Q: I have low grade lymphoma. My WBC was 4.0 six months ago, which has now dropped to a low of 3.6. Is this considered Leukopaenia? What is the treatment to raise the WBC count?

A:White blood cells (leukocytes) comprise granulocytes (cells with granules in their cytoplasm) and mononuclear cells. Granulocytes are of three types – neutrophils, eosinophils and basophils while mononuclear cells are lymphocytes and monocytes. The normal total leukocyte count (TLC) varies with the age of a person. It also has a diurnal cycle i.e. counts vary during a 24 hour day. Normally they range from 4000 to 10,000 per ml in an adult. Leukopenia is a decrease below the accepted normal range of total leukocytes. This reduction may be due to a decrease in granulocytes, lymphocytes or monocytes and is respectively called absolute neutropenia, absolute lymphopenia and absolute monocytopenia. The causes for each of these are many. Usually only one type of cell is responsible for this decrease, but there may be a simultaneous decrease in several cell types and this can be judged by a differential leukocyte count. The range of each of these cells also varies with the age of an individual. There are numerous causes for decrease in neutrophils, lymphocytes etc. Neutropenia when accompanied by lymphocytopenia (or monocytopenia) is a more serious problem than neutropenia alone. Neutropenia leads to an increased susceptibility to bacterial and fungal infections while lymphocytopenia predisposes to recurrent viral, fungal, or parasitic infections. Neutropenia may be classified as mild (1000 to 1500/µl), moderate (500 to 1000/µl), or severe (< 500/µl). Acute neutropenia occurs over a few days and is often due to rapid neutrophil consumption accompanied by impaired production. This can be life threatening, especially in immunocompromised patients. Decreased neutrophil production or excessive sequestration of neutrophils in the spleen usually causes chronic neutropenia (lasting for months or years). The commonest cause of neutropenia is drugs while it may be caused transiently by some viral infections and sepsis. It may also be due to megaloblastic anaemia caused by vitamin B12 or folate deficiency, Lymphocytopenia is defined by a total lymphocyte count of < 1000/µl in adults. The condition may be inherited lymphocytopenia when associated with inherited immunodeficiency diseases or acquired. AIDS is the most common infectious disease associated with lymphocytopenia while it can be secondary to autoimmune disorders, drugs etc. Are you on treatment? If so the low counts are secondary to therapy. If not on therapy, your doctor needs to evaluate you and consider treatment. A bone marrow examination and some other tests would be required to decide the best course.