Q: My 50 years old uncle is suffering from leukopenia for the last five months. He is diabetic also. His white blood count (WBC) is 1800 for the last five months but for the last one week his WBC is 500 with less neutrophils and more lymphocytes. Bone marrow biopsy showed no malignancy. He is suffering from pneumonia and malaria. Doctors have given 5 granulocyte (grafeel) injections but there is no improvement so far. What causes leukopenia?

A:The WBC are mainly concerned with immunity and fighting infections. In your uncle's case, there is an acute on chronic leucopenia and associated febrile neutropenia.Since bone marrow biopsy is not indicating a malignancy, we also need to know if the marrow is hypocellular/aplastic. He has sulpha allergy. Check the medications given for diabetes as lot of medication can cause leucopenia. Viral infections including hepatitis B and C, HIV need to be ruled out.Also check on vitamin b12 and folate levels, immunoglobulins levels. He needs strict barrier nursing, antibiotics and antifungals and colony stimulating factors like filgrastin/pegfilgrastin. Recovery will dependent on underlying cause.