Lymphopenia
Description:
Lymphopenia - decrease in total number of lymphocytes (< 1000/мкл у взрослых или < 3000/мкл у детей младше 2 лет). Последствия лимфопении включают развитие оппортунистических инфекций и повышенный риск онкологических и аутоиммунных заболеваний. Если при выполнении общего анализа крови выявляется лимфопения, необходимо выполнение диагностических тестов при иммунодефицитных состояниях и анализ субпопуляций лимфоцитов. Лечение направлено на основное заболевание.
The normal number of lymphocytes at adults of 1000 to 4800/mkl, at children are younger than 2 years from 3000 to 9500/mkl. At the age of 6 years the normal lower limit of lymphocytes makes 1500/mkl. At peripheral blood there are both T - and V-lymphocytes. About 75% make T lymphocytes and 25% - V-lymphocytes. As the share of lymphocytes makes only 20-40% of total number of leukocytes of blood, the lymphopenia can not be defined at blood test without definition of a leukocytic formula.
Nearly 65% of T-blood cells are CD4 T lymphocytes (helper). Most of patients with a lymphopenia have decrease in absolute number of T-cells, especially quantities of CD4 of T-cells. The average CD4 of T-cells at adults 1100/mkl (from 300 to 1300/mkl), average quantity of other large subpopulation of T lymphocytes, CD8 of T-cells (suppressors) is 600/mkl (100-900/mkl).
Differentiation of lymphocytes
Main functions of lymphocytes
Lymphopenia reasons:
The inborn lymphopenia is shown at inborn immunodeficient diseases and diseases at which there is a disturbance of products of lymphocytes. At some hereditary diseases, such as Viskotta-Aldrich's syndrome, there is a deficit of an adenosinedeaminase, purine nukleozidfosforilaza, there is an increased destruction of T lymphocytes. At many hereditary diseases is available as well deficit of antibodies.
The acquired lymphopenia meets at a large number of various diseases. Around the world the most frequent reason of a lymphopenia - insufficient proteinaceous food. The most frequent infectious disease causing a lymphopenia is AIDS at which the struck T-cell CD4 HIV collapse. The lymphopenia can be the consequence of disturbance of products of lymphocytes caused by damage of structure of a thymus gland or lymph nodes. At the acute viremiya caused by HIV or other viruses, lymphocytes can be exposed to the accelerated destruction caused by active infectious process, be taken a spleen or lymph nodes or to migrate to the respiratory highway.
Long therapy of psoriasis using Psoralenum and ultra-violet radiation can destroy T-cells.
The iatrogenic lymphopenia is caused by cytotoxic chemotherapy, radiation therapy or introduction anti-lymphocytic immunoglobulin. Glucocorticoids can induce destruction of lymphocytes.
The lymphopenia can meet at autoimmune diseases, such as hard currency, a pseudorheumatism, a myasthenia гравис, the enteropathy accompanied with protein loss.
Lymphopenia symptoms:
Lymphopenia in itself usually asymptomatically. However symptoms of the associated diseases, absence or reduction of almonds or lymph nodes indicate cellular immune deficiency. The most frequent symptoms of a lymphopenia - a skin disease, such as an alopecia, eczema, a pyoderma, a teleangiectasia; symptoms of hematologic diseases, such as pallor, petechias, jaundice, ulceration of a mucous oral cavity; a generalized lymphadenopathy and a splenomegaly which can indicate existence of HIV infection.
At patients with a lymphopenia the recurrent infections or infections caused by rare microorganisms, such as Pneumocystis proved (the former P. carinii), a cytomegalovirus, a rubella, chicken pox with pneumonia and a lymphopenia that assumes existence of an immunodeficiency are frequent. At patients with a lymphopenia calculation of subpopulations of lymphocytes and determination of level of immunoglobulins is necessary. Patients with frequent recurrent infections need to conduct full laboratory examination for immunodeficiency assessment even if initial screening tests are normal.
Treatment of a lymphopenia:
The lymphopenia disappears at elimination of the causative factor or a disease which caused it. Purpose of intravenous immunoglobulin is shown if the patient has chronic deficit of IgG, a lymphopenia and recurrent infections. Transplantation of haematopoietic stem cells can be applied with success at patients with a congenital immunodeficiency disorder.
