- Lymphopenia assc w/ ⬆️risk of sepsis
- More common in elderly and w/ co-morbidities
- lymphs account for 20-40% of WBC, may go unnoticed when WBC checked w/o diff
- Primary- recurrent infxns in kids, CVID in adults
- Secondary-⬇️production; ⬆️destruction; hiding in tissue
What is the most common cause of lymphopenia in hospitalized patients?
After reviewing several articles, I compiled a table with common causes of lymphopenia, I hope this is helpful for others. There are too many causes to be all inclusive.
I want to highlight that one of the most common causes of lymphopenia world-wide is #malnutrition.
Now, changing gears to sepsis immunology.
What specifically about sepsis and lymphopenia leads to increased mortality?
Although a massive loss of lymphocytes (both T and B) occurs at the onset of sepsis, its PERSISTENCE correlates with ⬆️mortality
Lymphopenia is caused by apoptosis mostly.
Also there is a ⬇️ number in circulation as lymphs go to inflamed tissue.
Pathogen & damage assc molecular patterns recog by TLRs➡️inflamm
W/ sepsis, dysreg host response➡️organ dysfxn & system activation (endothelium, complement➡️procoag state)
Loss of WBC and loss of blocking excess inflamm ➡️profound immune failure
With respect to labs and other studies, you should let the history and exam guide what to order.
You can use the following table to help, though not all the tests listed should be ordered to every patient...
other than #HIV of course!