Aust N Z J Med. 1997 Apr;27(2):170-4. Unique Identifier : AIDSLINE
BACKGROUND: Lymphocytopenia is a common finding in hospital patients
especially since the advent of automated differential leukocyte
counters. The causes and significance of lymphocytopenia are generally
poorly understood. There has been no large-scale study of its
significance for 25 years. The HIV epidemic, and the recently described
idiopathic CD4+ T-lymphocytopenia have raised interest in this finding.
AIMS: To describe the spectrum of lymphocytopenia in an adult teaching
hospital and investigate its clinical significance. METHODS: Using the
available computer facilities, patients with significant lymphocytopenia
(< 0.6 x 10(9)/L) were identified over a 102 day period and diagnoses,
operations and medication lists obtained. Where necessary, patient
histories were examined to supplement the above information. If
feasible, previous and subsequent lymphocyte counts were checked to
establish if the lymphocytopenia were temporary or longstanding.
RESULTS: One thousand and forty-two patients were identified, with a
mean age of 59.6 years, of whom 563 were male, and 757 were inpatients.
Thirty-six patients were pancytopenic. We checked previous and
subsequent counts for 698 patients and found 45 patients who were
consistently lymphocytopenic, some for more than ten years. Thirty-four
patients with previously normal counts remained lymphocytopenic
throughout follow up, while 457 had at least one subsequent lymphocyte
count > 1 x 10(9)/L. We found only one patient who was suspected of
having idiopathic CD4+ T-lymphocytopenia. Patients fell into several
categories (with some overlap): bacterial/fungal sepsis (250),
post-operative 228), corticosteroid therapy (definite 159, suspected 53,
inhaled steroids alone 14), malignancy (174 definite, six probable),
cytotoxic therapy and/or radiotherapy (90), trauma or haemorrhage (86),
transplants (73-38 renal and 35 bone marrow), viral infections' (26) and
HIV infection (13). Thirty-four patients died within the study period.
CONCLUSIONS: Lymphocytopenia in hospital patients is most frequently
reversible, and due to acute illness, notably sepsis and trauma
including surgery). Malignancy, with or without chemotherapy, and
steroid use are also common causes, but HIV infection is a relatively
uncommon cause in our hospital.