UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Approach to the adult with lymphocytosis or lymphocytopenia

Authors
Nancy Berliner, MD
Matthew S Davids, MD, MMSc
Section Editor
Stanley L Schrier, MD
Deputy Editor
Alan G Rosmarin, MD

INTRODUCTION

Lymphocytes are white blood cells (WBCs) that facilitate humoral and cellular immunity against foreign proteins and pathogens. Abnormal increases or decreases in the lymphocyte count (lymphocytosis or lymphocytopenia) may reveal a transient infection or one of a number of other benign or malignant conditions.

This topic reviews our approach to evaluating an adult with lymphocytosis or lymphocytopenia. The evaluation of children with lymphocytosis or lymphocytopenia is presented separately. (See "Approach to the child with lymphocytosis or lymphocytopenia".)

Information on the evaluation of malignant conditions associated with lymphocytosis is presented separately:

CLL – (See "Clinical presentation, pathologic features, diagnosis, and differential diagnosis of chronic lymphocytic leukemia".)

T cell LGL – (See "Clinical manifestations, pathologic features, and diagnosis of T cell large granular lymphocyte leukemia".)

                                      

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2016. | This topic last updated: Thu Oct 15 00:00:00 GMT+00:00 2015.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
References
Top
  1. Downey H, McKinlay CA. Acute lymphadenosis compared with acute lymphatic leukemia. Arch Intern Med 1923; 32:82.
  2. Vetsika EK, Callan M. Infectious mononucleosis and Epstein-Barr virus. Expert Rev Mol Med 2004; 6:1.
  3. Balfour HH Jr, Odumade OA, Schmeling DO, et al. Behavioral, virologic, and immunologic factors associated with acquisition and severity of primary Epstein-Barr virus infection in university students. J Infect Dis 2013; 207:80.
  4. Steeper TA, Horwitz CA, Ablashi DV, et al. The spectrum of clinical and laboratory findings resulting from human herpesvirus-6 (HHV-6) in patients with mononucleosis-like illnesses not resulting from Epstein-Barr virus or cytomegalovirus. Am J Clin Pathol 1990; 93:776.
  5. Horwitz CA, Henle W, Henle G, et al. Heterophil-negative infectious mononucleosis and mononucleosis-like illnesses. Laboratory confirmation of 43 cases. Am J Med 1977; 63:947.
  6. Remington JS. Toxoplasmosis in the adult. Bull N Y Acad Med 1974; 50:211.
  7. Ehrlich GD, Han T, Bettigole R, et al. Human T-lymphotropic virus type I-associated benign transient immature T-cell lymphocytosis. Am J Hematol 1988; 27:49.
  8. Kubic VL, Kubic PT, Brunning RD. The morphologic and immunophenotypic assessment of the lymphocytosis accompanying Bordetella pertussis infection. Am J Clin Pathol 1991; 95:809.
  9. Heininger U, Stehr K, Schmitt-Grohé S, et al. Clinical characteristics of illness caused by Bordetella parapertussis compared with illness caused by Bordetella pertussis. Pediatr Infect Dis J 1994; 13:306.
  10. Levene I, Wacogne I. Question 3. Is measurement of the lymphocyte count useful in the investigation of suspected pertussis in infants? Arch Dis Child 2011; 96:1203.
  11. Margileth AM. Cat scratch disease. In: Nelson Textbook of Pediatrics, 15th ed, Behrman RE, Kliegman RM, Arvin AM (Eds), WB Saunders, Philadelphia 1996.
  12. Saadatnia G, Golkar M. A review on human toxoplasmosis. Scand J Infect Dis 2012; 44:805.
  13. Teggatz JR, Parkin J, Peterson L. Transient atypical lymphocytosis in patients with emergency medical conditions. Arch Pathol Lab Med 1987; 111:712.
  14. Kho AN, Hui S, Kesterson JG, McDonald CJ. Which observations from the complete blood cell count predict mortality for hospitalized patients? J Hosp Med 2007; 2:5.
  15. Toft P, Tønnesen E, Svendsen P, et al. The redistribution of lymphocytes during adrenaline infusion. An in vivo study with radiolabelled cells. APMIS 1992; 100:593.
  16. Casassus P, Lortholary P, Komarover H, et al. Cigarette smoking-related persistent polyclonal B lymphocytosis. A premalignant state. Arch Pathol Lab Med 1987; 111:1081.
  17. Delannoy A, Djian D, Wallef G, et al. Cigarette smoking and chronic polyclonal B-cell lymphocytosis. Nouv Rev Fr Hematol 1993; 35:141.
  18. Troussard X, Mossafa H, Valensi F, et al. [Polyclonal lymphocytosis with binucleated lymphocytes. Morphological, immunological, cytogenetic and molecular analysis in 15 cases]. Presse Med 1997; 26:895.
  19. Lesesve JF, Troussard X. Persistent polyclonal B-cell lymphocytosis. Blood 2011; 118:6485.
  20. Cornet E, Lesesve JF, Mossafa H, et al. Long-term follow-up of 111 patients with persistent polyclonal B-cell lymphocytosis with binucleated lymphocytes. Leukemia 2009; 23:419.
  21. Delage R, Roy J, Jacques L, Darveau A. All patients with persistent polyclonal B cell lymphocytosis present Bcl-2/Ig gene rearrangements. Leuk Lymphoma 1998; 31:567.
  22. Dasanu CA, Codreanu I. Persistent polyclonal B-cell lymphocytosis in chronic smokers: more than meets the eye. Conn Med 2012; 76:69.
  23. Loembé MM, Lamoureux J, Deslauriers N, et al. Lack of CD40-dependent B-cell proliferation in B lymphocytes isolated from patients with persistent polyclonal B-cell lymphocytosis. Br J Haematol 2001; 113:699.
  24. Himmelmann A, Gautschi O, Nawrath M, et al. Persistent polyclonal B-cell lymphocytosis is an expansion of functional IgD(+)CD27(+) memory B cells. Br J Haematol 2001; 114:400.
  25. Salcedo I, Campos-Caro A, Sampalo A, et al. Persistent polyclonal B lymphocytosis: an expansion of cells showing IgVH gene mutations and phenotypic features of normal lymphocytes from the CD27+ marginal zone B-cell compartment. Br J Haematol 2002; 116:662.
  26. Delage R, Jacques L, Massinga-Loembe M, et al. Persistent polyclonal B-cell lymphocytosis: further evidence for a genetic disorder associated with B-cell abnormalities. Br J Haematol 2001; 114:666.
  27. Juneja S, Januszewicz E, Wolf M, Cooper I. Post-splenectomy lymphocytosis. Clin Lab Haematol 1995; 17:335.
  28. Garcia-Suarez J, Prieto A, Reyes E, et al. Persistent lymphocytosis of natural killer cells in autoimmune thrombocytopenic purpura (ATP) patients after splenectomy. Br J Haematol 1995; 89:653.
  29. Kelemen E, Gergely P, Lehoczky D, et al. Permanent large granular lymphocytosis in the blood of splenectomized individuals without concomitant increase of in vitro natural killer cell cytotoxicity. Clin Exp Immunol 1986; 63:696.
  30. Doll DC, Landreneau RJ, List AF. Malignant thymoma associated with peripheral T-cell lymphocytosis. Med Pediatr Oncol 1991; 19:496.
  31. Barton AD. T-cell lymphocytosis associated with lymphocyte-rich thymoma. Cancer 1997; 80:1409.
  32. Cranney A, Markman S, Lach B, Karsh J. Polymyositis in a patient with thymoma and T cell lymphocytosis. J Rheumatol 1997; 24:1413.
  33. Otton SH, Standen GR, Ormerod IE. T cell lymphocytosis associated with polymyositis, myasthenia gravis and thymoma. Clin Lab Haematol 2000; 22:307.
  34. Lishner M, Ravid M, Shapira J, et al. Delta-T-lymphocytosis in a patient with thymoma. Cancer 1994; 74:2924.
  35. Snow AL, Xiao W, Stinson JR, et al. Congenital B cell lymphocytosis explained by novel germline CARD11 mutations. J Exp Med 2012; 209:2247.
  36. Darte JM, McClure PD, Saunders EF, et al. Congenital lymphoid hyperplasia with persistent hyperlymphocytosis. N Engl J Med 1971; 284:431.
  37. Matos DM, Falcão RP. Monoclonal B-cell lymphocytosis: a brief review for general clinicians. Sao Paulo Med J 2011; 129:171.
  38. Dighiero G. Monoclonal B-cell lymphocytosis--a frequent premalignant condition. N Engl J Med 2008; 359:638.
  39. Shanafelt TD, Ghia P, Lanasa MC, et al. Monoclonal B-cell lymphocytosis (MBL): biology, natural history and clinical management. Leukemia 2010; 24:512.
  40. Kalpadakis C, Pangalis GA, Sachanas S, et al. New insights into monoclonal B-cell lymphocytosis. Biomed Res Int 2014; 2014:258917.
  41. Rawstron AC, Bennett FL, O'Connor SJ, et al. Monoclonal B-cell lymphocytosis and chronic lymphocytic leukemia. N Engl J Med 2008; 359:575.
  42. Marti GE, Carter P, Abbasi F, et al. B-cell monoclonal lymphocytosis and B-cell abnormalities in the setting of familial B-cell chronic lymphocytic leukemia. Cytometry B Clin Cytom 2003; 52:1.
  43. Rawstron AC, Yuille MR, Fuller J, et al. Inherited predisposition to CLL is detectable as subclinical monoclonal B-lymphocyte expansion. Blood 2002; 100:2289.
  44. Shim YK, Rachel JM, Ghia P, et al. Monoclonal B-cell lymphocytosis in healthy blood donors: an unexpectedly common finding. Blood 2014; 123:1319.
  45. Marti GE, Rawstron AC, Ghia P, et al. Diagnostic criteria for monoclonal B-cell lymphocytosis. Br J Haematol 2005; 130:325.
  46. Fazi C, Scarfò L, Pecciarini L, et al. General population low-count CLL-like MBL persists over time without clinical progression, although carrying the same cytogenetic abnormalities of CLL. Blood 2011; 118:6618.
  47. Mowery YM, Lanasa MC. Clinical aspects of monoclonal B-cell lymphocytosis. Cancer Control 2012; 19:8.
  48. Hallek M, Cheson BD, Catovsky D, et al. Guidelines for the diagnosis and treatment of chronic lymphocytic leukemia: a report from the International Workshop on Chronic Lymphocytic Leukemia updating the National Cancer Institute-Working Group 1996 guidelines. Blood 2008; 111:5446.
  49. Landgren O, Albitar M, Ma W, et al. B-cell clones as early markers for chronic lymphocytic leukemia. N Engl J Med 2009; 360:659.
  50. Sivakumaran M, Richards S. Immunological abnormalities of chronic large granular lymphocytosis. Clin Lab Haematol 1997; 19:57.
  51. Kaito K, Otsubo H, Ogasawara Y, et al. Severe aplastic anemia associated with chronic natural killer cell lymphocytosis. Int J Hematol 2000; 72:463.
  52. Loughran TP Jr. Clonal diseases of large granular lymphocytes. Blood 1993; 82:1.
  53. Bockorny B, Dasanu CA. Autoimmune manifestations in large granular lymphocyte leukemia. Clin Lymphoma Myeloma Leuk 2012; 12:400.
  54. Pontikoglou C, Kalpadakis C, Papadaki HA. Pathophysiologic mechanisms and management of neutropenia associated with large granular lymphocytic leukemia. Expert Rev Hematol 2011; 4:317.
  55. Liu X, Loughran TP Jr. The spectrum of large granular lymphocyte leukemia and Felty's syndrome. Curr Opin Hematol 2011; 18:254.
  56. Brady KA, Atwater SK, Lowell CA. Flow cytometric detection of CD10 (cALLA) on peripheral blood B lymphocytes of neonates. Br J Haematol 1999; 107:712.
  57. Chantepie SP, Salaün V, Parienti JJ, et al. Hematogones: a new prognostic factor for acute myeloblastic leukemia. Blood 2011; 117:1315.
  58. Sevilla DW, Colovai AI, Emmons FN, et al. Hematogones: a review and update. Leuk Lymphoma 2010; 51:10.
  59. Kanegane H, Yachie A, Miyawaki T, Tosato G. EBV-NK cells interactions and lymphoproliferative disorders. Leuk Lymphoma 1998; 29:491.
  60. Castelino DJ, McNair P, Kay TW. Lymphocytopenia in a hospital population--what does it signify? Aust N Z J Med 1997; 27:170.