What is this condition?

A shortage of white blood cells may involve granulocytes or lymphocytes.

A low granulocyte count can occur at any age and can lead to infections and sores in the throat, digestive tract, and other mucous membranes and on the skin. A low lymphocyte count, a rare disorder, is a deficiency of white blood cells produced mainly in the lymph nodes.

When the total white blood cell count falls to dangerously levels, the body is left unprotected against infection. The prognosis depends on the underlying cause and whether it can be treated.

What Causes this Condition?

A low granulocyte count may result from:

• radiation therapy or cancer drugs
• hypersensitivity to certain antibiotics and heart drugs
• disorders such as aplastic anemia, bone marrow cancer, some hereditary disorders, infectious mononucleosis, and certain viral and bacterial infections
• trapping of blood cells in the spleen.

A low lymphocyte count may result from:

• a genetic abnormality
• radiation therapy or cancer drugs
• dysfunctional lymphatic vessels in the bowel
• an excess of steroid hormones, caused by use of adrenocorticotropic hormone or steroids, stress, or congestive heart failure
• disorders such as Hodgkin’s disease, leukemia, aplastic anemia, sarcoidosis, myasthenia gravis, lupus, protein-calorie malnutrition, kidney failure, terminal cancer, and tuberculosis.

What are its Symptoms?

A low granulocyte count typically causes slowly progressive fatigue and weakness followed by sudden onset of overwhelming infection (heralded by fever, chills, rapid pulse, anxiety, headache, extreme exhaustion), mouth and throat sores, ulcers in the colon, pneumonia, and blood infection, possibly leading to mild shock. If the low count results from a drug reaction, infection symptoms develop suddenly, without slowly progressive fatigue and weakness.

A low lymphocyte count causes swollen glands, an enlarged spleen, and enlarged tonsils, along with signs of an associated disease.

How is it Diagnosed?

To diagnose a low white cell count, the doctor takes a thorough history and performs a physical exam to look for signs of an underlying disorder, orders appropriate blood cell tests, and, if necessary, obtains biopsy specimens of bone marrow and lymph node tissue for analysis.

How is it Treated?

To treat a low granulocyte count, the doctor must find and eliminate the underlying cause, then control infection until the bone marrow can generate more white blood cells. For many people, this means stopping drug or radiation therapy and starting antibiotics immediately, even while awaiting test results. Treatment may also include antifungal preparations. In a newer treatment, the person receives granulocyte colony-stimulating factor or granulocyte-macrophage colony-stimulating factor to stimulate bone marrow production of neutrophils. Generally, white blood cell production in the bone marrow resumes spontaneously within 1 to 3 weeks.

Treatment of a low lymphocyte count aims to eliminate or manage the underlying cause.