Lymphopenia Assessment

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Definition

Normal Lymphopenia count:
1.5-4.0x10/9L.

Moderate Lymphopenia count:
<1.0x10/9L

Severe Lymphopenia count:
<0.5x10/9L

Aetiology

Lymphopenia is common in acute and chronic illness.

1ry

Primary Immunodeficiency disorders


Severe combined immunodeficiency
Common variable immune deficiency

2ry Infection Viral (HIV, Influenza)
Bacterial
Parasitic (malaria)
Fungal
  Medication

Immunosuppressant’s (steroids, methotrexate)
Monoclonal antibodies (rituximab)
Chemotherapy

  Systemic disorders Autoimmune (RA, SLE)
Inflammatory bowel disease
Renal Failure
Cardiac Failure
Sarcoidosis
  Malignancy Lymphoproliferative
Solid organ malignancy
  Other Alcohol abuse
Malnutrition
Assessment
  • Check for recent (last 6 months) infection
  • Assess for signs of recurrent or prolonged infection (suggesting immunocompromise)
  • Review medication as above
  • Review for underlying systemic disease (Including weight loss, fever, night sweats)
  • Examination to include lymphadenopathy, splenomegaly, joint abnormalities, rashes
  • Check for alcohol misuse and malnourishment
Investigation

1. Unless acutely unwell, repeat FBC after 6/52 to confirm lymphopenia
2. Lymphopenia is common in the elderly. In the absence of concerning symptoms there is no need to investigate further if the lymphocyte count is > 0.5x109/L
For all other cases perform,
3. U+E/LFT
4. HIV if high risk activity or prolonged, unexplained lymphopenia
5. ANA/RF if connective tissue disorder suspected
6. Serum immunoglobulin’s if immunodeficiency suspected

Follow Up
  • If patient well, normal examination and investigation as above then repeat history/examination once at 6 months and if remains normal there is no need to investigate further (lymphopenia may persist but this is not a reason in itself for referral if the above normal).
  • Referral if concern: this may be to General Medicine, Rheumatology, Infectious Diseases, Haematology dependent on presentation and clinical findings.
Glossary
Abbreviation Meaning
SLE Systemic lupus erythematosus 
RA Rheumatoid arthritis 
FBC Full blood count
U+Es Urea and electrolytes
LFT Liver function test
HIV Human immunodeficiency virus
ANA/RF Antinuclear antibody/rheumatoid factor
Editorial Information

Last reviewed: 31 July 2015

Next review: 31 July 2017

Author(s): Consultant Haematologist

Version: 1

Approved By: TAM subgroup of ADTC

Reviewer Name(s): Dr Jo Craig

Document Id: TAM216