From the Guidelines
Leukopenia in anorexia nervosa is primarily treated with nutritional rehabilitation and weight restoration, as recommended by the American Psychiatric Association 1. The primary goal is to address the underlying malnutrition that leads to bone marrow suppression and subsequently to leukopenia.
- Key aspects of treatment include:
- Individualized goals for weekly weight gain and target weight for patients with anorexia nervosa who require nutritional rehabilitation and weight restoration 1.
- Eating disorder-focused psychotherapy for adults with anorexia nervosa, which should include normalizing eating and weight control behaviors, restoring weight, and addressing psychological aspects of the disorder 1.
- Monitoring for refeeding syndrome with regular checks of electrolytes, especially phosphate, potassium, and magnesium, during the refeeding process.
- A multidisciplinary approach involving a psychiatrist, dietitian, and medical doctor is essential for managing the underlying eating disorder and monitoring the patient's condition 1.
- Complete blood counts should be monitored periodically to track improvement in leukocyte counts.
- Patients with severe leukopenia (white blood cell count below 1,500/μL) may require additional precautions against infection, though prophylactic antibiotics are not routinely recommended.
- The mechanism behind leukopenia in anorexia involves reduced production of white blood cells in the bone marrow due to protein-energy malnutrition, with gelatinous bone marrow transformation sometimes observed in severe cases.
- With appropriate nutritional rehabilitation, most patients will see improvement in their white blood cell counts within weeks to months, as supported by the guidelines for the treatment of patients with eating disorders 1.
From the Research
Anorexia Nervosa and Leukopenia
- Anorexia nervosa (AN) is a psychiatric illness that can lead to significant morbidity and mortality, with leukopenia being one of its complications 2, 3, 4, 5.
- Leukopenia in AN is characterized by a deficiency of lymphocytes or neutrophils, and is often associated with other cytopenias such as anemia and thrombocytopenia 3, 4, 5.
- Studies have shown that patients with AN and leukopenia do not have an increased risk of infection, despite frequent and severe panleukopenia 2.
- The exact mechanism of leukopenia in AN is still unclear, but it is thought to be related to malnutrition, weight loss, and bone marrow atrophy 4, 5.
- Leukopenia and other hematological abnormalities in AN are often reversible with nutritional rehabilitation and weight gain 3, 4, 5.
- It is essential to routinely investigate, monitor, and correct hematological and biochemical abnormalities in patients with AN to prevent chronicity and potential severity of these abnormalities 5.