When to worry about low lymphocytes

When should you worry about low lymphocytes?
Low lymphocytes may be caused by any number of conditions, including cancer. Talking to your doctor about what your level indicates and which next steps you should take may help calm your nerves and put your mind at ease.

Doctors learn a lot about your health when they order blood work. The tests may tell whether you’re at high risk for diabetes or heart disease, or whether your kidneys and liver are healthy. Blood work may also measure the level of lymphocytes in your body and whether you have a healthy immune system.

Learning you have low lymphocyte levels may be cause for concern. Low lymphocytes may be caused by any number of conditions, including cancer. But, in many cases, the cause of low lymphocytes isn’t typically serious, and talking to your doctor about what your level indicates and which next steps you should take may help calm your nerves and put your mind at ease.

In this article, we’ll explore:

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Which lymphocyte levels are considered low?

Lymphocytes are a type of white blood cell that’s made in the bone marrow and found in the blood and lymph tissue. Lymphocytes account for up to 40 percent of the body’s total blood volume and play a main role in the immune system, helping to defend the body from foreign invaders like bacteria and viruses that may cause infection.

Lymphocytopenia, or lymphopenia, is the disorder that develops when the blood doesn’t have enough lymphocytes. Most of the time, lymphocytopenia doesn’t often cause symptoms and is detected during a routine health checkup or when you’re being tested for something else.

Lymphocytopenia may be caused when:

  • The body doesn’t make enough lymphocytes.
  • A disease, such as cancer destroys or damages lymphocytes.
  • Lymphocytes get stuck in the lymph nodes.

Lymphocytopenia may either be acute or chronic. It’s considered acute when it’s temporary (with levels dropping after an infection, for example, then returning to normal a short time later). Chronic lymphocytopenia occurs when the low lymphocyte count continues for months. Doctors typically perform further tests in the case of chronic lymphocytopenia to determine the underlying cause.

In adults, a normal lymphocyte count usually is between1,000 and 4,800 lymphocytes per microliter of blood. But your doctor may diagnose you with lymphopenia if you have fewer than 1,500 lymphocytes per microliter.

Levels higher than 4,000 may indicate a different condition, called lymphocytosis, which is most often caused by the body’s response to a temporary infection or inflammatory condition. More serious conditions, like leukemia and non-Hodgkin lymphoma, may also cause lymphocytosis. Other potential causes include stress and reactions to certain medicines.

If your lymphocyte levels are abnormally high, your doctor will work to discover what’s causing the high levels before determining whether treatment is necessary. One of the most common causes of high lymphocytes, for example, is the Epstein-Barr virus (the bug that causes mononucleosis), which may be treated with over-the-counter pain medications and rest.

Lymphocyte levels below 1,000 may also be temporary, indicating a mild infection or the flu. The biggest concern with low lymphocytes is that it may raise your risk for more serious infections, because it means your immune system isn’t functioning the way it should.

What are the different types of white blood cells?

The three main types of white blood cells in the body are:

  • Granulocytes (including neutrophils, eosinophils and basophils)
  • Monocytes
  • Lymphocytes, which have two main subtypes:
    • B-cell lymphocytes, which make antibodies to protect the body from foreign substances like bacteria
    • T-cell lymphocytes, which either help B-cells make antibodies (called helper T-cells) or kill foreign substances (called killer T-cells)

An increase or decrease in each type of white blood cell may be an indication of specific conditions or diseases. For instance:

An Increase in eosinophils may be a sign of an allergic reaction or parasitic infection.

An increase in monocytes may be caused by a chronic inflammatory disease, tuberculosis or a viral infection.

A decrease in monocytes may signal a bloodstream infection, skin infection or bone marrow disorder.

An increase in neutrophils may be triggered by stress, an infection, gout, trauma or pregnancy.

A decrease in neutrophils may be caused by certain types of anemia (a lack of red blood cells), a bacterial infection or the flu.

A decrease in basophils may be triggered by an acute allergic reaction.

How are lymphocyte levels measured?

Low lymphocyte levels are typically discovered during a routine blood test. A complete blood count (CBC) includes an absolute lymphocyte count, which is the total number of lymphocytes in the body. The absolute lymphocyte count may also be measured with a white blood cell (WBC) differential, which is a calculation that measures the percentage of each type of white blood cell in the body.

Factors such as age, race and lifestyle may affect the number of lymphocytes in the body, so there isn’t one magic number that’s considered normal. It’s important to keep the number of lymphocytes within a healthy range so your immune system works correctly.

What it means when your lymphocytes are low

Most of the time, lymphocytopenia is acquired, typically through diseases like viral hepatitis, human immunodeficiency virus (HIV), lupus or Hodgkin lymphoma or through cancer treatments like chemotherapy or immunotherapy. In rare cases, babies are born with lymphocytopenia—through inherited conditions like Wiskott-Aldrich syndrome, a rare disorder of the immune system that lowers the body’s ability to make lymphocytes, or DiGeorge syndrome, a condition that causes heart defects, low calcium levels and poor immune function.

Sometimes, low lymphocytes may be caused by other factors, like:

  • Malnutrition
  • Severe physical stress
  • Severe sickness and trauma
  • Steroid use

Even intense exercise, such as high-intensity interval training, or alcohol use may affect lymphocyte counts, says Revathi Suppiah, MD, Medical Oncologist at City of Hope Phoenix. It’s when the low levels are chronic that they can cause concern.

Symptoms of low lymphocytes

Most of the time, patients don’t experience any noticeable symptoms of lymphocytopenia. If symptoms do occur, they may include, either alone or in combination:

  • Frequent infections, such as pneumonia
  • Unusual infections that typically don’t cause problems for people with a healthy immune system
  • Infections that won’t go away
  • Swollen lymph nodes (particularly in the neck or groin)
  • A larger-than-normal spleen
  • Skin conditions, like eczema and alopecia (hair loss)
  • Joint pain and swelling
  • Signs of a viral infection, like a fever, cough or runny nose

What you should do if your lymphocytes are low

If your doctor suspects lymphocytopenia, he or she will try to determine the root cause of the condition by reviewing your medical history, conducting a physical exam to check for visible symptoms and, in some cases, ordering a flow cytometry, which measures the levels of different kinds of lymphocytes, including T-cells and B-cells.

For mild cases of lymphocytopenia without a clear cause, your doctor may not recommend treatment and instead see whether the condition resolves on its own. If your doctor identifies a clear cause, such as cancer or some other serious condition, he or she may recommend treatment that targets that specific cause.

In some cases, such as when the condition is chronic, your doctor may refer you to a hematologist. If the condition is caused by chronic conditions like the lupus or another auto-immune disease, it may require long-term treatment and a combination of medicines to manage.

The goal for patients with low lymphocytes is to increase counts to a healthy range by treating whatever is causing the decline. It’s also important that patients with low lymphocytes protect themselves from the risk of infection.

“Lymphocytes play an important role in your immune system and help protect you from developing infections,” Dr. Suppiah says. “Therefore, a low lymphocyte count may predispose you to certain infections.”

Because of this, you should take steps to reduce your risk by, for example:

  • Getting the recommended seasonal vaccines
  • Avoiding people with contagious viruses or other illnesses
  • Washing hands thoroughly and regularly
  • Practicing good oral hygiene

Whether you should be concerned about low lymphocyte levels depends on the cause, severity of the count and whether you’re symptomatic (if you get recurrent infections), Dr. Suppiah says. Always discuss your concerns with your doctor.

If you’ve been diagnosed with cancer and are interested in a second opinion about your cancer diagnosis and treatment plan, call us or chat online with a member of our team.