Pathology
Immune Responses
Lymphopenia typically occurs in all of the following EXCEPT for:
Answer:
Lymphopenia occurs in:- Immunodeficiency (e.g. HIV infection)
- Hodgkin lymphoma
- Widespread irradiation
- Severe bone marrow failure
- Corticosteroid and other immunosuppressive drug therapy
Abnormal White Cell Count
Pathology / Immune Responses
Last Updated: 24th August 2023
Neutrophilia
Neutrophil leucocytosis is defined as a neutrophil count greater than 7.5 x 109/L.
Causes:
- Bacterial infection
- Inflammation and tissue necrosis (e.g. cardiac infarct, trauma, vasculitis, myositis)
- Metabolic disorders (e.g. uraemia, acidosis, eclampsia, gout)
- Pregnancy
- Acute haemorrhage or haemolysis
- Neoplasms of all types
- Drugs (e.g. corticosteroid therapy, lithium, tetracyclines)
- Asplenia
- Myeloproliferative disorders (e.g. CML, essential thrombocythaemia, polycythaemia vera, myelofibrosis)
- Rare inherited disorders
Neutropaenia
Neutropaenia is defined as a neutrophil count of < 1.8 x 109/L (except in black people and in the Middle East where 1.5 x 109/L is normal). When the absolute count falls below 0.5 x 109/L the patient is likely to have recurrent infections and when the count falls to less than 0.2 x 109/L the risks are very serious. Neutropaenia may be selective or part of a general pancytopaenia.
Causes:
- Selective neutropaenia
- Congenital causes
- Acquired causes
- Drug-induced (e.g. chemotherapy, chloramphenicol, co-trimoxazole, phenytoin, carbamazepine, carbimazole, furosemide, chloroquine, clozapine, some DMARDs)
- Benign (racial or familial)
- Cyclical
- Immune (e.g. SLE, Felty's syndrome, hypersensitivity and anaphylaxis)
- Leukaemia
- Infections (e.g. HIV, hepatitis, fulminant bacterial infection)
- General Pancytopaenia
- Hypersplenism, aplastic anaemia, malignant infiltration of bone marrow, megaloblastic anaemia, chemotherapy, myelodysplasia
Monocytosis
A rise in blood monocyte count above 0.8 x 109/L is infrequent.
Causes:
- Chronic bacterial infections (e.g. tuberculosis, brucellosis, bacterial endocarditis, typhoid)
- Connective tissue disease (e.g. SLE, rheumatoid arthritis)
- Protozoan infection
- Chronic neutropaenia
- Malignancy
Eosinophilia
An eosinophil leucocytosis is defined as an increase in blood eosinophils above 0.4 x 109/L.
Causes:
It is most frequently due to:
- Allergic diseases (e.g. bronchial asthma, hay fever, atopic dermatitis, urticaria)
- Parasites (e.g. hookworm, ascariasis, tapeworm, schistosomiasis)
- Skin diseases (e.g. psoriasis, pemphigus, urticaria, angioedema)
- Drug sensitivity
Other causes include:
- Recovery from acute infection
- Vasculitis
- Graft-versus-host disease
- Hodgkin disease
- Metastatic malignancy with tumour necrosis
- Hypereosinophilic syndrome
- Pulmonary syndromes
- Myeloproliferative disorders
Basophilia
An increase in blood basophils above 0.1 x 109/L is uncommon.
Causes:
- Myeloproliferative disorders
- Myxoedema
- Chickenpox infection
- Ulcerative colitis
Lymphocytosis
Lymphocytosis often occurs in infants and young children in response to infections that would normally produce a neutrophil reaction in adults.
Lymphocytosis occurs in:
- Viral infections (e.g. infectious mononucleosis, HIV, rubella, mumps, viral hepatitis, cytomegalovirus, herpes simplex or zoster)
- Bacterial infections (e.g. pertussis, tuberculosis, toxoplasmosis, syphilis)
- Chronic lymphoid leukaemias
- Acute lymphoblastic leukaemias
- Non-Hodgkin lymphoma
- Thyrotoxicosis
Lymphopaenia
Lymphopenia occurs in:
- Immunodeficiency (e.g. HIV infection)
- Hodgkin lymphoma
- Widespread irradiation
- Severe bone marrow failure
- Corticosteroid and other immunosuppressive drug therapy
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- Biochemistry
- Blood Gases
- Haematology
| Biochemistry | Normal Value |
|---|---|
| Sodium | 135 – 145 mmol/l |
| Potassium | 3.0 – 4.5 mmol/l |
| Urea | 2.5 – 7.5 mmol/l |
| Glucose | 3.5 – 5.0 mmol/l |
| Creatinine | 35 – 135 μmol/l |
| Alanine Aminotransferase (ALT) | 5 – 35 U/l |
| Gamma-glutamyl Transferase (GGT) | < 65 U/l |
| Alkaline Phosphatase (ALP) | 30 – 135 U/l |
| Aspartate Aminotransferase (AST) | < 40 U/l |
| Total Protein | 60 – 80 g/l |
| Albumin | 35 – 50 g/l |
| Globulin | 2.4 – 3.5 g/dl |
| Amylase | < 70 U/l |
| Total Bilirubin | 3 – 17 μmol/l |
| Calcium | 2.1 – 2.5 mmol/l |
| Chloride | 95 – 105 mmol/l |
| Phosphate | 0.8 – 1.4 mmol/l |
| Haematology | Normal Value |
|---|---|
| Haemoglobin | 11.5 – 16.6 g/dl |
| White Blood Cells | 4.0 – 11.0 x 109/l |
| Platelets | 150 – 450 x 109/l |
| MCV | 80 – 96 fl |
| MCHC | 32 – 36 g/dl |
| Neutrophils | 2.0 – 7.5 x 109/l |
| Lymphocytes | 1.5 – 4.0 x 109/l |
| Monocytes | 0.3 – 1.0 x 109/l |
| Eosinophils | 0.1 – 0.5 x 109/l |
| Basophils | < 0.2 x 109/l |
| Reticulocytes | < 2% |
| Haematocrit | 0.35 – 0.49 |
| Red Cell Distribution Width | 11 – 15% |
| Blood Gases | Normal Value |
|---|---|
| pH | 7.35 – 7.45 |
| pO2 | 11 – 14 kPa |
| pCO2 | 4.5 – 6.0 kPa |
| Base Excess | -2 – +2 mmol/l |
| Bicarbonate | 24 – 30 mmol/l |
| Lactate | < 2 mmol/l |
