Leukopenia or something more

Is leukopenia cancer?

Leukopenia is not cancer.
This is a separate condition characterized by a decrease in the level of white blood cells in the blood. It is also diagnosed in healthy people. Often this clinical picture is observed in patients who have recently had ARVI or influenza. The stages of physiological changes are also considered to be a serious pathology: in children 6 months, 5-6 years. Leukopenia is benign when it is caused by “lazy leukocyte syndrome.” Of particular danger is the situation when a decrease in leukocytes is accompanied by the appearance of bruises throughout the body, an increase in body temperature, rapid fatigue, and numerous skin rashes. In this case, you need to undergo a comprehensive diagnosis and consult a doctor.

Leukopenia is one of the symptoms of blood cancer. This is a dangerous disease, the main insidiousness of which is the absence of a tumor that needs to be removed. That is why leukopenia requires a mandatory diagnostic examination, because oncology detected in the initial stages is highly treatable.

Leukopenia or something more

Mikhail, Moscow

November 28, 2020

Hello! Please tell me about my situation. Two years ago, in the summer of 2021, I had a general malaise: some kind of weakness, lethargy, fog, constant headaches in the parietal region. That year I visited all sorts of doctors, duplicating the opinions of specialists from the same field. I even did an MRI of the brain, fearing anything. Well, I mostly visited neurologists, of course. Gradually, somehow the condition returned to normal. But during all the tests, it was discovered that my leukocytes were constantly low (constantly around 3.4-3.5). This was the first time I heard the diagnosis of leukopenia. In the fall (November) I visited a hematologist, who immediately suggested a bone marrow puncture, but I chickened out. On my second visit, to my surprise, my white blood cell level returned to normal and became 4.2. Well, we said goodbye to the hematologist on a positive note. But immediately after the New Year, having decided to take a control blood test, I discovered that the leukocytes were again below normal ~3.5. In general, I went to the doctors again. I cured gastritis with a gastroenterologist, removed Helicobacter, etc. But the leukocytes were the same. They even dropped to 3.2. As a result, I pulled myself together and did a bone marrow puncture, which showed a decrease in mature granulocytes. Myelokaryocytes and megakaryocytes were reduced, and other indicators were also slightly different from the norm. In conclusion, there was no evidence of bone marrow disease. In July, this is where we said goodbye to the hematologist with the thesis that many people have leukopenia and that’s okay. Since then I have not done OAC anymore, because... I didn’t want to be nervous again, and there was no particular reason. I felt very good. I have nothing to associate the return of leukocytes to normal in the fall of 2021 except with Milgama (B12) injections. At this time, my hernia in my spine worsened, and I had to take a course. Maybe I'm wrong and this has nothing to do with it. Today, having created an electronic medical record on Mos.ru, I discovered that the only available document is an extract from the hospital from the hospital where I had the puncture. The procedure itself took half an hour, but as I have already found out, this does not matter and they write that they occupied a bed for a day. The most important thing is that this extract contains the admission diagnosis and the discharge diagnosis. And in both cases the cost is C92.7 myeloid leukemia! I called the center, where the employee assured me that I shouldn’t worry at all, the attending physician knew best (I don’t know those who signed for discharge from the hospital and have never contacted them). That this is a common thing to justify taking a puncture and suspicion, one diagnosis is written, and then the attending physician makes the final one. But what confuses me about all this is that they never told me about leukemia and that the discharge diagnosis is “leukemia.” What if my hematologist didn’t see this conclusion? The fact is that they create different cards for the attending physician and for the hospital. Therefore, I would like to hear the opinion of specialists regarding both the situation itself and my clinical picture! Thanks in advance! 37 years old, no bad habits, height 176, weight 75

The question is closed

blood analysis

leukocytes

leukopenia

leukemia

hematologist

Causes of leukopenia

Many factors can provoke the development of leukopenia. It is very important to determine the exact cause of this disorder, because treatment tactics will depend on it. The following factors can cause a decrease in leukocytes in a person’s blood:

• Pathologies of blood cells and bone marrow
  : aplastic anemia, myelofibrosis, myelodysplastic syndromes, hypersplenism, myeloproliferative syndrome;
• Hereditary diseases
  : myelocathexis, Kostman's syndrome;
• Infections
  : tuberculosis, HIV, AIDS, various viral infections;
• Autoimmune pathologies
  : systemic lupus erythematosus, polyneuritis, rheumatoid arthritis;
• Vitamin deficiency
  : lack of B vitamins, copper, zinc, and other minerals. Usually occurs due to an unbalanced diet;
• Taking certain medications
  : Interferon, Clozapine, Minocycline, Cyclosporine, some antibacterial agents;
• Sarcoidosis
  : a disease in which there is an overreaction of the immune system;
• Oncology
  : Cancer causes a decrease in the concentration of white blood cells due to damage to the bone marrow. A similar clinical sign is also observed in patients after radiation or chemotherapy, or bone marrow transplantation.

Diagnosis of leukopenia

Leukopenia can be determined using a general blood test. It shows the concentration of leukocytes in the blood. Additionally, a blood test is performed with leukocyte differentiation: the study helps determine which white blood cells are insufficient. This analysis allows us to identify a range of possible causes of leukopenia. Also, diagnosis of leukopenia includes:

• Hemogram
  - determines the absolute number of red blood cells, leukocytes, platelets, shows the percentage of different types of white cells;
• Immunological blood test
  - detects antigranulocyte and antinuclear immunoglobulins;
• Biochemical blood test
  - reflects the amount of folate, vitamin B12, liver transaminases, bilirubin in the blood;
• Cytological examination
  - aimed at determining the specific type of leukopenia, establishes the mechanism of its development;
• Blood test for hepatitis
  , rheumatoid factor.

Other studies may be required. They are needed to determine the cause of leukopenia. Some time after the first examination, repeat tests are prescribed - this is necessary to obtain a reliable result.

Treatment methods

At the first signs of infection, patients with leukopenia are prescribed antibacterial drugs. Initially, broad-spectrum antibiotics are used. When the results on the sensitivity of microorganisms are ready, suitable therapy is selected. If the patient's condition improves within 72 hours, then the treatment regimen has been selected effectively. The drugs are continued to be taken for a week or until symptoms disappear completely at the same dosage.

The lack of effect of treatment indicates antibiotic resistance, when microorganisms are resistant to the active ingredients of the drug, or the presence of two or more infections. If the patient has no signs of infection, but the white blood cell count is significantly reduced, prophylactic antibiotic therapy is given. For fungal infections, antifungal drugs are indicated.

Colony-stimulating factors - growth factors - are also prescribed for the treatment of leukopenia. They force the red bone marrow to more actively produce new blood cells. Two types of drugs are used:

• G-CSF
  – granulocyte colony-stimulating factors. Promotes rapid growth of neutrophils;
• GM-CSF
  – granulocyte-macrophage colony-stimulating factors. Causes accelerated production of granulocytes and macrophages.

Glucocorticosteroids, anabolic steroids, and vitamin complexes are prescribed as maintenance therapy. They do not help produce white blood cells, but prevent their rapid destruction.

With the development of a severe infectious process (sepsis, pneumonia, necrotizing enteropathy) and in the absence of effect from antibiotics, a leukocyte transfusion is performed. If leukopenia occurs during radiation or chemotherapy, it is necessary to reconsider the treatment regimen used or replace individual drugs.

Bone marrow transplantation for leukopenia

In rare cases, leukopenia is caused by a low level of agranulocytes in the blood. In this case, drug therapy is ineffective. Chemotherapy, which is necessary to treat cancer, destroys your own bone marrow. To treat this type of leukopenia, a bone marrow transplant is performed - the transplantation of part of the stem cells. They are the ones who will produce new leukocytes.

If the leukocyte count is low, a leukocyte transfusion is also performed. Typically, the procedure is prescribed to patients with a systemic viral infection in the absence of effect from antibiotics. However, in case of local bacteriological inflammation or infection with a virus, transfusion of leukocyte mass does not give any result.

Leukopenia: causes, symptoms, diagnosis, treatment

Oncological hospital in Moscow / Leukopenia

Cancer treatment at the Moscow Oncology Hospital

Leukocytes is the general name for a group of blood cells that includes lymphocytes, monocytes, eosinophils, neutrophils and basophils. They are different in structure and function, but they also have something in common - they all participate in the body’s immune defense against external and internal foreign agents.

Normally, the number of leukocytes ranges from 4.5 to 10 thousand cells per microliter (µl) of blood. Leukopenia is a decrease in the number of leukocytes per unit volume.

Degrees of leukopenia

Depending on the number of leukocytes in a certain volume of blood, several degrees of leukopenia are distinguished, each of which requires special tactics. It is clear that the higher the degree of leukopenia, the more the protective function suffers, and the more vulnerable the body is to infections.

1. I Art. – reduction in the number of leukocytes to no more than 3 thousand cells/μl;
2. II Art. – decrease in the number of leukocytes from 2 to 2.9 thousand cells/μl;
3. III Art. – the leukocyte count drops to 1-1.9 thousand cells. /µl;
4. IV Art. – the number of leukocytes is less than 1 thousand cells/μl.

Leukopenia can be acute when it lasts no more than 3 months, and chronic when it lasts longer than this period. The duration of its existence is of great clinical importance. For example, even critical leukopenia of 0.1 thousand cells/µl is complicated by an infectious process in only one patient out of four, if it lasts no more than a week; if it persists for one and a half months, infectious complications occur in 100%.

Causes of leukopenia

Cancer patients often suffer from leukopenia. Sometimes this is due to primary damage to the bone marrow due to tumors of the blood system. Sometimes metastases of other tumors develop in it.

All this suppresses the normal process of white blood cell production, and bone marrow cells are replaced by tumor cells. At the same time, the formation of other blood cells - red blood cells and platelets - also suffers. Therefore, patients suffer not only from leukopenia, but also from anemia and increased bleeding.

The influence of chemotherapy and radiotherapy is the most common and significant cause of leukopenia in cancer patients. Rapidly dividing bone marrow cells are extremely sensitive to the effects of radio rays and toxic chemotherapy drugs. In this case, all hematopoietic germs in the bone marrow are also affected, reaching their greatest severity by the first or second weeks from the start of treatment.

Symptoms of leukopenia

Minor leukopenia can only be detected by a clinical blood test. More pronounced symptoms have external manifestations, some of which are caused by concomitant anemia and thrombocytopenia. Patients note:

1. increased body temperature;
2. general weakness;
3. dizziness;
4. feeling of lack of air;
5. pain in bones and joints;
6. stomach ache.

Infectious complications are common in patients with severe leukopenia. First of all, the mucous membrane of the mouth and oropharynx, which is initially abundantly populated with bacterial flora, is affected. It begins to actively manifest itself as immunity declines. Ulcerative necrotic stomatitis develops.

Cystitis is not uncommon; a specific manifestation of leukopenia in women is increased, lengthened and irregular menstrual bleeding.

Severe intestinal damage may develop - necrotizing enteropathy.

Sepsis - generalized inflammation provoked by a local focus of infection - is the most dangerous complication of leukopenia with a high percentage of deaths.

Treatment of leukopenia

Mild leukopenia does not require drug treatment, but infection prevention measures are increased. Patients are especially careful about hygiene, including oral hygiene, avoid crowds of people, eat only thermally processed food, and douse vegetables and fruits with boiling water after washing.

Leukopenia of a more pronounced degree requires isolation of the patient in a sterile box, where personnel communicate with him, observing all the rules of asepsis and antiseptics. Such patients may be prescribed:

1. hormonal drugs;
2. colony-stimulating factors;
3. agents that improve cellular metabolism and accelerate cell regeneration;
4. antibiotics for prophylactic purposes.

Prevention of leukopenia in the European clinic

At the European Clinic, the cellular composition of the blood is always carefully monitored, including the number of leukocytes. These indicators are monitored with redoubled attention when prescribing chemotherapy and radiation therapy.

Following the standards in the mode of their use, as well as preventing negative effects with the help of accompanying therapy, allows us to minimize their damaging effect on blood cells.

If leukopenia develops, an experienced oncologist-hematologist working in the clinic takes part in treatment.

Contact us

Prognosis and prevention

Mortality from leukopenia during radiation or chemotherapy is 4-6%. If the disease is not caused by oncology treatment, then the rate fluctuates at 5-10%. Just 20 years ago this value reached 20%. A reduction in this parameter was achieved through the development of adequate antibacterial therapy, competent patient care, and the use of CSF.

High mortality is observed in elderly patients, in people with renal and liver failure, if leukopenia is complicated by septic shock or bacteremia. There is no specific prevention of leukopenia. Doctors give the following mandatory recommendations:

• Get a blood test every week;
• Take vitamin complexes;
• Minimize stress and anxiety;
• Wear a protective mask in public places;
• Follow the rules of personal hygiene, take a shower daily;
• Do not come into contact with pets or their feces;
• Avoid shaving, manicuring (anything that could cause injury);
• Avoid working with soil;
• Eat properly and nutritiously;
• Give up bad habits;
• Follow the chemotherapy protocol strictly.

Leukopenia is a dangerous condition. It requires mandatory compliance with all doctor’s recommendations. Ignoring these rules often leads to fatal complications. If you are undergoing chemotherapy, you need to be as attentive as possible to your health. Medscan Medical Center will help you monitor the course of leukopenia and choose effective treatment. Experienced doctors will be able to develop an individual treatment regimen that will reduce the risk of developing any complications.

Leukopenia (neutropenia)

Neutrophils are white blood cells that help fight infection. Neutropenia is a decrease in the level of neutrophils.

This complication, as a rule, occurs 7-14 days after the administration of chemotherapy and, in good cases, resolves itself by 21 days. When the neutrophil count falls below a certain level, bacterial complications can develop.

Why is neutropenia dangerous?

• development of bacterial complications;
• the need to postpone the next course of chemotherapy;
• the need to reduce the dose of chemotherapy drugs, which negatively affects the results of treatment;
• Febrile neutropenia without appropriate treatment can cause the development of life-threatening conditions, including death.

The lower limit of normal for blood neutrophil levels is approximately 2000/mm3. A neutrophil level below this is considered neutropenia, which is classified according to severity.

What are the severity levels of neutropenia?

• light (1000–1500/µl);
• moderate (500–1000 µl);
• severe (<500/µl).

Main symptoms of neutropenia

The most serious complication of neutropenia is febrile neutropenia. This is a combination of fever with a decrease in the number of neutrophils; at least a two-fold increase in body temperature >38.0°C per day, or a single increase in temperature >38.3°C with a neutrophil content <0.5×109/l.

Main causes of neutropenia

• Some drugs can cause bone marrow problems, reducing the production of neutrophils.
• Some forms of tumor affect the bone marrow directly (including leukemia or lymphoma), and can crowd out normal bone marrow cells.
• Radiation therapy can also affect the bone marrow, especially if it irradiates large areas of the body or bones in the pelvis, legs, chest, or abdomen.

What main treatment regimens lead to the development of neutropenia?

Chemotherapy regimens with a high risk of febrile neutropenia (more than 20%):

• Breast cancer: oxorubicin, cyclophosphamide/paclitaxel once every 2 weeks
• Bladder cancer: methotrexate, vinblastine, doxorubicin, cisplatin, paclitaxel, cisplatin
• Cervical cancer: paclitaxel, cisplatin
• Non-small cell lung cancer: docetaxel, carboplatin
• Small cell lung cancer: cyclophosphamide, doxorubicin, etoposide
• Gastric cancer: docetaxel, fluorouracil, cisplatin
• Ovarian cancer: topotecan 1.5 mg/m2 (days 1–5)
• Testicular tumors: etoposide, ifosfamide (+ mesna), cisplatin
• Head and neck tumors: paclitaxel, ifosfamide, cisplatin
• Sarcomas: doxorubicin, ifosfamide, dacarbazine

Symptoms of febrile neutropenia

• Against the background of a sharp drop in the absolute number of neutrophils (this indicator is less than 500) or granulocytes (this indicator is less than 1000), there is a sharp increase in the patient’s body temperature to 38 °C or more.
• A general drop in the tone of the whole body, up to severe asthenic syndrome.
• Minor tremor (involuntary small trembling of body parts).
• Increased heart rate.
• Reduced blood pressure. This manifestation can lead to shock or cardiovascular collapse.
• Possible heavy sweating.

Are there factors that increase the risk of developing febrile neutropenia?

• age over 65 years;
• female;
• antimicrobial prophylaxis was not carried out;
• late stage of the disease;
• there have already been episodes of FN;
• there are severe concomitant diseases;
• severe general condition of the patient;
• there are open wounds or infections;
• malnutrition;
• chemo-radiation therapy;
• damage by a bone marrow tumor;
• hemoglobin below 120 g/dl

The occurrence of a symptom complex of febrile neutropenia is a direct basis for a number of diagnostic procedures and immediate (within 1 hour) prescription of antibacterial therapy. See a doctor immediately!

• temperature 38 degrees and above;
• chills, sweat;
• cough or shortness of breath;
• sore throat or mouth ulcers;
• redness or swelling of the skin;
• loose stools;
• difficulty urinating - increased frequency or burning sensation;
• vaginal discharge or itching;
• flu-like symptoms;
• soreness at the insertion site of a dropper needle, syringe or other device through which medications enter the body.

Treatment and prevention of neutropenia

To prevent the development of febrile neutropenia (FN) and its treatment, colony-stimulating factors (CSF) are prescribed. Recommendations for prescribing CSF:

• When FN develops, it is mandatory to prescribe systemic antibiotics (intravenously) of a wide spectrum (in patients with a low risk of severe infections, tablets are possible). The administration of G-CSF does not replace the administration of systemic antibiotics.
• Before each course of chemotherapy, individual factors that may increase the risk of FN should be assessed (see above).
• The use of CSF should be prescribed when there is an increased risk of FN and/or when using certain chemotherapy regimens (see above).
• Risk factors are assessed immediately before starting chemotherapy.
• The use of targeted drugs (cetuximab, bevacizumab, retuximab) in combination with cytostatics increases the incidence of FN! KSF are prescribed!
• Prophylactic use of CSF is recommended if the risk of functional failure during chemotherapy is ≥ 20%. If the likelihood of FN is lower, individual risk factors are assessed.
• If chemotherapy is palliative in nature, the choice of a less myelosuppressive combination or a change in dose/regime of drugs to prevent the risk of developing FN should be discussed.
• Mandatory administration of CSF during intensive chemotherapy regimens.
• Treatment with CSF drugs should be carried out in the presence of febrile neutropenia and ineffectiveness of antibiotics. This may reduce the likelihood of developing infectious complications and death from them in patients with an extremely high risk of life-threatening infections associated with febrile neutropenia, such as sepsis or septic shock.

The most effective drugs currently are filgrastim, lenograstim and pegfilgrastim.

How to protect yourself with low white blood cells?

• Wash your hands often: for at least 10 seconds, before and after using the toilet, and before eating.
• Take a warm shower every day; Wipe yourself dry.
• Use moisturizing skin creams.
• Maintain good oral hygiene; The toothbrush should be soft.
• Prevent constipation: try to have bowel movements every day.
• After defecation, clean the area around the anus well. Women should wipe from the front to the anus.
• In case of acute neutropenia, sex should be avoided. It is recommended to use water-soluble lubricants during sex and maintain personal hygiene after it.
• To prevent injury, use gloves when cleaning the house and working in the garden.
• Avoid sunburn.
• Be sure to tell your doctor that your white blood cells are low.

What is best to avoid if you have neutropenia?

• crowded places or public places;
• any vaccinations without the permission of the oncologist;
• contacts with people who have recently received a live vaccine;
• contact with pet feces or material on which they urinate/defecate;
• carrying out dental procedures without the permission of an oncologist;
• eating raw fish or meat that has not undergone sufficient culinary processing; visiting buffet restaurants;
• manicure, pedicure.

There is no single diet that can raise white blood cell levels.

You should not rely on folk remedies.

General dietary recommendations for neutropenia

• It is recommended to check the expiration dates of products and avoid expired ones.
• It is recommended to discard cans that are swollen or damaged.
• It is not recommended to store thawed food.
• It is recommended to keep hot foods hot and cold foods cold.
• It is recommended to avoid old, crushed, or damaged fruits and vegetables.
• It is recommended that meat, poultry and fish be thoroughly cooked.
• It is recommended to thoroughly wash fruits and vegetables.
• It is not recommended to eat raw eggs and fish.

Nutrition for neutropenia

The list was compiled based on the recommendations of the American Association of Hematologists, adapted for the Russian Federation.

Rehabilitation for neutropenia

Performing a complex of exercise therapy including aerobic exercise during chemotherapy reduces the duration of leukopenia.

https://rassc.org/ru/oslozhneniya/nejtropeniya/37-neutropeniaincancer-patients-risk-factors-and-management https://rassc.org/ru/oslozhneniya/nejtropeniya/38-koloniestimuliruyushchie-faktory-v-onkologii https://rassc.org/ru/oslozhneniya/nejtropeniya/39-prevention-of-febrile-neutropenia https://rosoncoweb.ru/calculators/febrile_neutropenia/ https://www.cancer.net/coping-with-cancer /physical-emotional-and-social-effects-cancer/managing-physical-side-effects/neutropenia https://www.cdc.gov/cancer/preventinfections/pdf/neutropenia.pdf