publication year: 2022

TOP-5 causes of increased lymphocytes in the blood. 

«Nature is conquered by the one who obeys her; when all her icons are understood, a person will become an unlimited ruler over her».

doctor, Veresaev Vikenty Vikentievich

Hello! My name is Evgeny Zaytsev, and I will tell you about the 5 main reasons for the increase in the level of lymphocytes in the blood.

I work as a medical consultant. I am approached with questions about the interpretation of laboratory tests by phone, via WhatsApp, through social networks, on average about one thousand questions per month.

You will also learn why Russian doctors were the first to diagnose an increase in the level of lymphocytes. There will be many clinical examples from personal practice. But first, I'll briefly cover the basics:

Types of lymphocytes

Types of lymphocytes

The number of lymphocytes is examined in a general blood test with a leukocyte formula. Blood can be divided into 3 parts - plasma, erythrocytes (red cells) and leukocytes (white cells). "Leikos" is Greek for "white". Leukocytes are divided into fractions of eosinophils, basophils, neutrophils, monocytes and lymphocytes. In turn, lymphocytes are divided into B-cell (lymphocytes), T-cell (lymphocytes). B-lymphocytes produce protective antibodies. T-lymphocytes are also divided into T-helpers and T-cytotoxic lymphocytes. Lymphocytes live from a week to several months, but some live for years, and are responsible for the immunological "memory".

Lymphocytes are derived from hematopoietic stem cells in the bone marrow. Then they migrate to the thymus, to the lymph nodes, to the spleen and then end up in the bloodstream.

The level of lymphocytes in the form of results can be reflected in the relative number in percent and absolute, 10^9 /liter or 1000/microliter. It is worth paying less attention to the violation in percentage than to changes in absolute values.

reference intervals of lymphocytes - norms

reference intervals of lymphocytes

The number of lymphocytes changes with age. The norms may differ in different laboratories, this is due to the fact that they use different literature data. The most stringent upper limit for adults I have seen is 3,000/µL, but it is generally accepted that one should actively look for the cause of lymphocytosis in adults if lymphocytes are more than 5,000/µL. In children, lymphocytes can be 2 times higher than in adults, so we always look at the reference data of the norms and remember that children have a percentage crossover of the leukocyte formula on the 5th day of life and later at 5 years old.

The absolute number of B-cells and T-lymphocytes is very high in the first months of life and decreases with age. Is it not here that we should look for the answer to the question of why children tolerate the new covid-19 favorably?

So, let's already discuss the TOP-5 reasons for the increase in lymphocytes in the blood.

№ 1 Chronic Lymphocytic Leukemia

It is typical for older people (>65 years).

The mechanism for increasing lymphocytes is clonal hematopoiesis of B-lymphocytes.

The number of lymphocytes can reach huge values. In absolute quantity more than 5 thousand/µl (in relative quantity more than 80%). In most cases, chronic lymphocytic leukemia is an accidental finding and surprise for patients. If timely detected and treated, then it is possible to achieve a life expectancy the same as that of all people.

Gumprecht's shadows appear on the blood smear. But in any case, immunophenotyping of lymphocytes is needed here to make a final diagnosis.

Gumprecht's shadows are characteristic destroyed lymphocytes

Gumprecht's shadows are characteristic destroyed lymphocytes

Doctors use flow cytometry to find a monoclonal population of B cells with specific CD markers.

Immunophenotyping of bone marrow/peripheral blood lymphocytes

Different clinical manifestations of lymphocytic leukemia formed the basis of the classification developed by Andrey Ivanovich Vorobyov, the first Minister of Health of the Russian Federation.

Andrei Ivanovich Vorobyov cooperate is Dr. Brilliant Marina Davydovna . She very carefully led the patients and, every day, doing a blood test for them, entered the results on the temperature sheet. All doctors in the world are taught to keep such a list - only few do it.

Brilliant and Vorobyov also found that in acute radiation sickness, the change in the number of peripheral blood leukocytes over time reflects the dose of total radiation that the patient received on the bone marrow. Observation of victims in many radiation accidents of that time allowed them to learn how to determine the dose of emergency exposure with an accuracy of several tens of rads.

Andrei Ivanovich has a lot of books and publications, including about the reasons for the increase in lymphocytes.

№2 Transient lymphocytosis

Changes in the level of lymphocytes occur in conditions of psychological and physical stress, such as exercise. It is believed that this is indirectly associated with a change in catecholamines and steroid hormones. There is a redistribution of lymphocytes in the vessels of the lymphatic system. And perhaps this is due to the activation of herpes family viruses during stress, but this is my personal observation. Physically induced lymphocytosis load usually resolves within a few hours, but can be much longer.

One scientific study was conducted in a specialized hospital of 52 adults with a primary increase in lymphocytes greater than 4.0 thousand/µl.

All patients with available follow-up data showed a decrease in the absolute number of lymphocytes to normal. In some cases, stress lymphocytosis can last much longer than 48 hours and still be a temporary phenomenon. Only 1 patient showed signs of lymphoproliferative disease.

In the study of transient lymphocytosis, a great contribution was made by the Soviet and Russian medical scientist, physiologist Garkavi, Lyubov Khaimovna.

Lyubov Khaimovna found another non-specific adaptive reaction of the body, called the reactivation reaction by the author of the discovery. The reactivation reaction, as well as stress, occurs in the body to strong stimuli and has features of damage and stress, however, by the nature of the changes, it is the opposite of the stress reaction.

If the dose or strength of stress is not reduced in a timely manner, then the reaction of increased activation easily turns into stress, and sometimes into another reaction into overactivation. It is characterized by an excessive increase in the relative number of lymphocytes. And it is already characterized by a sharp increase in both glucocorticoids and mineralocorticoids, thyroid hormones. Excessive excitation predominates in the nervous system.

The video below is in Russian, but thanks to YouTube for the subtitles!

№3: Infectious mononucleosis

The disease is caused by the Epstein-Barr virus, in young people from 5 to 25 years old (especially at 16-20 years old, since in these years we often kiss like an adult, and the virus is transmitted through saliva). The temperature rises, lymph nodes, spleen, liver increase. The disease lasts an average of 1 month, the main thing at this time is to limit the sports load due to the danger of rupture of the spleen. When this virus infects B-lymphocytes, the lymphocytes are capable of unlimited growth.

With an infection, atypical mononuclear cells appear in the blood - activated T-lymphocytes.

Reactive lymphocytes (atypical mononuclear cells) in a 14-year-old boy with infectious mononucleosis

Reactive lymphocytes (atypical mononuclear cells) in a 14-year-old boy with infectious mononucleosis

The incubation period is 1-2 months! That is, if you kissed in November, then do not be surprised where the temperature of 38 degrees came from in January of the new year. For laboratory diagnostics, I recommend donating 2 types of antibodies: IgM class antibodies to the VCA capsid antigen and IgG antibodies to EBNA. If IgM is negative and IgG EBNA is positive, infectious mononucleosis is unlikely. At the very beginning of the disease, there may be a decrease in the total number of leukocytes, but then an increase begins.

Diagnosis of infectious mononucleosis

The infectious nature of mononucleosis was pointed out back in 1887 by the Russian doctor Filatov Nil Fedorovich, who was the first to pay attention to a febrile illness with an increase in lymph nodes. The described disease for many years bore his name - Filatov's disease. Nevertheless, Russian doctors are very attentive and found hidden causes of symptoms, especially with lymphocytosis.

Filatov N., Russian doctor discovered disease infectious mononucleosis

Filatov N., Russian doctor discovered disease infectious mononucleosis

№4 Allergic conditions

As a rule, allergic rhinitis manifests itself in childhood. But the peak incidence (increasing symptoms such as runny nose and nasal congestion) occurs between the ages of 18 and 24. The mechanism of lymphocytosis is the activation of lymphocyte proliferation by an allergen.

With an allergic reaction, an increase in the populations of lymphocytes is determined; this was proved in the doctoral dissertation of the physiologist Alexander Alekseevich Soldatov, who deduced the allergization index.

The Allergization Index is a highly specific and sensitive method for determining the allergic process. Please note that with atopic dermatitis or eczema, there will also be an increase in the index due to an increase in lymphocytes and eosinophils.

In allergic reactions, along with an increase in the number of eosinophils, an increase in the number of lymphocytes is also observed.

In allergic reactions, along with an increase in the number of eosinophils, an increase in the number of lymphocytes is also observed.

A characteristic picture of a blood smear for allergies is an increase in eosinophils, but of course this does not always happen.

Do not forget about the symptoms of allergies: and about the laboratory possibilities of its confirmation.

№5 Bordetella pertussis

Whooping cough is an acute bacterial respiratory disease caused by a Gram-negative bacterium that is life-threatening, especially in infants under 3 months of age.

For diagnosis, the age of the patient is very important. When contacting a doctor, it is also necessary to talk about the vaccinations carried out. But since there will always be those who do not want to be vaccinated, whooping cough will occur in clinical practice all the time.

Pertussis forms a toxin - lymphocytosis - a stimulating factor that leads to an increase in the number of lymphocytes in the blood due to its direct binding to CD3 receptors, thereby inhibiting the ability of lymphocytes to move from the blood to lymphoid tissues. These changes are combined with the activation of B-lymphocytes.

Clinical case. The child was admitted with a cough lasting 1 week. A blood test of 45 thousand leukocytes with a predominance of lymphocytes. Under the microscope, the lymphocytes were cleaved nuclei. Floor A positive PCR test for Bordetella pertussis from a nasopharyngeal swab confirmed the diagnosis of whooping cough.

Clinical case №2 below in the photo:

Whooping cough diagnosis lymphocytes

The description of the clinical picture of whooping cough was presented in his book by the Russian doctor Stepan Fomich Khotovitsky. «Pediatrika» was printed in only 600 copies and sold out immediately. After 5 years, the book was already a bibliographic rarity. The time of Khotovitsky's life coincided with a difficult period, when 300 children out of 1000 born did not live up to one year. Let me remind you that the whooping cough vaccine was developed only in 1926 by Leila Denmark. This is a female pediatrician who lived to be 114 years old. And she retired at 103 years!

Vikenty Veresaev, Tula, Russia

Vikenty Veresaev, Tula, Russia

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