LEUKOPENIA

• It is a condition in which there are fewer leukocytes than normal, results from neutropenia (diminished neutrophils) or lymphopenia (diminished lymphocytes). Even if other types of leukocytes (eg, monocytes, basophils) are diminished, their numbers are too few to reduce the total leukocyte count significantly.
• In adults leukopenia is a total WBC count <3700 cells/mm3. Most cases result from absolute neutropenia (<2500 cells/mm3); rare cases are secondary to absolute lymphopenia (<1500 cells/mm3).

ETIOLOGY

• Blood cell or bone marrow conditions
  • Aplastic Anemia
  • Hypersplenism or overactive spleen
  • Myelodysplastic syndromes
  • Myeloproliferative syndrome
  • Myelofibrosis
• Cancer like leukemia and treatments for cancer
  • chemotherapy
  • radiation therapy (especially when used on large bones, such as those in your legs and pelvis)
  • bone marrow transplant
• Congenital problems
  • Severe congenital neutropenia (Kostmann syndrome)
  • Myelokathexis
• Infectious diseases
  • HIV or AIDS
  • Tuberculosis
• Autoimmune disorders
  • SLE, systemic lupus erythematosus
  • Rheumatoid arthritis
• Malnutrition - vitamin or mineral deficiencies
  • vitamin B-12
  • folate
  • copper
  • zinc
• Medications
  • clozapine
  • cyclosporine
  • interferons
  • minocycline
  • penicillin
  • sodium valproate
  • steroids
• Viral infections
• Sarcoidosis - by formation of granulomas form in your bone marrow, leukopenia can result.

CLINICAL MANIFESTATIONS

• Insidious onset, may be discovered during routine physical examination.
• Commonly sign and symptoms of infections can appear as:
  • Fever
  • Ulcers
  • Abscesses (collections of pus)
  • Rashes
  • Wounds that take a long time to heal

DIAGNOSTIC INVESTIGATION

• Monitor complete blood count (CBC) and differential daily especially
• absolute neutrophil count [ANC] - ANC less than 1000/mm³ Critical
• lymphocyte count- less than 1500/mm³ Critical
• Globulin, albumin, total protein levels.
• All culture and sensitivity test
• x-ray

MEDICAL MANAGEMENT

• Depending on its cause
• Medication induced, the offending agent is stopped immediately, if possible.
• Underlying neoplasm - can temporarily, but with bone marrow recovery, may improve it. Withholding or reducing the dose of chemotherapy or radiation therapy may be required immunologic disorder - Corticosteroids may be used
• The use of growth factors such as G-CSF or granulocyte-macrophage colony-stimulating factor can be effective when the cause of the neutropenia is decreased production.
• If the Leukopenia is accompanied by fever,
  • The patient is considered to have an infection
  • Admitted to the hospital.
  • Cultures of blood, urine, and sputum, as well as a chest x-ray done
  • Adequate therapy against the infectious organisms, broad-spectrum antibiotics are initiated as soon as the cultures are obtained, The antibiotics may be changed after culture and sensitivity results are available.

NURSING MANAGEMENT

Risk for infection secondary to impaired immunocompetence

• Everyone must perform hand hygiene before entering patient's room each and every time.
• Allow no one with a cold or sore throat come in contact with patient at home.
• Use private room for patient if ANC is < 1000/mm³ or lymphocyte count- < 1500/mm³.
• Change water in containers every shift (include O² humidification systems every 24 hours).
• Ensure room is cleaned daily.
• Provide low-microbial diet.
• Encourage adequate hydration.
• Avoid suppositories, enemas, rectal temperatures.
• Practice deep breathing (with incentive spirometer) every 4 hours while awake.
• Ambulate; wear high-efficiency particulate air (HEPA) filter mask if neutropenia is severe.
• Prevent skin dryness with water-soluble lubricants, especially in high-risk areas (eg, lips, corners of mouth, elbows, feet, bony prominences).
• Provide meticulous total body hygiene daily (preferably with antimicrobial solution), including perineal care after every bowel movement.
• Provide thorough oral hygiene after meals and every 4 hours while awake; warm saline, or salt and soda solution, is effective; avoid use of lemon-glycerine swabs, commercial mouthwashes, and hydrogen peroxide.
• Avoid plastic cannulas for peripheral IVs when ANC is <500/mm³ if possible; a central vascular access device is preferred for long-term or intensive IV therapy.
• Inspect IV sites every shift; monitor closely for any discomfort; erythema may not be present.
• Maintain meticulous IV site care.
• Cleanse skin with antimicrobial solution before venepuncture (unless patient is allergic).
• Moisture-vapor–permeable dressings are permissible with strict adherence to institutional protocol.
• Change IV tubing per institution policy, using aseptic technique.
• Administer antimicrobial agents on time.