Normal Lymphopenia count: |
Moderate Lymphopenia count: |
Severe Lymphopenia count: |
Lymphopenia Assessment
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Lymphopenia is common in acute and chronic illness.
1ry |
Primary Immunodeficiency disorders |
|
2ry | Infection | Viral (HIV, Influenza) Bacterial Parasitic (malaria) Fungal |
Medication |
Immunosuppressant’s (steroids, methotrexate) |
|
Systemic disorders | Autoimmune (RA, SLE) Inflammatory bowel disease Renal Failure Cardiac Failure Sarcoidosis |
|
Malignancy | Lymphoproliferative Solid organ malignancy |
|
Other | Alcohol abuse Malnutrition |
- 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
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
- 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.
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 |