Leukopenia

Leukopenia is a low white blood cell (leukocyte) count that indicates a decrease in disease-fighting cells in your body. Leukopenia can indicate a variety of health complications, including serious infections, diseases, and cancer. Leukopenia can involve one or more types of white blood cells and may include neutropenia, monocytopenia, and more.

This article discusses conditions that may present as leukopenia, as well as causes, tests, treatment, and when to see a healthcare provider.

Symptoms of Leukopenia 

Leukopenia may not present with any symptoms. However, underlying conditions that can cause leukopenia can be severe.

Furthermore, if you don't have enough leukocytes, medical problems can worsen and infections can cause substantial harm to the body.

Symptoms of conditions associated with leukopenia include: 

• Fever, chills, sweats
• Sore throat, congestion 
• Fatigue 
• Sores that take longer than usual to heal 
• Infected wounds 
• Loss of appetite, nausea, vomiting, diarrhea 
• Weight loss 
• Enlarged lymph nodes
• Enlarged liver or spleen
• Mucosal bleeding and small bruises on the skin

While some infections can improve on their own, persistent leukopenia (specifically, neutropenia), can permit infections to recur and be prolonged and severe, which would require treatment. Other underlying conditions, such as cancer, can progress into potentially life-threatening conditions.

Causes of Leukopenia  

Health problems that destroy leukocytes or diminish leukocyte production can cause leukopenia.

Common causes of leukopenia include:

• Medications, especially immunosuppressants and cancer therapies
• Bone marrow disorders, including bone marrow cancer
• Infections that consume or attack white blood cells, such as human immunodeficiency virus (HIV) or AIDS
• Malnutrition

What Medications Cause Leukopenia 

Many different medications can cause leukopenia as a side effect. For example, chemotherapy medications for people with cancer may exacerbate (worsen) leukopenia. Immunosuppressants may also cause leukopenia.

Many other categories of over-the-counter (OTC) and prescription treatments can also cause leukopenia. However, not everybody who takes these medications will experience leukopenia.

Some medications that can cause a specific type of leukopenia called neutropenia include the following:

• Phenothiazine
• Antithyroid drugs (thiouracil and propylthiouracil)
• Aminopyrine
• Chloramphenicol
• Sulfonamides
  

Leukopenia caused by medication should resolve shortly after the medication is discontinued, but sometimes other measures are needed if the resolution is taking too long.

How to Treat Leukopenia

Treatment will aim to manage symptoms as well as resolve the underlying cause and prevent persistent or recurring symptoms.

Symptomatic treatment can include:

• Fever: Acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs)
• Bacterial infections: Antibiotics 
• Fungal infections: Antifungal medications 
• Viral infections: Can be treated with supportive care (fluids, fever reduction) and sometimes with antiviral therapy 
• Cancer: Chemotherapy, radiation treatment, targeted therapies, immunotherapy, or surgery 
• Injuries: Keeping wounds clean and getting medical attention for injuries 

All of these strategies can help reduce the effects of underlying conditions associated with leukopenia.

Prevention of infections is also important and includes handwashing, avoiding undercooked or potentially contaminated food, avoiding contact with people who have a contagious infection, and staying updated on recommended vaccinations.

Additionally, a 2022 study supports the use of Neupogen (filgrastim) and Neulasta (pegfilgrastim) in helping patients get relief against severe chemotherapy-induced neutropenia.

Are There Tests to Diagnose the Cause of Leukopenia?

If you have leukopenia, it’s important to determine why you have developed this problem. Your complete blood count (CBC) will provide information about your total number of leukocytes and the percentage and number of each individual type. This will help your healthcare providers get an idea about the possible cause. 

Neutrophils are the most common type of leukocytes. In fact, sometimes neutropenia is referred to as leukopenia because a low neutrophil count usually causes a low total leukocyte count.

You may already know that you are at risk if you’ve been taking a medication that causes leukopenia or if you have been diagnosed with HIV, cancer, or a bone marrow disorder. You might need tests to follow the progress of your condition—such as a viral load (the amount of virus detectable in your body) if you have HIV. 

If the cause of your leukopenia is not known, you may need tests to determine the cause, which can indicate which type of leukocytes are affected and your risk factors.

Tests you may need include: 

• A stool test to identify digestive malabsorption
• Peripheral blood smear to identify abnormal blood cells
• HIV test
• Bone marrow biopsy if there is concern about possible blood cancer
• Lymph node biopsy if there is concern about possible cancer in the lymph node

When to See a Healthcare Provider 

Leukopenia can put you at risk for dangerous infections. You can also develop serious medical problems due to the underlying condition associated with leukopenia.

If you have been diagnosed with leukopenia, you may need to have periodic blood tests to monitor your white blood cell count. Your healthcare providers can also tell you what signs to look for that could indicate a medical complication. 

Get medical attention if you experience any of the following: 

• High fever of 102 degrees Fahrenheit or above 
• Severe or persistent chills or sweats
• Difficulty breathing 
• A sore that becomes red, painful, or filled with pus
• Confusion, neck stiffness, vision changes 
• Severe vomiting or diarrhea or signs of dehydration (weakness, dizziness, deceased urination, dry skin)
• Change in consciousnesses 

Symptoms may not be present with leukopenia or, if present, they may be nonspecific and evolve quickly into something more serious.

Summary 

Leukopenia is a low white blood cell count. This condition may accompany underlying diseases and lead to complications, such as infections. Common causes of leukopenia are medications (especially chemotherapy), bone marrow disorders, blood cancer, and some infections.

If you have leukopenia, it’s important to seek medical care to clarify the cause and treatment. Usually, identifying the underlying cause involves diagnostic testing before a treatment plan can be started.

A Word From Verywell 

If you have been told that you have leukopenia, you may become very concerned when you begin to learn about the possible causes. However, it’s important for you to know that many of the causes of leukopenia are not life-threatening and can be treated with medication. With treatment, your leukocytes can return to healthy levels and the risks of leukopenia can resolve as well.