White blood balls or leukocytes present in the blood are immune cells responsible for protecting the body. They create a line of defense against pathogens, their movement in the body, decay products and toxins. In addition, they control their microflora.
The number of white blood cells at different ages varies. There are 5 subgroups, and each of them has its own task. According to morphology, they differ, but they have one protective function.
Types of white blood cells
By structure, they are divided into granular and non-granular. Granular or granulocytes are large. These blood cells include the most numerous neutrophils, and the smallest - baso- and eosinophils. Non-granular or agranulocytes are smaller in size, mono- and lymphocytes are included here.
The production of leukocytes (leukopoiesis) in the body is engaged in bone marrow (CM), spleen and liver. And in the lymph nodes and glands, lymphocytes are created additionally. The destruction of white blood cells occurs in the liver and spleen.
Leukocyte subgroups
Neutrophils kill bacteria in the blood. Their main ability is phagocytosis. Neutropenia refers to their decrease below 1.8 thousand / μl. But a direct threat arises with quantities of 0.5 or less.
Lymphocytes are responsible for immune memory. Monocytes actively absorb particles of pathogens (microbes and parasites) in the blood.
When they say that there are 10-2 leukocytes in the blood, it is most often a question of monocytes in the norm. This figure remains constant from the month of life to 16 years. Eosinophils are involved in the fight against allergies and prevent atypical cells from growing.
Eosinopenia is a decrease in the white blood cells of this population from 0.2 thousand / μl and <.
Basophils are the smallest group of white blood cells. Their main task is to detect and suppress allergens. Basopenia - when the number of basophils is not more than 10 per microliter of blood.
What is leukopenia?
The very word "singing" in Greek means lack, poverty. Leukopenia can occur under different names: neutropenia, agranulocytosis, granulocytopenia - all these are the names of one severe syndrome, accompanied by a decrease in different leukocytes.
With agranulocytosis, the number of leukocytes is not more than 0.5x10 in the 9th degree / liter. In severe cases, they are not at all.
Leukopenia tends to chronize and recur. The number of white blood cells is not a constant value, and not every fluctuation in them is dangerous. The reason for a mandatory visit to a doctor is a drop in white blood cells to an indicator of <3 thousand / µl. With leukocytes 2.2 in the blood, the body's resistance decreases sharply. There is a high susceptibility to various infections and their complications. Agranulocytosis can provoke radiation, tumors, hepatitis, autoimmune processes.
In a newborn baby, granulocyte counts drop dramatically with Rh factor incompatibility.
What does it mean in the blood of leukocytes 3-2? Such indicators indicate the state after hemolysis or acute blood loss, aplastic anemia (bone marrow pathology), spleen pathology, congenital immunity anomalies, chronic inflammations and intoxications, autoimmune diseases (SLE, rheumatism, periarteritis nodosa, etc.).
The main causes of leukopenia
Leukopenia is a polyetiological syndrome, it can be primary and secondary. Secondary leukopenia in adults and children has the same causes:
- brain tumors;
- violations of the gene structure - congenital leukopenia;
- chemotherapy;
- tuberculosis of any form and stage;
- leprosy;
- Vitamin deficiency. B12, B9 and copper;
- metabolic disorders with failure of glycogen metabolism;
- infections - bacterial, fungal;
- protozoal diseases (malaria, toxoplasmosis, leishmaniasis, etc.);
- Epstein-Barr virus (EBV), CMV, HIV retrovirus, hepatitis B and C, parvovirus B19, rubella, measles, mumps;
- contact with pesticides, insecticides for a long time;
- poisoning with arsenic, lead, mercury, gold;
- taking certain drugs.
Drugs that cause leukopenia:
- anti-tuberculosis;
- antisyphilitic;
- mercury diuretics;
- antihistamines;
- all sulfonamides;
- antibiotics - penicillin series and amphenicol;
- antirheumatic drugs (gold preparations);
- thyreostatics;
- non-steroidal anti-inflammatory and analgesics;
- antidepressants and tranquilizers;
- anticonvulsants.
Leukopenia also develops when the thymus gland is removed, X-ray diagnostics, and drainage of the lymphatic duct of the chest.
Causes of childhood primary leukopenia
Fortunately, congenital leukopenia is a very rare occurrence. The reasons include:
- Gensler's syndrome - benign congenital neutropenia, which has a cyclical nature. Its frequency is 1 case per 1 million babies. Debuts in the first year of life. Periodic neutropenia of short duration is noted.
- Costman's syndrome - also congenital, is inherited. The debut is in the first year of life in the form of recurrent bacterial infections, pneumonia. The forecast is unfavorable.
- Congenital lymphoproliferative syndrome - occurs with infection with EBV. It is manifested by the destruction of the thymus (thymus gland), CM aplasia, resulting in aplastic anemia with neutropenia. Unfavorable prognosis.
- Good's syndrome - immunodeficiency with thymoma (thymus tumor). With this pathology, CM does not have the ability to recover, and aleukia develops.
- Di Georgie's Syndrome - Congenital insufficiency of the thymus and parathyroid gland. There are congenital heart defects, abnormalities of the development of the face, etc.
- Severe combined immunodeficiency (TKID) or Steenberger syndrome. Frequency - 1 case per 5 million. Thymus is completely absent or it is very small. The manifestation begins before 6 months of life and is characterized by candidiasis, pneumonia, diarrhea, etc.
- Fanconi Anemia (AF) is a very severe congenital aplastic anemia. Frequency 1 per 1 million. Symptoms: general damage to the production of white blood cells, abnormal development of internal organs, the child is sluggish, pale, the skeleton may contain immature bones. There is clubfoot, physical underdevelopment, immunodeficiency. Pathology manifests itself in 2 years of life. Increases the risk of leukemia and liver tumors.
- Chronic hereditary neutropenia - there is a delay in the release of mature granulocytes from CM, and young neutrophils in the blood quickly die. Congenital neutropenia is divided into cyclic and acyclic.
- Chediak – Higashi syndrome - giant granules appear in leukocyte groups, manifested by recurrent infections. There is no pigment in the cornea. With this congenital disease, the risk of lymphomas increases.
Low blood leukocytes
If leukocytosis indicates the available protective resources of the body and is considered a good sign, then leukopenia always indicates a disease and a decrease in body strength. For example, white blood cells in a child of 2 years will normally range from 6 to 11 thousand. With a decrease in the level significantly less than 6, leukopenia is diagnosed. With a slight decrease, do not worry.
If leukopenia lasts more than 2 weeks, the infection will develop in 100% of cases. When the body does not have the strength to repel external attacks, the infection will be a sign of prolonged leukopenia.
In the first few days, the main manifestation is fever and chills. Sometimes the temperature becomes the only sign of a low white blood cell count.
Hyperthermia is the result of intoxication not suppressed by white blood cells. All other symptoms of a catarrh infection may not be present. In these cases, doctors say that the diagnostic case is unclear, and treatment is delayed. This is always dangerous and can lead to septic shock.
Main symptoms
There are no specific symptoms of leukopenia. Besides temperature, tonsils, pallor of the skin, tachycardia, exhaustion of the body, aphthae and stomatitis, gums bleed, and the voice becomes hoarse, can be hypertrophied.
2.2 leukocytes in the blood indicate a rather severe stage 3 leukopenia and require urgent medical attention. A decrease in platelet count - thrombocytopenia also joins the temperature. It is particularly dangerous because it causes hemorrhagic syndrome.
White blood cells 2.2 and a decrease in platelet counts can lead to bleeding and become a serious cause of blood loss.
Signs of Leukopenia in Children
There are no special pathognomonic signs, but pay attention to:
- soreness of the child compared to peers;
- boils appear with remaining pockmarks;
- worried about periodontitis, poorly treatable;
- lag in physical development.
In children, Dr. Komarovsky E. advises to pay attention to the presence of temperature combinations with pneumonia, stomatitis, sinusitis and lymphadenitis. Leukopenia in children is detected more often, this is due to mandatory professional examinations.
Norm indicators
According to a new approach to assessing a blood test, leukopenia is a condition of pathology when the sum of all the white blood cells circulating in the blood drops significantly below normal.
If the white blood cells are 0-2 in the blood, this is an indicator of a neglected case and speaks of agranulocytosis. Why are white blood cells in children more abundant than in adults? Because they have a maturation of the immune system, and the immune cells are larger in terms of weight.
Also, the level of leukocytes in adults depends on nutrition and time of day, finally. Only in the puberty period are indicators already equal to adult norms - the range of leukocytes in the blood at 12, for example, is from 4.2 to 9. There are no gender differences.
The leukocyte blood composition of an adult normally looks like this:
- neutrophils - 55% (of which 47–72% - segmented are predominant);
- lymphocytes - 35%; monocytes - 5%; eosinophils - 2.5%; basophils - up to 0.5-1%.
People with a white blood cell count of 3.2-3.7 are subject to examination.
The blood picture in children is very different from that in adults. For example, if the norm of leukocytes in the blood at 2 years reaches 16.5, in an adult - this is a picture of leukocytosis.
For each age, the child has its own values, so tables are created by age. For example, the white blood cell count in a child at 2 years old or at 5 years old will differ.
- Newborns in the first week of life - up to 32 × 10 to the 9th degree (U / L).
- Age up to a year - from 6 to 17.5 × 10 in the 9th degree of Units / liter.
- White blood cells in 2 years - up to 17 thousand.
- Age up to 6 years - from 5 to 15.5 × 10 to the 9th degree U / L.
- Age up to 16 years - from 4.5 to 13.5 to the same degree U / L.
If it is indicated that there are 2 leukocytes in the blood, then we are talking about stab neutrophils, most likely. This average value is maintained from the first days of life to 16 years. In children, in the first weeks of life, normal leukocytes in the blood are 2.6 x 1090 / l. And only by the age of 10-12 the blood “matures” to the adult norm.
For example, the norm of leukocytes in the blood of children 2 years old (neutrophils) an average of 3.5. The range is from 1.5 to 8.5.
Adults (men) - leukocytes in the blood 4.2 to 9 × 109 units / l, in women can be up to 10.4.
Elderly - from 3.7 to 9 × 109 units / liter.
The older a person becomes, the less active the bone marrow is and produces less white blood cells, i.e. the indicator shifts to the left. But leukocytes 2 in the blood of an adult in old age indicate leukopenia.
Degrees of development
The classification is based on the duration of the syndrome, the presence and severity of complications. There is also the concept of false leukopenia - it occurs in the case of diluted blood, for example, with increased intravenous infusions, a large amount of fluid used.
- Mild leukopenia - the content of 3.9 -3.0 x10 to 9 degrees / liter of blood.
- The average severity is 2.9-2.0.
- Severe - leukocytes in the blood 1-2.
- Agranulocytosis is below 1.0.
So white blood cells 2 - what does it mean? This indicates the transition of leukopenia to stage 3.
Leukopenia is also relative and absolute. Absolute occurs with bone marrow depression, excessive destruction of white blood cells in the blood, their massive allocation from the body. Relative develops with improper redistribution of leukocytes.
The degree of leukopenia in duration
If the process of reducing white blood cells does not take more than 3 months, they speak of acute leukopenia, otherwise it is a chronic form.
By time of appearance:
- primary leukopenia is heredity;
- secondary leukopenia - we are talking about acquired cases for various reasons, i.e. she is postnatal.
What is dangerous leukopenia?
Among the main hazards are the following:
- the development of tumors - the risk increases 3 times;
- viral hepatitis B and C;
- AIDS.
- severe violations of the bone marrow;
- pneumonia;
- intestinal tissue necrosis;
- abscesses of internal organs;
- ARF and death due to sepsis.
For children, the danger lies in the development of leukemia.
Mortality depends on the general condition of the body and associated diseases. It is from 4 to 40%.
How to treat leukopenia
There is no specific treatment. The doctor must treat the causative pathology. He also conducts preventive therapy of bacterial, fungal and viral complications - antibiotics and mycostats.
Algorithm for treating leukopenia in adults:
- Laboratory diagnostics.
- etiotropic therapy.
- Creating aseptic conditions for the patient (especially with chemotherapy).
- Transfusion of leukocyte mass.
- Restoring the required level of leukocyte production.
- Conducting detoxification.
- Specialized diets. According to WHO recommendations, which are called protocols, the patient is urgently hospitalized in a sterile box.
The staff works in compliance with all aseptic rules.
Drugs for leukopenia
2 groups of drugs are used: stimulants of cellular immune processes and corticosteroids.
Stimulants - Leucogen, Neupogen, Methyluracil and Pentoxyl - hematopoiesis stimulants, they are prescribed as part of a comprehensive treatment.
Hormonal drugs - stimulants of leukopoiesis in the bone marrow - Filgrastim and Pegfilgrastim (G-CSF), as well as Sargramostim (GM-CSF). Release form - bottles for infusions.
With severe degrees of leukopenia, Leukomax, Molgramostim, Filgrastim, Lenograstim and Granocyte are prescribed. All of them accelerate the maturation of leukocytes and contribute to their release from the bone marrow.
With exacerbation of infections that occurred with leukopenia, antibiotic therapy is used, and treatment with immunostimulants, vitamins and symptomatic drugs.
Glucocorticosteroids or corticosteroids (Prednisone, Hydrocortisone, Dexamethasone, etc.) do not stimulate leukopoiesis, therefore, do not belong to leukopoiesis stimulants. But the level of leukocytes with their appointment is growing. The fact is that at the beginning of their application there is a redistribution of existing mature white blood cells. They intensely enter the circulating bloodstream from the spleen and bone marrow. Then comes with prolonged use of GCS leukopenia, so GCS is prescribed only in a short course.
Radical treatment can also be used - this is TCM (bone marrow transplantation). Hematopoiesis stem cells are transplanted. This is especially effective in children.
Chronic leukopenia as a complication of spleen diseases completely disappears after organ removal. The treatment of congenital leukopenia follows the same principle.
Chamber for the patient
To avoid infection, the patient is in a sterile box. The conditions here are aseptic, the staff works in masks and gloves.
Quartzing is carried out every 3 hours, the room is processed des. solutions. Visitors are not allowed. Sanitation of the mucous membranes and skin, especially the oral cavity, is provided. Products received or transmitted in transmissions are also carefully processed.
White blood cell behavior after chemotherapy
Chemotherapy is a very difficult method of treatment and cannot be reflected in the blood picture. At the same time, white blood cells suffer - they drop sharply. Further, they continue to decline for another 2-3 weeks, this explains the patient’s weakness.
Then their number gradually begins to recover. Therapeutic measures are carried out with 2.2 leukocytes in the blood, similar to the treatment of leukopenia in general.
Diet for leukopenia
The basic rules of the diet:
- the diet should contain a lot of protein and greens;
- a lot of vegetables and fruits;
- animal fats are excluded, replaced with vegetable fats, especially olive oil;
- vegetable broths are required;
- seafood is undesirable because it often contains cobalt and aluminum.
Prevention
Prevention includes the following activities:
- There should be constant blood control during treatment with myelotoxic drugs.
- Self-medication of any serious disease is excluded.
- Strict adherence to the prescribed dosages.
- Control of the blood picture when using drugs with hematological effects.
- The regularity of hygiene.
- Qualitative treatment of infections; healthy eating.
- Monitoring dosages of drugs during the treatment of oncology.
- Strengthening the immune system and its smooth operation.
- The use of multivitamin and mineral complexes.
- Careful use of dietary supplements with antioxidants.
With chemotherapy, prevention does not make sense.