Leukopenia is a blood leukocyte count that is lower than the norm . This change is not unusual in chemotherapy for the treatment of cancer, because cytostatics not only attack the tumor cells, but also impair the function of the blood-forming cells in the bone marrow.
Key facts at a glance!
- Leukopenia means that there are too few white blood cells in the blood .
- The effects of leukopenia are fatal because they are accompanied by a weakening of the immune system: there are too few leukocytes and antibodies available to defend against pathogens.
- Leukopenia is not uncommon in the course of chemotherapy. Cytostatics impair cell growth, so that especially fast-growing cells are damaged. However, this applies not only to cancer cells, but also to the cells of the hematopoietic system in the red bone marrow.
- Accordingly, it is important to constantly monitor the leukocyte blood levels during chemotherapy. It must be ensured that the white blood cells do not fall below a critical value, otherwise the patient is helpless at the mercy of any infection.
- That’s why cancer patients need to have their blood counts checked before each new round of chemotherapy. If the leukocytes have not yet sufficiently recovered, the next treatment must be awaited.
Why is leukopenia dangerous?
Leukopenia, more precisely leukocytopenia, means a reduced number of white blood cells (leukocytes) in the blood. The opposite of this, i.e. increased leukocyte values , is called leukocytosis .
Leukocytes represent only a small but important part of the blood cells. White blood cells are the elements of the immune system , which consists of a cellular and a humoral part. Cells are the lymphocytes , the various forms of granulocytes (neutrophilic, basophilic, and eosinophilic granulocytes ), and monocytes .
The “soluble” part of the immune system, the antibodies that are formed by certain white blood cells, is called humoral . Others are responsible for storing the information about an antigen contact and ensuring that the defense system reacts much more quickly if a pathogen comes into contact again.
Leukopenia is correspondingly dangerous for the immune system: the fewer white blood cells there are, the less the body has to counter invading viruses and bacteria.
How does chemotherapy cause leukopenia?
The purpose of chemotherapy is to stop cells from growing. Chemicals that affect cell division, attack DNA or prevent the division of the chromosomes stop the growth of cells that are trying to divide when the cytostatic is distributed in the body. Above all, this should prevent the cancer cells from further growth, because the control mechanisms that prevent healthy cells from multiplying unchecked fail in them, so that they are in the process of continuous growth.
Unfortunately, most cytostatics are not particularly specific and have the same effect on all other cells. Those that are particularly affected are those that grow rapidly, like cancer cells. In the human organism, this applies to cells that have to be constantly replaced and are subject to high turnover. Therefore, during chemotherapy, hair falls out and the skin and mucous membranes are affected. The consequences are skin reactions and, above all, impairment of the gastrointestinal tract, in which new cells are constantly being produced. If the replenishment does not work properly, this manifests itself in nausea, vomiting and diarrhea – side effects from which many cancer patients suffer.
Less obvious but no less serious is the impairment of the cells of the blood-forming system in the red bone marrow. Both red and white blood cells have a high turnover rate – erythrocytes, for example, live for around 120 days before the spleen sorts them out and recycles them. Leukocytes are “used up” depending on how busy the immune system is. Therefore, even a massive infection with viruses or bacteria can lead to leukopenia.
Caution with chemotherapy and leukopenia!
Chemotherapy is therefore almost always associated with a decrease in the number of white blood cells in the blood count. Doctors therefore often have the blood values examined in the small and large blood count in the course of chemotherapy so that the leukocyte value does not fall below a critical value. A blood value of 4,000 leukocytes per microliter (thousandth of a milliliter) of blood is considered critical.
If you follow this leukocyte blood value in the course of chemotherapy, you will find a decrease, after which the values will slowly rise again. This low point is called the leukocyte nadir.
Before a new round of treatment with chemotherapy, the blood count of the cancer patient must be checked. If the blood values of the leukocytes are too low, you may have to wait a while until they have recovered further.
What happens with leukopenia as a result of chemotherapy?
Leukopenia in the context of chemotherapy manifests itself in an increased susceptibility to infections, especially to bacterial infections.
At the front are the skin and mucous membranes , which are in constant contact with the outside world and therefore the microorganisms. Blackheads , boils and carbuncles form particularly easily on the skin because the normal flatmates are not adequately contained and penetrate the hair funnels deeper than usual.
Leukopenia and chemo often lead to involvement of the oral mucosa , leading to inflammation ( stomatitis ) and ulcerative changes ( ulcers ). The gums are often attacked and inflamed ( gingivitis ), which later leads to periodontitis and tooth loss .
The mucous membranes of the respiratory tract are also constantly exposed. If the immune system is not sufficiently active here, a whole series of inflammatory reactions occur, such as in the sinuses ( sinusitis ), the throat ( pharyngitis ) and down to the lungs ( pneumonia ).
General signs of an impaired immune system due to chemotherapy and leukopenia are fever and lymph node swelling .
Sources, links and further reading
- Reinhard Andreesen, Hermann Heimpel: Clinical hematology. Munich 2009: Urban & Fischer/Elsevier-Verlag. ISBN-10: 343731498X.
- Willibald Pschyrembel: Clinical Dictionary . 266th edition. Berlin 2014: Walter de Gruyter-Verlag. ISBN-10: 3110339978.
- Gerd Herold: Internal medicine. Cologne 2016: G. Herold-Verlag. ISBN-10: 3981466063
- Wolfgang Piper: Internal medicine. 2nd Edition. Stuttgart 2012: Springer Verlag. ISBN-10: 3642331076.
- Marlies Michl: BASICS Hematology. Munich 2016: Urban & Fischer/Elsevier-Verlag. ISBN-10: 3437421697.
