diff between lymphopenia & leukopenia

[holly1234]

hello.  i'm new here.  my primary has been thought to be systemic lupus.  i've been under investigation by immunology since may...at the same big teaching hospital as my rheumatology lupus clinic.  am 61.

even before prescription systemic treatment for SLE began 4 years ago (for what has turned out to be chilldhod onset lupus) my characteristic blood results have tended to hover just below or just at the lowest poss normal levels, but, in feb past, results were low enough to mean referral to immunology for hypogammaglobulinaemia (reduced G, A, M) & lymphopenia (FBC lymphocytes reduced: with CD8 T reduced & B phenotyping showing reduced switch memory B cells)

immunology now thinks my immunodeficiency isn't primary.  but investigations continue.  for the time being, IVIG isn't indicated.  instead i'm continuing with home emergency kits of antibiotics etc

Meanwhile, i'm getting my head around the finer points of my diagnoses...and find myself a bit hung up re understanding the basic diffs between lymphopenia & leukopenia...so will be v grateful for help please

also, is it ok to take part here if my deficiency really really turns out not to be primary?

thanks in advance

[conniek]

I am a medical technologist, and can help you with some of your questions.

Leukopenia means that the total white cell count is decreased
Lymphopenia means that total lymphocyte count (part of the total white count) is decreased. There are a number of different types of lymphocytes. The doctor has to specifically order the lymphocyte subclasses - which it looks like your doctor has already ordered. Lymphopenia can also occur when you have a serious bacterial infection, where there is an increased number of neutrophils (the other primary type of leukocyte); this generally means that the total white count, especially the neutrophil count, is elevated. In a massive infection, the total white count can be decreased.

Your medications for SLE are immunosupressants, to reduce your immune response. It is possible, therefore, to have secondary immunodeficiency as a result.
www.uptodate.com/contents/secondary-immunodeficiency-induced-by-drugs-and-biologic-therapies

You should be aware that people with primary immunodeficiency often do have autoimmune diseases such as SLE. Do you have the symptoms of primary immunodeficiency which predate the treatment you are getting for lupus? If so, it could be that you do have primary.

I hope that you can get your symptoms and illnesses sort out, and that your health improves.

[holly1234]

Hello connie is & thanks for your reply in July: you helped me a lot. I'm now a bit further into immunology investigations. I posted the following on the general discussions section of this forum recently. I think I should've posted it here. Anyway, this answers your questions, I hope. I'd be very grateful for your thoughts....but am not sure that you'll actually discover I've replied to you...fingers crossed you do!

am several months into investigations by immunology, having been referred last Feb by my lupus and Vasculitis rheumatology clinic due to hypogammaglobulinaemia (G, A, M consistently just below normal range) and lymphopenia (also consistently just below normal range) + a history of various types of persistent complex recurring infections. These deficiencies existed before I began rheumatology-led immunosuppression treatment in 2011 for what has turned out to be infant onset lupus + a host of secondaries inc sjogrens that have developed over my 62 years.

Yes I am aware that my meds can cause secondary immunodeficiency, but I have a long history of lower than normal lymphocyte results, and also pre immunosuppression below normal immunoglobulin results. I have read a bit on this subject, but your link is new to me and very interesting.

My therapeutic doses of daily immunosuppressants are:
400mg hydroxychloroquine sulfate
1000mg mycophenolate mofetil Cellcept
3.5mg prednisolone
Over the past 4+ years, these meds have helped me feel generally better than I have since my 20s: this feels wonderful.. Neither rheumatology nor immunology are suggesting a change to my autoimmune conditions treatment plans.

I understand that so far immunology investigations have made good headway into beginning to describe my immunodeficiency. at the outset, they discovered I have 0 (no) pneumonia antibodies. So I had the pneumovax 23, and was tested again: Then they found that I had again made 0 (no) pneumonia antibodies in response to pneumovax 23. So now I'm to have prevenar 13 (PCV13), and be tested to see if I make any antibodies. Also the immunology consultant made it clear that they have quite a lot more investigations to carry out before they can put name/s to my version of immunodeficiency.

meanwhile I'm packing a home emergency kit of coamoxiclav 625 (2 week course) and getting my head around the protocols re:
sputum/phlegm sample collection
post nasal drip collection
starting amoxiclav while lab sample is tested
changing antibiotic if lab results require this
going onto IV antibiotics if no significant pos response to antibiotics within 2-3 days and symptoms are severe

my respiratory infections (Bacterial tracheitis/poss bronchiectasis), the long term osteomyelitis I've had in my upper left jawbone associated with sinusitis, etc etc have been very responsive to high dose long course antibiotics over the decades. But no lab samples have ever been collected and, although there has been some imaging by various clinics, the only actual infection sample lab testing that has been carried out has been during my UTIs and pyelonephritis sessions (am quite good carrying out this sort of lab sample collection & home urinalysis)

My infections typically flare during late autumn-Spring. Over the months, I've spent a reasonable amount of time checking out what info NHS Choices et al have to offer re lab sample collections, my respiratory infections etc, and I've read several very helpful threads here on forum. Now I'd be very grateful for any advice or comments anyone feels like giving re the finer points of how best an individual like me might manage all this recognising onset of infection promptly, new lab collections etc etc stuff....for instance, am vague about the point at which I should decide I probably have an infection & had better start sampling (my immunosuppression complicates the signs and signals, for instance my temperature tends to stay only just above normal).

Also, I'm particularly interested in the possible significance in a case like mine of producing 0 (no) antibodies after the pneumovax 23. I gather this can indicate possible CVID

Read more: primaryimmuno.proboards.com/thread/858/pneumonia-antibodies-after-pneumovax-23#ixzz3rSsJbOIy