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White blood cells and bone marrow in typhoid fever
Insights
Typhoid fever can cause low white blood cell counts (leukopenia) and low neutrophil counts (neutropenia). Bone marrow examination revealed hemophagocytosis, a key factor in these blood count changes.
Area of Science:
- Hematology
- Infectious Diseases
- Pediatrics
Background:
- Leukopenia and neutropenia are commonly associated with typhoid fever.
- Previous studies suggest these findings are characteristic of the disease.
Purpose of the Study:
- To investigate the prevalence of leukopenia and neutropenia in children with typhoid fever.
- To explore the underlying mechanisms, including hemophagocytosis, contributing to these blood count abnormalities.
Main Methods:
- Studied 29 children (8 months to 15 years) diagnosed with typhoid fever.
- Performed epinephrine stimulation tests in 3 patients to rule out margination.
- Conducted bone marrow examinations in 3 neutropenic/leukopenic patients and 3 controls.
Main Results:
- Mild neutropenia (3%) and leukopenia (20%) were observed in the studied children.
- Epinephrine tests did not support excessive margination as the cause.
- Bone marrow analysis revealed hemophagocytosis in affected patients but not in controls.
Conclusions:
- Hemophagocytosis is a significant mechanism contributing to neutropenia, leukopenia, anemia, and thrombocytopenia in typhoid fever.
- These findings highlight the importance of bone marrow examination in understanding hematological changes in infectious disorders.
Abstract:
Leukopenia and/or neutropenia are thought to be characteristic findings in patients with typhoid fever. In a study of 29 children 8 months to 15 years of age mild neutropenia was found in 1 (3%) and leukopenia in 6 (20%) patients. These findings are similar to those reported recently. Epinephrine stimulation tests done in 3 patients excluded the possibility of excessive margination as a cause of neutropenia or leukopenia. In 3 neutropenic or leukopenic patients bone marrow examination showed hemophagocytosis with an increased number of histiocytes that had phagocytized neutrophils, red blood cells and platelets. This phenomenon was not seen in the bone marrow of 3 patients with normal white blood cell counts. Hemophagocytosis is an important mechanism in producing neutropenia, anemia and thrombocytopenia in several infectious and noninfectious disorders.