Lymphopenia

What is lymphopenia?

Lymphopenia is a condition when there are too few white blood cells called lymphocytes in your blood. A lymphocyte is just one type of white blood cell. About 20% to 40% of your white blood cells are lymphocytes.

These white blood cells help your body fight germs that can make you sick, including viruses, bacteria, parasites and fungi. They help destroy abnormal cells, like cancer cells.

Lymphocytes can be broken down into three types:

• T lymphocytes (T-cells).
• B lymphocytes (B-cells).
• Natural killer cells (NK cells).

Low lymphocytes — or lymphopenia — may make you more susceptible to infections and other conditions.

Lymphopenia is also called lymphocytopenia and lymphocytic leukopenia. Leukopenia means having a low white blood cell count. “Lymphocytic” leukopenia means you have a low number of lymphocytes in particular.

What are normal lymphocyte levels?

What’s considered a normal lymphocyte level differs for adults and children.

• In adults,the normal range is between 1,000 and 4,800 lymphocytes per microliter of blood. Lymphopenia involves having less than 1,000 lymphocytes per microliter of blood.
• In children,the normal range is between 3,000 and 9,500 lymphocytes per microliter of blood. Low levels (or lymphopenia) depend on your child’s age. Children under 2 years old have lymphopenia if they have less than 3,000 lymphocytes per microliter of blood.

What are the symptoms of lymphopenia?

Lymphopenia alone doesn’t cause symptoms. Instead, conditions associated with lymphopenia may cause symptoms, including:

• Fever.
• Cough.
• Runny nose.
• Rash or other skin irritation.
• Swollen lymph nodes.
• Swollen joints.
• Mouth ulcers.
• Jaundice.
• Enlarged spleen (splenomegaly).

With severe lymphopenia, you may experience frequent infections or infections that last a long time.

With mild lymphopenia, you may not experience any symptoms at all.

What causes lymphopenia?

You may be born with a condition that causes lymphopenia, or you may get it over time. Depending on the cause, you may have lymphopenia that requires lifelong treatment (chronic). Or you may have lymphopenia that resolves with treatment or on its own without treatment (acute).

Lymphopenia has many causes. The most common causes are infections, medications and nutritional deficiencies.

Infections

Viruses, bacteria, parasites and fungi can all cause infections that lead to lymphopenia. Infectious diseases that can cause lymphopenia include:

• HIV and AIDS.
• Influenza (flu).
• COVID-19.
• Hepatitis.
• Malaria.
• Measles.
• Pneumonia.
• Tuberculosis.

Nutritional deficiencies

You can get lymphopenia if you’re not getting enough protein in your diet (malnutrition) or enough vitamins or minerals like vitamin B12, folic acid or zinc in your diet. This is the most common cause of lymphopenia worldwide.

Inherited conditions

Conditions that you inherit from your biological parents can lead to lymphopenia, including:

• Ataxia-telangiectasia.
• Common variable immunodeficiency.
• DiGeorge syndrome.
• Severe combined immunodeficiency syndrome (SCID).
• Wiskott-Aldrich syndrome.

Autoimmune diseases

Autoimmune diseases happen when your immune system attacks your body’s healthy cells, which may include lymphocytes. Conditions include:

• Lupus.
• Sarcoidosis.
• Myasthenia gravis.
• Rheumatoid arthritis.

Blood disorders and cancer

Blood disorders and cancer can interfere with your body’s ability to make lymphocytes. Conditions include:

• Aplastic anemia.
• Lymphoma.
• Leukemia.
• Myelodysplastic syndromes.

Medication and treatment side effects

Cancer treatments and drugs that treat autoimmune diseases can lead to lymphopenia. Causes may include:

• Bone marrow transplant.
• Chemotherapy.
• Radiation therapy.
• Immunosuppressants (including corticosteroids).

Alcohol toxicity

Excessive alcohol (such as beer, wine or liquor) can also lead to lymphopenia.

How is lymphopenia diagnosed?

A healthcare provider will review your history and symptoms, ask about your lifestyle and perform tests to diagnose lymphopenia.

• Medical history: Information about your past and present conditions, medicines and treatments can help your healthcare provider diagnose lymphopenia. For example, a recent COVID-19 infection may signal that a viral infection is causing your low lymphocytes. Your provider may suspect your low levels are related to medication if they learn you’re taking corticosteroids.
• Physical exam: Your provider will ask about your symptoms and look for signs of an infection, like a fever, swollen lymph nodes or an enlarged spleen.
• Lifestyle questions: Your provider may ask you about your diet to see if a nutritional deficiency may be causing your low levels. They may ask about your sex life (like whether you practice safer sex) to rule out common infectious causes of lymphopenia, like HIV.

Your provider may perform various tests to check your blood cells and bone marrow.

What tests will be done to diagnose lymphopenia?

Tests that check your blood and bone marrow can help your healthcare provider diagnose lymphopenia.

• Complete blood count (CBC): A CBC counts how many blood cells — including white blood cells — you have.
• Complete blood count with differential: A CBC with differential counts how many of the individual types of white blood cells (including lymphocytes) you have.
• Flow cytometry: A flow cytometry test measures the different types of lymphocytes, including B lymphocytes, T lymphocytes and natural killer cells.
• Immunoglobulin level test: An immunoglobulin level test measures how many proteins called antibodies are in your blood. It can help diagnose several conditions associated with lymphopenia, including infections, autoimmune diseases and cancer.
• Bone marrow analysis: A bone marrow analysis can show issues with blood cell production that may be causing lymphopenia.

You may receive tests that check for specific diseases and conditions associated with lymphopenia. Tests may include an HIV test, a tuberculosis test, a flu test or a COVID-19 test, among others.

What are the treatments for lymphopenia?

Mild cases of lymphopenia that don’t cause symptoms don’t require treatment. Often, levels eventually return to normal once your body recovers from an infection.

Otherwise, treatment requires addressing the underlying condition. Your healthcare provider can recommend treatments based on what’s causing your low levels.

Is there a cure for lymphopenia?

If you were born with a condition that prevents your body from making enough lymphocytes, a hematopoietic stem cell transplant might be a potential cure. This procedure replaces damaged or defective blood-forming blood cells (called stem cells) with healthy stem cells. The stem cells eventually develop into fully mature blood cells, including lymphocytes.

Still, a stem cell transplant is a complex procedure with risks. Not everyone is eligible for this type of procedure. Your healthcare provider can tell you if a stem cell transplant is right for you.

What medications are used to treat lymphopenia?

You may need immunoglobulin (IG) shots if you have severe lymphopenia. This treatment can strengthen your immune system so it’s better able to fight infections. Your provider may recommend regular IG shots to prevent frequent infections.

How can you prevent lymphopenia?

You can’t prevent lymphopenia that results from a condition you’re born with. You can reduce your risk of acquiring lymphopenia. For example, take precautions to protect yourself from germs that can make you sick. Practice safer sex to reduce your risk of getting a sexually transmitted infection (STI), like HIV. Make sure you drink in moderation — no more than one can of beer, one glass of wine or one shot of liquor per day.

How can you prevent infections if you have lymphopenia?

You can reduce your risk of an infection if you:

• Get vaccinated for the flu and COVID-19.
• Avoid situations where you’re at an increased risk of infection. This means avoiding people who are (or who may be) sick and avoiding crowded indoor areas.
• Wash your hands regularly with soap and water or use an alcohol-based hand sanitizer.
• Wear a mask when you may come in contact with an airborne virus.
• Ensure food is cooked to the appropriate temperature, and wash fruits and vegetables thoroughly before eating them.
• Avoid activities where you risk injuries, like cuts or scrapes that can introduce germs into your body.

Ask your healthcare provider about extra precautions you may need to take to prevent infection.

What is the outlook (prognosis) for people who have lymphopenia?

Your outlook depends on what’s causing your low lymphocyte levels. Usually, your lymphocytes will return to normal once your body has recovered from an infection. If something more serious is causing your low levels, treatment may be a longer, more involved process.

When should I see my healthcare provider?

See a healthcare provider if you have an infection. If you have a condition that makes you more susceptible to infections, ask your healthcare provider about the signs and symptoms that should alert you to seek medical care.

Is lymphopenia cancer?

No. But cancers can cause lymphopenia if they interfere with your body’s ability to make lymphocytes. Some forms of cancer treatment can temporarily lower your lymphocyte levels.

A note from Cleveland Clinic

Lymphopenia is having a lower-than-normal level of lymphocytes in your blood. Ask your healthcare provider if you should be concerned about your low lymphocytes. Often, lymphocytes return to normal once your body has recovered from an infection. But if you have a chronic condition, you may need ongoing care to ensure you have enough white blood cells to prevent infections. Your healthcare provider will let you know if your lymphopenia requires treatment.