocyte (white blood cell) count can indicate a viral infection, as seen in studies 2, 3.
• In the context of COVID-19, a decreased granulocyte count, specifically a decrease in neutrophils, can be associated with a mild or moderate disease course, while an increased lymphocyte count may not be a reliable indicator of disease severity 3, 4.
• However, an elevated lymphocyte count can be seen in some cases of viral infections, and a decreased granulocyte count can be associated with bacterial infections, such as bacteremia 5.
• The combination of an elevated lymphocyte count and a decreased granulocyte count can be seen in some cases of COVID-19, but its clinical significance is not fully understood and requires further research 3, 4.

Diagnostic Value of White Blood Cell Parameters

• White blood cell parameters, including lymphocyte and granulocyte counts, can be useful in distinguishing between viral and bacterial infections, but their diagnostic value is limited 2, 5.
• The measurement of immature granulocytes (IGs) has been shown to be a potential marker for bacteremia and sepsis, and can be used as an alternate indicator for infection 6, 5.
• The neutrophil-to-lymphocyte ratio (NLR) has been shown to be a useful marker for predicting disease severity and progression in COVID-19 patients 3, 4.

Clinical Utility of Automated Immature Granulocyte Measurement

• Automated IG measurement can be a useful tool in the early diagnosis of bacteremia and sepsis, and can provide valuable information for clinical decision-making 5.
• The clinical utility of IG measurement in predicting positive blood culture results has been demonstrated, and its use as a potential marker for infection has been suggested 5.