Lymphocytosis

A pathological condition characterized by an increase in the number of lymphocytes in the peripheral blood flow. Lymphocytes, which are white cells, are produced by bone marrow tissue. They normally comprise just over 40% of the total mass. Their increase indicates the presence of a pathological process in the body. Classical lymphocytosis should be considered as a complex disease.

Causes of occurrence. A clear range of reasons has not yet been fully determined. The most common causes:

Acute viral infectious diseases,

The consequences of rubella, chickenpox, measles, scarlet fever, viral hepatitis C,

Nervous and emotional stress,

Significant physical activity over time,

Spontaneous redistribution of cells responsible for immunity,

Acute and chronic intoxications, where the poisonous substances are carbon disulfide, arsenic or lead, actively develop lymphocytosis,

Vitamins, AIDS, general depletion of the body.

Types and forms. Physiologically, there are five types of white blood cells that make up a single protective barrier. There are four types of lymph inflammation:

Relative lymphocytosis is characterized by a proportional composition of cells. The most common type is diagnosed by a slightly reduced or normal number of white blood cells.

Absolute lymphocytosis is characterized by a significant excess of the norm of the content of white blood cells. A distinctive feature is a surge in the formation of lymphocytes and confirmation of diseases such as hepatitis, infectious mononucleosis, diseases of the endocrine system, lymphosarcoma.

Infectious lymphocytosis occurs with the penetration of the lymphotropic virus, with the formation of acute viral damage.

Symptoms Usually, the initial stage of the disease proceeds without certain clinical manifestations, the symptoms are smoothed out. Most often, the patient's complaints relate to the presence of a particular infection, which is a provoking factor.

Swollen lymph nodes, spleen and liver,

External signs are infections of the nose, hyperemia of the oral mucosa, a relatively low level of general condition,

Symptoms of a respiratory tract disease

A sharp decrease or increase in body temperature, accompanied by chills, general exhaustion,

Disorders of the intestines, nausea, constipation and diarrhea,

In children - characteristic paroxysmal vomiting,

General disorder of nervous activity, insomnia, a strong increase in tonsils against the background of an increase in temperature to 40 ° C.

Clinical analyzes show an increase in lymphocyte counts in bone marrow tissue.

Diagnostics. Clinical diagnosis is based on an analysis of the blood picture, for which purpose general clinical blood test. In most cases, the diagnosis is based on the following items:

elevated lymphocytes in combination with an increased general level of leukocytes,

relatively large growth of the lymphocyte formula and platelet count - hypersplenism and autoimmune thrombocytopenic purpura,

synchronous increase in red blood cells and lymphocytes,

the presence of signs of bacterial and viral infections,

imbalance with low white blood cells and low lymphocytes,

leukopenia, as a complication of tuberculosis, as well as any viral disease.

Treatment. Therapy is symptomatic. Given the fact that a violation of the blood composition is a consequence of a variety of pathologies, only after their diagnosis is a specific treatment prescribed.

The appointment of anti-inflammatory drugs, antibiotics and antiviral agents is prescribed to lead to the normalization of the level of lymphocytes.

The determination of the appearance of a neoplasm leads to the appointment of chemotherapy, or surgical bone marrow transplantation.

Prevention. The main principles of prevention are timely access to a specialist and a healthy lifestyle.

Causes of Lymphocytosis

The causes of lymphocytosis can be as follows:

Stressful conditions, jumps in the level of hormones in the body. In addition, physical activity and menstrual bleeding in a woman can cause an increase in the level of lymphocytes. Such lymphocytosis is temporary and passes on its own.

Tobacco for many years. If a person suffers from this addiction, then the level of lymphocytes in him can remain stably high. In parallel, erythrocytosis is observed.

Infectious diseases with damage to the body by viruses, bacteria or parasites. In this case, immunity is rapidly activated. If the infection is bacterial in nature, the level of neutrophils in the blood increases, and with viral infection, the number of lymphocytes increases. Therefore, any viral infection is accompanied by lymphocytosis. This indicates the activation of the body's defenses and its active resistance to the disease. Elevated levels of lymphocytes will persist until recovery occurs. Mononucleosis, pertussis, tuberculosis, syphilis and some other bacterial infections of a chronic course can lead to lymphocytosis.

Blood cancer: chronic lymphocytic leukemia and acute lymphoblastic leukemia. When the bone marrow is damaged, immature lymphoblasts are formed in it, which do not have the ability to become full-fledged lymphocytes. These cells are not able to form a normal immunity, so a person begins to suffer from various infections. Moreover, he will be sick hard and for a long time. Acute lymphoblastic leukemia most often develops in childhood, in adults the pathology is less common. In chronic lymphocytic leukemia in the bone marrow, the number of mature lymphocytes increases, but they are not able to perform their functions.

Thyrotoxicosis. Lymphocytes take part in the immune reactions of the body, proceeding in a delayed manner. Therefore, an increase in their abundance in the blood may indicate autoimmune processes. Thyrotoxicosis is one of the striking examples of such a violation. In addition, other autoimmune processes can be accompanied by lymphocytosis: Crohn’s disease, rheumatoid arthritis, etc.

Intoxication of the body with lead, arsenic, or carbon disulfide. In case of poisoning, relative lymphocytosis is observed, at this time it is important to monitor the level of neutrophils in order to prevent a sharp drop in immunity.

Undergoing treatment with a number of drugs. The use of drugs such as: chloramphenicol, levodopa, phenytoin, valproic acid, some analgesics can lead to lymphocytosis.

Splenectomy. Removing the spleen is an operation that can be performed in a hospital only for certain indications. Its absence in the body can provoke a temporary increase in the level of lymphocytes in the blood. Then the internal systems adapt and the blood counts return to normal.

Symptoms of Lymphocytosis

Lymphocytosis is not an independent pathology, but only a consequence of any disorders or changes in the body. Therefore, symptoms of increased levels of lymphocytes in the blood will be determined by the symptoms of the underlying disease.

With viral infections, an increase in body temperature, sore throat, intestinal disorders, skin rashes, etc. come to the fore. In addition to lymphocytosis, the patient will also have other deviations in blood counts.

With tumors of the hematopoietic tissue, patients experience bone pain, body temperature will always remain elevated. Bleeding increases, immunity decreases.

With lymphocytosis and neutropenia, a high probability of a viral infection, such as: whooping cough, acute respiratory viral infections, diphtheria, sepsis, etc. With lymphocytosis and monocytopenia, it makes sense to suspect measles, chickenpox, and mumps. If monocytes and lymphocytes are significantly higher than normal, then the patient should be checked for monocytic leukemia or myelodysplastic syndrome.

With infectious mononucleosis, the patient has an increase in body temperature, a sore throat appears, lymph nodes increase in size, weakness and sweating increase, especially at night. The Epstein-Barr virus causes the disease.

Serious poisoning and bacterial infections increase the absolute and relative levels of lymphocytes. At the same time, the leap can be quite impressive.

Chronic lymphocytosis, which persists in a person over a long period of time, may be a sign of a sluggish infection, immunodeficiency, or a developing cancer. As a rule, the immunity of such patients is reduced, they are sick for a long time and often, suffer from constant weakness. Body temperature can be maintained at the level of subfebrile values.

At the same time, a prolonged slight increase in the level of lymphocytes in healthy people is possible. Experts do not exclude that this may be due to the individual characteristics of the body.

How to diagnose lymphocytosis?

To diagnose a person with lymphocytosis, a clinical blood test must be taken. In past years, laboratory technicians performed all calculations manually, examining a blood smear under a microscope. Modern laboratories are equipped with automated devices that perform this work. Therefore, lymphocyte counts may vary in the same person, depending on how they were counted.

If the doctor has any doubts, then he can prescribe another blood test with the calculation of the absolute value of the lymphocytes. Existing deviations from the norm are compared with specific symptoms that concern the patient. As necessary, additional examinations are prescribed.

Lymphocytosis treatment

There is no treatment for lymphocytosis, since this condition is not an independent disease. Therapy is determined by the cause, which provoked an increase in the level of lymphocytes in the blood.

In acute infections, antiviral drugs or antibiotics are prescribed. Antifungal agents may be required. For a speedy recovery, you need to drink as much fluid as possible, in parallel, symptomatic treatment is carried out aimed at lowering body temperature, eliminating pain, relieving intoxication, etc.

If a malignant tumor is detected, the patient is prescribed cytostatics, immunosuppressants. To prevent complications from joining the patient, fungicides and antibiotics are prescribed.

To prevent the development of lymphocytosis, it is necessary to direct efforts to strengthen the immune system, lead a healthy lifestyle, eat right, and temper. During periods of outbreaks of viral infections, crowded places should be avoided, hands should be washed with soap, and vitamin and mineral complexes should be taken.

Lymphocytosis is not a cause for panic. Most likely, after getting rid of the disease, the lymphocytes will return to normal on their own. In any case, with the appearance of unexplained weakness, with prolonged subfebrile condition and other pathological symptoms, you need to consult a doctor and undergo a comprehensive examination. The faster the treatment is prescribed, the higher the chances of a speedy recovery.

Education: Moscow Medical Institute I. Sechenov, specialty - "Medical business" in 1991, in 1993 "Occupational diseases", in 1996 "Therapy".

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Types of lymphocytosis

When conducting a peripheral blood analysis, not only the absolute lymphocyte count per unit volume of blood is calculated, but also the percentage of lymphocytes relative to the total number of leukocytes is calculated.

In accordance with this, the following types of lymphocytosis in adults and children are distinguished:

  1. Absolute lymphocytosis. It is characterized by an absolute increase in the content of lymphocytes in the blood (normally 1000–4500 cells in 1 μl), which occurs against the background of an increase in the total number of leukocytes (leukocytosis).
  2. Relative lymphocytosis. The patient has an increase in the percentage of lymphocytes, often against the background of a normal or reduced total number of leukocytes (leukopenia). In clinical practice, it is observed much more often than absolute lymphocytosis.

Depending on the etiological factor underlying the occurrence of lymphocytosis, it is divided into reactive and malignant.

If lymphocytosis is detected by the results of a blood test and the patient does not have any clinical symptoms inherent in an infectious pathology, or an indication of a previous infectious disease, a detailed examination is indicated.

The ingestion of an infectious agent into the body causes the development of a response, which leads to reactive lymphocytosis, that is, to a normal reaction of the immune system. In cases where lymphocytosis develops as a result of the body’s struggle not with infection, but with cancer cells, they speak of malignant lymphocytosis.

Diagnostics

Diagnosis of lymphocytosis is carried out according to the results of a general (clinical) blood test.

With absolute lymphocytosis in patients, an increased number of lymphocytes is combined with an increase in the total number of leukocytes.

The combination of relative lymphocytosis and thrombocytopenia (a decrease in platelet count) is most often observed in autoimmune thrombocytopenic purpura or hypersplenism.

In bacterial and viral infections accompanied by dehydration of the patient (high fever, frequent vomiting, diarrhea), a simultaneous increase in lymphocytes and red blood cells is detected in the analysis of peripheral blood.

Tuberculosis and many viral infections are accompanied by the development of leukopenia (a decrease in the total number of leukocytes) in combination with relative lymphocytosis.

Lymphocytosis often accompanies cancer. Therefore, if lymphocytosis is detected by the results of a blood test and the patient does not have any clinical symptoms inherent in an infectious pathology, or an indication of a previous infectious disease, a detailed examination is shown, which, depending on the indications, includes the following methods:

  • identification of tumor markers,
  • Ultrasound of the abdominal cavity and pelvis,
  • computed and / or magnetic resonance imaging,
  • X-ray research methods,
  • fibrogastroduodenoscopy (FGDS),
  • a biopsy of suspicious lesions detected by diagnostic imaging, followed by histological analysis of tissue samples.

When conducting a peripheral blood analysis, not only the absolute lymphocyte count per unit volume of blood is calculated, but also the percentage of lymphocytes relative to the total number of leukocytes is calculated.

Prevention

Prevention of lymphocytosis is aimed at increasing the defenses of the human body, preventing infection with infectious diseases.

It includes the following activities:

  • balanced diet,
  • compliance with the alternation of work and rest,
  • active lifestyle (regular physical education, frequent walks in the fresh air, outdoor activities during the day),
  • giving up bad habits (smoking, alcohol abuse),
  • careful observance of personal hygiene rules,
  • isolation of patients with infectious diseases,
  • vaccination of major infections in accordance with the national calendar of vaccinations,
  • regular preventive examinations, this is especially important for people at risk for malignant blood damage (lymphoma in the family history, etc.).

Classification

There are no clear numerical criteria for the separation of lymphocytosis in severity. Conditionally allocated moderate (up to 60%) and high lymphocytosis (more than 60%). The main cause of high lymphocytosis are malignant diseases of the hematopoietic and lymphatic tissue. Lymphocytosis, like other types of leukocytosis, is divided into:

  • Absolute. Absolute lymphocytosis means an increase in the number of lymphocytes along with the total number of leukocytes (in adults more than 4000, in children under 5 years of age more than 6000).
  • Relative. Relative lymphocytosis is much more common and means a percentage increase in lymphocytes (more than 40%) against the background of a normal or even reduced total number of leukocytes.

Physiological conditions

The most striking example is physiological lymphocytosis in children under the age of 4-5 years. The reason for this phenomenon is associated with age-related changes in the child’s immune system. From the 7th day of life in children, an active increase in the number of lymphocytes (up to 55-60%) and a drop in neutrophils (the first cross of the leukocyte formula) begins. Then, by the age of 4, lymphocytes return to indicators as in adults (up to 40%), and neutrophils, on the contrary, increase (the second cross). Pathological lymphocytosis in children should be considered figures more than 60%.

Separate isolated short-term lymphocytosis, not associated with any disease. Among these causes of lymphocytosis are:

  • Stress.
  • Alimentary factors: fasting, following a vegetarian diet.
  • Drug use: phenytoin, para-aminosalicylic acid, narcotic analgesics.

Viral infections

Lymphocytes are the main "tool" of the immune system against viruses. They produce special antibodies (immunoglobulins), which, when bound to the virus, prevent its entry into the cells. Subsequently, viral particles undergo phagocytosis. Another mechanism of antiviral immunity is the destruction of cells infected with viral DNA or RNA by triggering programmed cell death (apoptosis). Likewise, lymphocytes fight some bacteria, intracellular parasites (toxoplasmas).

  • Acute viral infections. The most common cause of lymphocytosis in children is recognized as such infectious diseases as measles, rubella, chickenpox, in adults - influenza, SARS. Typically, lymphocytosis is moderate, it occurs sharply, reaches a maximum parallel to the height of the disease, then, as the symptoms resolve, it quickly returns to normal values.
  • Infectious mononucleosis. Infectious mononucleosis caused by the Epstein-Barr virus is a specific viral infection in children. With infectious mononucleosis, lymphocytosis is more persistent, it can persist for several weeks or months. Sometimes the virus persists for years and can cause chronic fatigue syndrome.

In addition to quantitative changes, viral infections are considered to be the cause of the appearance of atypical mononuclear cells (virocytes) - lymphocytes that have a different shape, altered structure of the nucleus, and basophilic cytoplasm. In small amounts (less than 10%), they are present for any viral infections. A higher concentration of such cells (more than 10%) indicates an infectious mononucleosis.

Bacterial infections

In adults, one of the common causes of lymphocytosis is bacterial infections with a chronic course, accompanied by the formation of specific epithelioid granulomas (tuberculosis, brucellosis, syphilis). Typhoid diseases (typhoid fever, typhus, paratyphoid fever) are less commonly the cause of lymphocytosis in adults. The only acute bacterial infection that causes lymphocytosis in children is pertussis.

Basically, slight lymphocytosis is observed, and almost always relative, against the background of general leukopenia. In view of the chronic course of diseases, lymphocytosis can persist indefinitely (months, years), increasing during periods of exacerbation. With tuberculosis, lymphocytosis indicates a benign course and is considered a predictor of a favorable outcome.

Malignant blood diseases

Myeloproliferative and lymphoproliferative diseases are recognized as the most dangerous cause of lymphocytosis in adults and children. In such cases, lymphocytosis is due to proliferation of tumor clones of the lymphatic tissue or malignant transformation of hematopoietic cells in the bone marrow. In adults, chronic leukemia, non-Hodgkin's lymphomas (lymphosarcomas) are mainly observed. In children, lymphogranulomatosis (Hodgkin's lymphoma) is more common. Lymphocytosis reaches very high numbers (up to 70-90%).

The growth of lymphocytosis occurs gradually: the maximum value is achieved after several years, decreases slowly, only under the influence of chemotherapy courses. A quick return to normal levels is only possible with a bone marrow transplant. In addition to lymphocytosis, signs such as a simultaneous increase in eosinophils and basophils (basophilic-eosinophilic association), the presence of a large number of blasts, intermediate forms (prolymphocytes) are noted.

Endocrine disorders

In some cases, the cause of lymphocytosis is diseases of the endocrine organs. The exact mechanism of this phenomenon has not yet been fully established. A moderate degree of lymphocytosis often develops simultaneously with an increase in the concentration of eosinophils. In adults, this pattern is observed with acromegaly, thyrotoxicosis, adrenal insufficiency. In children, congenital dysfunctions of the genital glands become a frequent cause. Lymphocytosis quickly regresses after the appointment of hormone replacement therapy.

Other reasons

  • Rheumatological pathologies: rheumatoid arthritis, acute rheumatic fever, systemic lupus erythematosus.
  • Blood diseases: aplastic anemia, B12-folic deficiency anemia, post-transfusion syndrome.
  • Parasitic infestations: malaria, Chagas disease, schistosomiasis.
  • Allergic reactions: bronchial asthma.

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