Lymphopenia Assessment

Lymphopenia is common in acute and chronic illness.

• 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.