Lymphopenia (Guidelines)

TAM (Treatments and Medicines) NHS Highland
NHS Highland

Audience

  • Highland HSCP

The reference range depends on age but in adults is generally 1.5 to 4 × 109/L.

Causes

  • Acute infections especially bacterial
  • Chronic infections g. tuberculosis
  • HIV
  • Increasing age
  • Medications e.g. steroids
  • Autoimmune diseases
  • Chronic diseases g. cardiac failure, renal failure
  • Congenital immunodeficiency syndromes
  • Lymphoma

History and examination 

Look to exclude the above causes. Examination for lymphadenopathy and ask about B symptoms and recurrent infections. Look for symptoms or signs of autoimmune disease. Review older blood tests.

Suggested investigations

  • HIV test

Management

  • If the lymphopenia is persistent with no secondary causes and no clinical concerns then no further action is required
  • It would be extremely unusual for a patient to have lymphopenia as the sole presenting feature of lymphoma however if there are other clinical concerns e.g. lymphadenopathy, B symptoms then please refer to the relevant department (neck nodes-ENT, axillary-breast service, inguinal-general surgeons.
  • If the patient has recurrent infections and is lymphopenic (and HIV negative) then suggest check immunoglobulins and discuss with immunology service

Editorial Information

Last reviewed: 29/01/2024

Next review date: 31/01/2027

Author(s): Haematology Department .

Version: 2

Approved By: APPROVED TAM Subgroup of the ADTC

Reviewer name(s): Dr P Forsyth, Consultant Haematologist .

Document Id: TAM216