From the Guidelines
Neutropenia with lymphocytosis is a significant condition that requires prompt evaluation and management to prevent morbidity and mortality, particularly in patients with cancer or those undergoing immunosuppressive therapy, as it can lead to severe infections and sepsis 1.
Causes and Risk Factors
This blood pattern can result from various underlying causes, including:
- Viral infections, such as influenza, hepatitis, and COVID-19, which can temporarily suppress neutrophil production while increasing lymphocyte production to fight the virus
- Autoimmune disorders, like lupus or rheumatoid arthritis, which can create a similar blood profile
- Certain medications, particularly those affecting bone marrow function, such as chemotherapy drugs, which can suppress neutrophil production while lymphocytes remain elevated
- Specific types of leukemia, such as chronic lymphocytic leukemia, which can also indicate this pattern
Evaluation and Management
If you have this blood pattern, it's essential to consult with a healthcare provider for proper evaluation, which typically includes:
- A complete blood count with differential
- Physical examination
- Possibly additional testing based on your symptoms and medical history Treatment depends entirely on the underlying cause rather than the blood count pattern itself. In some cases, granulocyte-colony-stimulating factor (G-CSF) may be administered to reverse neutropenia and reduce the risk of bacterial infections 1.
Prognosis and Outcome
The prognosis and outcome of neutropenia with lymphocytosis depend on the underlying cause and the patient's overall health status. In patients with cancer or those undergoing immunosuppressive therapy, this condition can lead to severe infections and sepsis, which can be life-threatening if not promptly treated 1. Therefore, it's crucial to seek medical attention immediately if you experience any symptoms of infection, such as fever, chills, or difficulty breathing.
From the Research
Definition and Classification of Neutropenia
- Neutropenia is defined as a neutrophil count lower than 1.5g/L, with categorization as mild, moderate, or severe when the count is 1.5-1g/L, 1-0.5g/L, or <0.5g/L, respectively 2
- Neutropenia can be classified as transient or chronic, with chronic neutropenia further described as extrinsic or intrinsic 3
Causes of Neutropenia
- Medications are a common cause of neutropenia, particularly in patients with rheumatoid arthritis 2
- Other causes of neutropenia include folic acid deficiency, autoimmune reactions, and splenomegaly 2
- Drug-induced immune neutropenia (DIIN) occurs when drug-dependent antibodies form against neutrophil membrane glycoproteins and cause neutrophil destruction 4
Lymphocytosis with Neutropenia
- A study found evidence of a novel, abnormal T-cell population associated with antibody-mediated neutrophil destruction in a patient with chronic lymphocytosis and neutropenia 5
- Autoimmune neutropenias (AIN) in adults are characterized by autoantibodies directed against neutrophils, resulting in destruction of neutrophils, and can be associated with underlying autoimmune diseases, malignancies, infections, or drug exposure 6
Clinical Significance of Neutropenia with Lymphocytosis
- Neutropenia with lymphocytosis can increase the risk of infections, particularly in patients with severe neutropenia 2, 3
- The presence of lymphocytosis with neutropenia may indicate an underlying autoimmune or malignant process 5, 6
- Treatment of neutropenia with lymphocytosis depends on the underlying cause and may involve discontinuation of offending medications, treatment of underlying infections or autoimmune diseases, and use of colony-stimulating factors or other immunomodulatory therapies 2, 3, 6