Leukopenia in children

Author Ольга Кияница

2019-03-03

The work of the immune system is closely related to leukocytes, the number of which must be within certain limits. Since the children's body reacts sensitively to any changes, an insufficient number of white blood cells, like their excess, can lead to various disorders. Then we will talk about leukopenia in children, its manifestations and treatment.

Leukopenia - determining the number of leukocytes (white blood cells) is below normal. The disorder occurs for various reasons and most often is a symptom of another disease. Particular attention is paid to leukopenia in children, because the children's body is sensitive to various external and internal changes.

The number of leukocytes in the blood depends on the age of the child, therefore, make appropriate blood tests to find out the main indicators of leukocyte formula.

Leukocytes play an important role because they help the body to resist various pathological pathogens. Accordingly, with a shortage of leukocytes, there is a serious risk of infection. Therefore, leukopenia in children is necessary, after finding out the cause, should be amenable to appropriate treatment.

Video: What Does a Low White Blood Cell Count Mean?

Description of leukopenia in children

Blood is a liquid substance and in addition to plasma, it turns on three different types of cells that are produced by the bone marrow:

  • Red blood cells that transport oxygen to all cells.
  • Platelets that are involved in closing wounds and stopping bleeding.
  • White blood cells, also called “white blood cells”, help to fight various infections.

There are several different types of white blood cells, each of which plays a special role in protecting the body against infection:

  • Neutrophils - fighting bacteria and fungal infections.
  • Lymphocytes that fight viruses, produce antibodies and regulate the immune system.
  • Monocytes / macrophages , which are the largest leukocytes and act as blood purifiers for relatively large foreign particles.
  • Eosinophils and basophils - the first assistants in the fight against parasites, are additionally involved in allergic reactions.

Leukocyte differentiation

Many disorders can lead to bone marrow producing too much or too little leukocytes, or leukocytes that are not functioning properly begin to be produced.

Table of the normal number of leukocytes in the blood of children of different ages

Child's age Leukocytes, * 10 ^ 9 / l
1 day 8.5-24.5
1 month 6.5-13.5
6 months 5.5-12.5
1 year 6.0-12.0
1-6 years 5-12
7-12 years old 4.5-10
13-16 years old 4.3-9.5

Types of leukopenia

Changes in the number of neutrophils and lymphocytes is the most common. Disorders associated with monocytes and eosinophils are less common, and basophilic disorders are even less common.

Examples of pathological conditions arising from a low leukocyte count:

  • Neutropenia is a generic term for a low number of neutrophils in the blood. Neutropenia can be congenital (due to genetic causes) or acquired (caused by drugs / drugs, toxins, viruses or attacks from a child’s own immune system).
  • Shwachman-Diamond syndrome is a rare hereditary disease characterized by pancreatic dysfunction and congenital neutropenia — a low number of neutrophils due to insufficient bone marrow production.
  • Kostman syndrome is a severe form of congenital neutropenia. In this hereditary disease, neutrophils are practically absent in the blood, because they do not mature properly. As a result, patients have infections and wounds on the mucous membranes, especially in the mouth, from an early age.

Additionally, leukopenia can occur with disorders that occur when leukocyte malfunction. Examples of such disorders are as follows:

  • Chronic granulomatous disease is a hereditary pathology in which neutrophils, monocytes and macrophages (collectively called phagocytes for their ability to absorb pathogenic microorganisms) are not able to effectively fight bacteria and fungal infections.
  • Leukocyte adhesion deficiency is a rare hereditary group of diseases in which white blood cells cannot produce the proteins they need to move to the site of infection.
  • Myeloperoxidase deficiency is a disease characterized by the absence of enzymes that help neutrophils fight bacteria.
  • Chediaka-Higashi syndrome is a very rare hereditary disease in which cells of the immune system can not properly accumulate and secrete the necessary enzymes.

Depending on the type of leukocyte disorder in a child, the doctor may prescribe:

  • A blood test to assess the number and morphology of leukocytes, that is, external and quantitative characteristics are investigated.
  • Analysis of the level of vitamin B12 and folic acid.
  • Blood testing for antibodies against neutrophils.
  • Checking the bone marrow, for which aspiration or biopsy of the bone marrow is performed. This helps doctors understand why a child has a low neutrophil level.
  • Search for changes in genes that indicate hereditary bone marrow dysfunction.

Doctors may conduct additional special tests to confirm or exclude certain irregularities. In particular, it can be used:

  • Specific analysis of the function of leukocytes.
  • A sample of feces to clarify the syndrome Shvahmana-Diamond.

After completing all diagnostic tests, hematologists will be able to find out the cause of the disease and prescribe the most appropriate treatment option.

Examination of the lymph nodes

Leukopenia in a child: causes

A low number of white blood cells usually means that the body does not produce enough white blood cells. It is important to remember that this may increase the risk of developing all sorts of infections.

Common causes that cause low white blood cell count are:

  • Treatment of cancer through radiation therapy.
  • Acceptance of antipsychotic drugs.
  • Medication for reducing the activity of the thyroid gland.
  • The development of infectious diseases such as HIV or hepatitis.
  • Autoimmune disorders such as rheumatoid arthritis.

Some populations with Afro-Caribbean and Middle Eastern descent are often more prone to low white blood cell counts.Also, a low number of leukocytes in the blood is sometimes transmitted by heredity. Such cases are considered normal and do not increase the risk of infection, therefore, drug correction is not required.

Video: Neutropenia

Leukopenia in children: symptoms

Symptoms depend on the type of quantitative leukocyte change in a child. Common signs of a condition where the leukocytes are too small or they do not function properly are as follows:

  • Frequent infectious diseases, mainly affects the lungs, ears or paranasal sinuses.
  • Abscesses of the skin.
  • Ulcers in the mouth.
  • Invasive fungal diseases.
  • Severe damage to the teeth and gums (periodontal disease).

Brief clinical characteristic:

  • Ear inflammatory diseases cause pain in the affected ear.
  • Infections of the paranasal sinuses can cause headache, difficulty breathing or coughing.
  • Pneumonia is an inflammation of the lungs that can cause chills, coughing, shortness of breath and muscle pain.
  • Infectious inflammation of the bladder is often the cause of fever, nausea, or pain when urinating.

Some disturbances may manifest unique symptoms, such as:

  • Slowing of wound healing with leukocyte adhesion deficiency.
  • Chronic, sometimes fatty, diarrhea, which is characteristic of Shvakhman-Diamond syndrome.

Less characteristic signs are weakness, fatigue, dizziness, chills and shivering, but their appearance should not be ignored. If the child has even the usual cold symptoms, it is worth contacting the attending pediatrician. If necessary, the doctor will refer to a hematologist for further research, and if necessary, prescribe medication.

Leukocyte adhesion deficiency

Leukopenia in children: treatment

Treatment of leukopenia in children depends on the underlying problem (for example, acquired or congenital pathology).It also matters the severity of the disease. If necessary:

  • Symptoms are treated, for example, oral or intravenous antibiotics are prescribed to fight infection.
  • A colony stimulating factor is assigned to stimulate the bone marrow in order to produce more leukocytes.
  • Stem cell transplantation (bone marrow) is performed, which is most often indicated for severe congenital diseases.Bone marrow transplantation involves the replacement of a diseased bone marrow with healthy tissue taken from another person (donor).

Unfortunately, the listed methods of treatment, especially bone marrow transplantation, may not help everyone. For example, the success of a transplant depends on many factors, such as how close the relationship between the child and the donor is (siblings are the best donors; if the child has a brother, then the probability that the tissues will coincide is 1 to 4). Also the age of the patient is important. As a rule, young children tolerate such treatments better than adolescents.

The decision on bone marrow transplantation is discussed with the hematologist who is treating the child, and a group of doctors involved in stem cell transplantation.

Bone marrow transplantation

Additional recommendations

If a child has a low white blood cell count caused by a disease or medication, measures should be taken to avoid infections.

1. What is allowed to do?

  • Avoid close contact with sick people.
  • Store and cook food properly to avoid food poisoning
  • Wash hands regularly with soap and warm water
  • Use disposable personal hygiene products where necessary (for example, a teenager is better to use a disposable razor)
  • Avoid using a shower or toilet in public places.

2. What should not be done?

  • Do not share food, cups, dishes, toothbrushes or cosmetics.
  • Do not eat raw foods such as meat, shellfish and eggs.
  • Do not contact with animal feces and do not communicate with animals, especially patients.
  • Do not walk barefoot
  • Do not swim in ponds and rivers

Additional recommendations that may be useful in the treatment of leukopenia in a child may be given by a pediatrician or hematologist.

Conclusion

Thanks to ongoing research, the treatment of patients with low white blood cell levels has improved significantly over the past 20 years. Genetic testing, which is currently used for many congenital disorders of leukocytes, including congenital neutropenia, allows a better assessment of the patient's prognosis. Improved therapy and supportive care help patients with the most severe neutrophilic disorders live longer and better.

Video: Possible Causes of Leukopenia


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