Show More. Login Register. We want you to take advantage of everything Cancer Therapy Advisor has to offer. To view unlimited content, log in or register for free. Register now at no charge to access unlimited clinical news, full-length features, case studies, conference coverage, and more. At a Glance Lymphocytosis is defined as a peripheral blood lymphocyte count greater than 2SD above the mean for the patient population.
Continue Reading. In addition, what follow-up tests might be useful? In particular, does your patient take any medications - OTC drugs or Herbals - that might affect the lab results? This is largely a physical exam finding. People may also have symptoms of the condition underlying their lymphocytosis.
For example, flu could cause lymphocytosis and symptoms including a cough , muscle aches , and fever. Lymphocytosis has various potential causes ranging from minor infections to cancers. In addition, EBV can cause an illness called infectious mononucleosis , which doctors also call mono. There is no treatment for EBV, but home remedies such as getting plenty of rest, drinking fluids, and taking over-the-counter medicines can relieve symptoms.
People should also be sure to avoid all contact sports, as being tackled can rupture an enlarged spleen. Stress due to severe diseases and medical conditions may cause lymphocytosis. This most commonly occurs in individuals who have heart conditions , use epinephrine , or experience seizures. Symptoms will depend on which condition is causing the stress. Most bacterial infections cause a high count of neutrophils , another type of white blood cell. However, some bacterial diseases, such as syphilis and cat-scratch disease CSD , can cause lymphocytoses.
Bartonella henselae is a type of bacteria that can cause CSD. The name refers to its typical cause, a cat scratch. Symptoms of CSD include:. In many cases, CSD is not serious and requires no medical treatment. However, doctors may prescribe antibiotic medication to people with CSD who have a weakened immune system due to HIV or another medical condition.
Your primary care doctor may refer you to an infectious disease specialist to find out what's causing the infections. You also may see a hematologist blood disease specialist or an immunologist immune disorders specialist. Blood diseases and immune disorders can cause lymphocytopenia.
Your doctor will do a physical exam to look for signs of infection, such as fever. He or she may check your abdomen for signs of an enlarged spleen and your neck for signs of enlarged lymph nodes. Your doctor also will look for signs and symptoms of diseases and conditions that can affect your lymphocyte count, such as AIDS and blood cancers.
Your doctor may recommend one or more of the following tests to help diagnose a low lymphocyte count. A complete blood count CBC measures many parts of your blood. The test checks the number of red blood cells, white blood cells, and platelets in your blood. The CBC will show whether you have a low number of white blood cells.
Lymphocytes account for 20 to 40 percent of all white blood cells. Although a CBC will show an overall low white blood cell count, it won't show whether the number of lymphocytes is low. You may need a more detailed test, called a CBC with differential, to find out whether you have a low lymphocyte count.
This test shows whether you have low levels of certain types of white blood cells, such as lymphocytes. The test results can help your doctor diagnose lymphocytopenia. Flow cytometry si-TOM-eh-tree looks at many types of blood cells. It's even more detailed than a CBC with differential. Flow cytometry can measure the levels of the different types of lymphocytes—T cells, B cells, and natural killer cells.
The test can help diagnose the underlying cause of lymphocytopenia. Some underlying conditions cause low levels of T cells. Others may cause low levels of B cells or natural killer cells. Many diseases and conditions can cause lymphocytopenia. Your doctor will want to find the cause of the disorder. Tests for these underlying conditions might include blood tests , bone marrow tests , and lymph node tests.
Lymph nodes are part of the immune system. They're found in many places in your body. During a physical exam, your doctor may find that certain lymph nodes are swollen. In lymphocytopenia, the lymph nodes may hold on to too many lymphocytes instead of releasing them into the bloodstream.
To test a lymph node, you may need to have it removed. Removing a lymph node involves minor surgery. If you have mild lymphocytopenia with no underlying cause, you may not need treatment. The disorder may improve on its own. If you have a disease or condition that's causing lymphocytopenia, your doctor will prescribe treatment for that illness. Treating the underlying problem will help treat the lymphocytopenia. A low lymphocyte count makes it hard for your body to fight infections.
You may get infections caused by viruses, fungi, parasites, or bacteria. Treatment for an infection will depend on its cause. You also may need treatment after an infection is gone to help prevent repeat infections. Children who have serious, ongoing bacterial infections may get a medicine called immune globulin.
This medicine helps boost the immune system and fight infections. If the diagnosis remains in question, determining the clonality of the lymphocytes may be helpful. Serum free light chains, if elevated and skewed toward kappa or lambda, may also provide evidence for lymphocyte clonality. In addition, FISH florescent in-situ hybridization cytogenetics can be performed on the peripheral blood to evaluate for markers typical of a lymphoproliferative disorder.
For example, a case with flow cytometry results that are atypical but consistent with CLL may show del 13q14, which would further support the CLL diagnosis. If the above studies remain inconclusive, a bone marrow aspirate and core biopsy may be indicated to more definitively rule out a malignant etiology of the lymphocytosis.
T-PLL carries a particularly poor prognosis. Any patient presenting with lymphoctyosis should have an aggressive work-up to rule out a malignant etiology. If the initial work-up is unrevealing for a reactive cause, or if a malignant etiology is highly suspected, the following additional tests should be pursued:.
Imaging is rarely required in the evaluation and management of lymphocytosis. Exceptions include patients whose lymphocytosis is thought to be most likely due to non-Hodgkin lymphoma, patients with palpable lymphadenopathy, patients with CLL and unfavorable cytogenetic abnormalities such as del 17p or del 11q who may have bulky intra-abdominal lymphadenopathy not appreciated on physical exam, and patients with a suspicion of T-ALL, to rule out the presence of a mediastinal mass.
It is unusual for immediate therapy to be required, and time should be taken to establish a definitive diagnosis prior to initiating treatment. One exception is in patients with aggressive lymphomas with circulating disease, such as Burkitt lymphoma, who may undergo spontaneous tumor lysis syndrome. In patients with these metabolic derangements, aggressive electrolyte management, early administration of intravenous fluids, allopurinol, and, when required, rasburicase, are all important interventions to stabilize the patient while they are being worked up.
The prognosis of patients with lymphocytosis depends on the etiology of the condition, and discussions about prognosis with the patient and family should be postponed until a definitive diagnosis is established.
If an identifiable cause of reactive lymphocytosis such as infectious mononucleosis is found, supportive care with observation is appropriate. However, should the lymphocytosis persist longterm for example, greater than 2 months , a re-evaluation must be performed, with a low threshold for pursuing studies to rule out an underlying malignant lymphocytosis. If lymphocytosis is found to be intermittent, it should not be ignored, and further evaluation may be necessary. For example, patients with early stage CLL or indolent NHL may have borderline elevations of lymphocyte counts that wax and wane, and although these patients may not require immediate treatment, monitoring and definitive diagnostic evaluation should be performed.
The pathophysiology of lymphoctyosis varies widely, and depends on the underlying etiology driving the condition, as described in more detail in the topics covering these conditions.
In both reactive and malignant lymphocytosis, the mechanisms leading to an increased number of circulating lymphocytes may include increased lymphocyte production, release of already formed lymphocytes into the blood, or decreased clearance of lymphocytes by the reticulo-endothelial system.
Deardon, C. Overview of PLL with focus on monoclonal antibody therapies.
0コメント