Page 1230 - Williams Hematology ( PDFDrive )

1204 Part IX: Lymphocytes and Plasma Cells Chapter 79: Lymphocytosis and Lymphocytopenia 1205

TABLE 79–3. Causes of Lymphocytopenia
I. Inherited causes C. Iatrogenic
A. Congenital immunodeficiency diseases (Chap. 80) 1. Immunosuppressive agents
1. Severe combined immunodeficiency disease 175 a. Antilymphocyte globulin therapy 198
a. Aplasia of lymphopoietic stem cells b. Alemtuzumab (Campath 1-H) 199
b. Adenosine deaminase deficiency 176 c. Glucocorticoids 198
c. Absence of histocompatibility antigens 2. High-dose psoralen plus ultraviolet A treatment 200
d. Absence of CD4+ helper cells 3. Stevens-Johnson syndrome 201
e. Thymic alymphoplasia with aleukocytosis (reticular 4. Chemotherapy
dysgenesis) 177 5. Renal transplant 202
f. Mutations in genes required for T-cell development 6. Radiation 203
2. Common variable immune deficiency 154 7. Major surgery 116
3. Ataxia-telangiectasia 178 8. Extracorporeal bypass circulation 204
4. Wiskott-Aldrich syndrome 9. Hematopoietic stem cell transplant 205
5. Immunodeficiency with short-limbed dwarfism (carti- 10. Thoracic duct drainage 139
lage-hair hypoplasia) 179 11. Hemodialysis 206
6. Immunodeficiency with thymoma 180 12. Pheresis for donor lymphocyte infusion 140
7. Purine nucleoside phosphorylase deficiency 181 D. Systemic disease associated
8. Immunodeficiency with venoocclusive disease of the
liver 182 1. Autoimmune diseases
B. Lymphopenia resulting from genetic polymorphism 121 a. Systemic lupus erythematosus 207
II. Acquired causes b. Sjögren syndrome 142
A. Aplastic anemia (Chap. 35) c. Myasthenia gravis 208
183
B. Infectious diseases d. Systemic vasculitis 209
1. Viral diseases e. Behçet-like syndrome 210
a. Acquired immunodeficiency syndrome (Chap. 81) f. Dermatomyositis 211
184
b. Severe acute respiratory syndrome 128 g. Wegener granulomatosis 212
213
c. West Nile encephalitis 158,185 2. Hodgkin lymphoma (Chap. 99)
d. Hepatitis 186 3. Carcinoma 214
e. Influenza 187 4. Idiopathic myelofibrosis 215
f. Herpes simplex virus 188 5. Protein-losing enteropathy 216,217
g. Herpes virus type 6 (HHV-6) 189 6. Heart failure 145
h. Herpes virus type 8 (HHV-8) 190 7. Sarcoidosis 218
i. Measles virus 191 8. Thermal injury 144
j. Other 192 9. Severe acute pancreatitis 219
2. Bacterial diseases 10. Strenuous exercise 220
a. Tuberculosis 193 11. Silicosis 221
b. Typhoid fever 194 12. Celiac disease 222
c. Pneumonia 195 E. Nutritional and dietary
d. Rickettsiosis 196 1. Ethanol abuse 149
e. Ehrlichiosis 197 2. Zinc deficiency 148
f. Sepsis 131 III. Idiopathic
3. Parasitic diseases A. Idiopathic CD4+ T lymphocytopenia 153
a. Acute phase of malaria infection

a disease course-related immunodeficiency that can predispose patients (decrease in percent of lymphocytes, not absolute lymphocyte count)
to infection with opportunistic infectious agents (see Table 79–3). was frequently noted. 132
130
The prognostic value of lymphocytopenia as a consequence of sepsis
has been evaluated. In a single-center retrospective study, persistent Iatrogenic
131
lymphopenia on the fourth day after the diagnosis of sepsis predicted Radiotherapy, cytotoxic chemotherapy, glucocorticoids, or administra-
both 28-day and 1-year survival. Lymphopenia is considered a surro- tion of antilymphocyte globulin or alemtuzumab (Campath-1H) each
gate marker for sepsis-induced immunosuppression. In patients hos- can lead to lymphocytopenia by destroying circulating lymphocytes
pitalized with decompensated heart failure, relative lymphocytopenia (see Table 79–3). Long-term treatment of psoriasis with psoralen and

Kaushansky_chapter 79_p1199-1210.indd 1205 9/17/15 4:07 PM