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Published on: July 20, 2016
[Diagnosis of lymphocytopenia]
Alice Berezné1, Wafaa Bono, Loïc Guillevin
1Service de médecine interne, Hôpital Cochin, AP-HP, université Paris-Descartes, faculté de médecine, Paris (75).
Insights
Lymphopenia, a low lymphocyte count, can result from production defects, increased breakdown, or abnormal trapping. This classification aids in understanding diverse causes of this immune condition.
Area of Science:
- Immunology
- Hematology
Context:
- Lymphopenia is defined by specific lymphocyte counts in adults and young children.
- Understanding the underlying mechanisms of lymphopenia is crucial for diagnosis and management.
Purpose:
- To propose a mechanistic classification of lymphopenia.
- To categorize lymphopenia based on lymphocyte production defects, catabolism, trapping, and other poorly understood causes.
Summary:
- Classifies lymphopenia into four main categories: lymphocyte production defects (primary immune deficiencies, malnutrition, zinc deprivation), excess catabolism (radiotherapy, chemotherapy, HIV, lupus), abnormal lymphocyte trapping (splenomegaly, viral infections, septic shock, burns, corticosteroids), and other causes (ethnicity, lymphoma, renal insufficiency, idiopathic CD4 lymphocytopenia).
Impact:
- Provides a structured framework for understanding the diverse etiologies of lymphopenia.
- Facilitates more accurate diagnosis and targeted treatment strategies for patients with lymphopenia.
Abstract:
Lymphopenia is defined as a peripheral lymphocyte count lower than 1500/mm3 in adults and 4500/mm3 in children younger than eight months of age. We propose a classification of lymphopenia according to the mechanism involved: lymphocyte production defects, including primary immune deficiencies and immune deficiencies secondary to malnutrition or zinc deprivation; excess catabolism, due to causes including radiotherapy, chemotherapy, immunosuppressive therapy, HIV infection, and systemic lupus erythematosus; abnormal lymphocyte trapping, including mainly splenomegaly, certain viral infections, septic shock, extended burns, systemic granulomatosis, and corticosteroids; other causes of lymphocytopenia, with mechanisms that remain poorly understood: ethnicity (Ethiopians), lymphoma, renal insufficiency, and idiopathic CD4 lymphocytopenia.
