Lymphopenia
This guideline applies to adults.
Introduction
Isolated lymphopenia is common (especially in old age), is described in an array of conditions and carries no particular clinical significance of its own accord. On its own it requires no further action nor monitoring and haematology review is not indicated.
In scope: Lymphocyte count <1x109/L on FBC
Not in scope: All other forms of blood disorders.
Red Flag Features
B symptoms – weight loss, fevers, night sweats, bulky lymphadenopathy
*This list is not exhaustive
Investigations required
There should be a low threshold for HIV testing.
In the absence of systemic symptoms or other abnormalities on blood tests, isolated lymphopenia requires no further monitoring.
Management optimisation
Lymphopenia may reflect a response to stress such as acute infection or recent surgery.
The patient’s medical history and examination should determine if any further action is required.
Consider reviewing medication as lymphopenia can be iatrogenic eg from steroids and other immunosuppressants.
Other causes to consider include a history of excess alcohol, malnutrition and post viral.
Advice and Guidance
Haematology A&G can be accessed via ERS: Haematology Advice & Guidance
This service should not be used for suspected fast track referrals.
Referral
In the absence of any concerning features, haematology review is not indicated for isolated lymphopenia.
References
- Peninsular Cancer Alliance, Haematological SSG Advice and Guidance for non-haematological clinicians, October 2024
- Lymphopenia – GPnotebook
- Investigating an incidental finding of lymphopenia | The BMJ
Page Review Information
Review date: |
27 May 2025 |
Next review date: |
27 May 2027 |
Clinical editor: |
Dr Laura Lomas |
Contributors:
|
Dr Michelle Furtado, Peninsular Cancer Alliance, Haematology Site-Specific Group |