Relative Lymphocytosis Associated with Granulocytopenia Neutropenia and Agranulocytosis

Neutropenia is defined by a decrease in the number of neutrophilic granulocytes with segmented nuclei to less than 1500/^1 (1.5 x 109/l). A neutrophil count of less than 500/^l (0.5 x 109/l) constitutes agranulocytosis. Absolute granulocytopenias with benign cause develop into relative lymphocytoses.

In the most common clinical picture, drug-induced acute agranulocytosis, the bone marrow is either poor in cells or lacks granulopoietic precursor cells (aplastic state), or shows a "maturation block" at the myeloblast-promyelocyte stage. The differential diagnosis of pure agranulocytosis versus aplasias of several cell lines is outlined on page 146.

Classification of Neutropenias and Agranulocytoses

1. Drug-induced:

a) Dose-independent—acute agranulocytosis. Caused by hypersensitivity reactions: for example to pyrazolone, antirheumatic drugs (anti-inflammatory agents), antibiotics, or thyrostatic drugs.

b) Relatively dose-dependent—subacute agranulocytosis (observed for carbamazepine [Tegretol], e.g. antidepressants, and cytostatic drugs).

c) Dose-dependent—cytostatic drugs, immunosuppressants.

2. Infection-induced:

a) E.g., EBV, hepatitis, typhus, brucellosis.

3. Autoimmune neutropenia:

a) With antibody determination of T-cell or NK-cell autoimmune response b) In cases of systemic lupus erythematosus (SLE), Pneumocystis carinii pneumonia (PCP), Felty syndrome c) In cases of selective hypoplasia of the granulocytopoiesis ("pure white cell aplasia")

4. Congenital and familial neutropenias:

Various pediatric forms; sometimes not expressed until adulthood, e.g. cyclical neutropenia

5. Secondary neutropenia in bone marrow disease:

Myelodysplastic syndromes (MDS), e.g., acute leukemia, plasmacy-toma, pernicious anemia

Bone marrowdiagnosis is indicated in cases of unexplained agranulocytosis

Agranulocytosis

Fig. 29 The bone marrow in agranulocytosis. a In the early phase of agranulocytosis the bone marrow shows only red cell precursor cells (e.g., 1), plasma cells (2), and lymphocytes (3); in this sample a myeloblast—a sign of regeneration—is already present (4). b Bone marrow in agranulocytosis during the promyelocytic phase, showing almost exclusively promyelocytes (e.g., 1); increased eosinophilic granulocytes (2) are also present.

Fig. 29 The bone marrow in agranulocytosis. a In the early phase of agranulocytosis the bone marrow shows only red cell precursor cells (e.g., 1), plasma cells (2), and lymphocytes (3); in this sample a myeloblast—a sign of regeneration—is already present (4). b Bone marrow in agranulocytosis during the promyelocytic phase, showing almost exclusively promyelocytes (e.g., 1); increased eosinophilic granulocytes (2) are also present.

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Responses

  • Brogan Stewart
    Is agranulocytosis dose dependant?
    5 years ago
  • LARRY
    What absolute and relative neutropenia?
    5 years ago
  • KRISTIAN
    What is lymphocytosis granlopenia?
    3 months ago
  • ute schulz
    What is lymphocytosis granulopenia?
    1 month ago

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