Leukopenia

Introduction Leukopenia refers to a group of symptoms caused by a continuous decline in the surrounding white blood cell count. Typical manifestations include dizziness, fatigue, weak limbs, loss of appetite, apathetic, and low fever, which are the flawless category of the motherland medicine. Leukopenia is a disease caused by unexplained causes and secondary to other diseases. It is divided into primary and secondary categories. The cause of the primary is unknown; the secondary person thinks that the disease is due to acute infection, physical and chemical factors, blood system diseases, diseases with splenomegaly, connective tissue diseases, allergic diseases, hereditary diseases, etc., acquired or Causes of unexplained neutropenia, etc.

Cause

(1) Bone marrow damage:

1. Drug-induced damage: anti-tumor drugs and immunosuppressive agents can directly kill the proliferating cell population, drugs inhibit or interfere with granulocyte nucleic acid synthesis, affect cell metabolism, and hinder cell division. The direct toxic effects of the drug cause neutropenia to be associated with drug dose. Other classes of drugs can also have direct cytotoxicity or reduce granulocyte production through immune mechanisms.

2. Chemical poisons and radiation: chemical benzene and its derivatives, dinitrophenol, arsenic, etc. have toxic effects on hematopoietic stem cells. X-rays and neutrons can directly damage hematopoietic stem cells and bone marrow microenvironment, causing acute or chronic radiation damage. , granulocyte reduction occurs.

3. Immune factors: autoimmune neutropenia is the action of autoantibodies, T lymphocytes or natural killer cells in different stages of granulocyte differentiation, causing bone marrow damage and granulocyte production disorders. Common in rheumatism and autoimmune diseases.

4. Systemic infections: bacterial infections such as mycobacteria (especially Mycobacterium tuberculosis) and viral infections such as hepatitis virus.

5. Abnormal cell infiltration of bone marrow: cancer bone marrow metastasis, hematopoietic malignant disease and myelofibrosis cause bone marrow hematopoietic function failure.

6. Cell maturation disorder - Ineffective hematopoiesis: such as folic acid and vitamin B12 deficiency, affect DNA synthesis, bone marrow hematopoietic activity, but cell maturation is stagnant and destroyed in the bone marrow. Some congenital agranulocytosis and acute non-lymphocytic leukemia, myelodysplastic syndrome, paroxysmal nocturnal hemoglobinuria also have maturity disorders, while granulocytes are reduced.

(B) abnormal distribution of circulating granulocytes.

(3) The demand for granulocytes in extravascular tissues is increased and consumption is accelerated.

(4) Mixed factors.

Such as chronic idiopathic neutropenia, periodic neutropenia and the like. Clinically, the above three types of leukopenia are often mixed and should be analyzed.

an examination

The clinical manifestations are mainly primary disease. The majority of leukopenia patients are often short-lived, self-limiting, with no obvious clinical symptoms or non-specific manifestations such as dizziness, fatigue, hypothermia, and pharyngitis. Neutrophils are the first line of defense against infection, so the clinical symptoms of neutropenia are mainly susceptible to repeated infections. The risk of infection in a patient is directly related to the neutrophil count, time to decrease, and rate of decrease. Therefore, the reasons for clearing leukopenia such as blood routine and bone marrow are examined to provide a basis for further treatment.

Differential diagnosis

Granulocyte deficiency is completely different from general leukopenia, with onset fever, sweating, and general discomfort. Serious infections occur almost within 2-3 days. Lung, urinary, oropharynx and skin are most susceptible to infection. Mucosa can have necrotizing ulcers. Due to the lack of granulocytes that mediate the inflammatory response, the signs and symptoms at the time of infection are usually not obvious. For example, severe pneumonia is only slightly infiltrated on the chest radiograph, and there is no purulent sputum. Severe skin infection does not cause bloating, and pyelonephritis does not see pyuria. Wait. The infection is easily spread quickly, progressing to sepsis, and the mortality rate is very high. The common cause of this disease is drug reaction, which may have a related medical history. After the drug was stopped, the body temperature returned to normal, and the peripheral blood leukocytes rose, indicating that the condition improved.

Chronic specific neutropenia: the most common type of chronic neutropenia. It is more common among young and middle-aged women, with no clear history of special medications and exposure to chemicals. Clinically asymptomatic or fatigue, low fever, night sweats or insomnia. There were no special findings on peripheral blood cells and bone marrow smears.

Periodic agranulocytosis: characterized by repeated periodic neutropenia with generalized fatigue, fever, and mild infection. Most patients develop onset in infancy and may start onset later. Can affect several members of the family. The attack period is about 4-14 days, and the interval is 12-35 days. The symptoms can completely disappear.

Familial benign neutropenia: a dominant autosomal hereditary disease with a relatively high age of onset, intermittent onset, moderate neutropenia, and good progression. Bone marrow granules are arrested in the mid-young and late granule stages and may be associated with hypogammaglobulinemia. With age, you can relieve yourself.

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