Monocytopenia is a laboratory syndrome in which there is a decrease in the level of monocytes below 500 in 1 μl of blood. Isolated monocytopenia is extremely rare. Most often, it is combined with a decrease in the number of neutrophils (neutropenia) or with a drop in the content of all blood cells (pancytopenia). The cause of monocytopenia can be severe bacterial infections, malignant myeloproliferative diseases, oppression of hematopoiesis, etc. The level of monocytes is examined when calculating the leukocyte formula in a clinical blood test. Correction of this condition is carried out in the treatment of the underlying disease.
A decrease in the number of monocytes in peripheral blood does not always indicate the presence of a disease or pathological condition. In some cases, women in the early postpartum period may experience monocytopenia, which does not require any treatment. The level of monocytes normalizes independently already 2-3 days after delivery.
The most common cause of monocytopenia is bacterial infections. Some bacteria, for example, pyogenic (staphylococci, streptococci), are able to secrete toxins that inhibit the process of hematopoiesis in the hematopoietic cells of the bone marrow. First, as a rule, there is a decrease in the level of neutrophils (neutropenia), then, with further progression of the infection and its generalization, the number of monocytes decreases.
The development of monocytopenia indicates a severe course of the disease and is a marker of an unfavorable prognosis. After antibiotic therapy and elimination of the infectious focus, the level of monocytes gradually returns to normal within a few days. Infections accompanied by monocytopenia:
Sometimes monocytopenia can occur due to medical intervention. For example, in some patients, a decrease in the level of monocytes is observed on the first day after a surgical operation, their number is restored to normal values after 4-5 days. Also, monocytopenia, along with a decrease in the content of other leukocytes, often occurs after courses of chemotherapy.
Most often, monocytopenia develops against the background of long-term use of glucocorticosteroids. These hormonal preparations are quite widely used, they are prescribed for the treatment of a huge number of diseases, primarily autoimmune disorders (Crohn's disease, systemic lupus erythematosus, ankylosing spondylitis), dermatological (eczema, psoriasis), allergic (bronchial asthma), etc.
Monocyte
Although many myelo- and lymphoproliferative diseases are accompanied by monocytosis (an increase in the number of monocytes), monocytopenia is a very characteristic feature of hairy cell leukemia. It is observed in almost 90% of patients. Hairy cell leukemia is a chronic B-cell lymphoproliferative disorder of unknown etiology that affects the bone marrow and spleen.
The main clinical symptoms of this pathology include an increase in the size of the spleen, peripheral lymph nodes. In the blood there is thrombocytopenia, anemia, leukopenia due to monocytes and neutrophils. Monocytopenia begins to develop gradually, persistently persists until specific treatment is carried out. Normalization of the number of monocytes is considered one of the criteria for successful chemotherapy.
This disease can be both hereditary and acquired in nature, and is characterized by the replacement of bone marrow with adipose tissue. As a result, the formation of all blood cells is suppressed (pancytopenia). In addition, the clinical picture includes hepatosplenomegaly, lymphadenopathy. In the early stages of aplastic anemia, monocytopenia can occur, which often requires a differential diagnosis with hairy cell leukemia (HCL).
In rare cases, monocytopenia may be due to a genetic mutation. GATA 2 is a hematopoietic transcription factor gene and is expressed in stem cells in the bone marrow. GATA 2 deficiency is a group of different disorders with a high mortality rate caused by a common genetic defect. As a result of mutation in the human body, the number of dendritic cells, lymphocytes, and monocytes is sharply reduced.
Such patients are highly susceptible to viral and bacterial infections. They have an increased risk of developing malignant neoplasms, myelodysplastic syndrome, leukemias and lymphomas. Monocytopenia is permanent until the patient undergoes bone marrow transplantation.
Due to the wide range of etiological factors of monocytopenia, its detection in a blood test requires an appeal to a general practitioner. At the reception, a patient is interviewed, anamnestic data are collected. It is clarified whether the patient is registered with the dispensary and whether he takes hormonal medications. A careful physical examination is performed to identify symptoms that may help narrow the differential diagnosis of the causes of monocytopenia.
Body temperature, blood pressure, pulse are measured. The skin and mucous membranes are examined for pallor, the presence of hemorrhages (petechiae, ecchymosis). Peripheral lymph nodes, liver, spleen are palpated. Additional research methods are also assigned:
Blood sampling for laboratory research
By itself, monocytopenia may not require any treatment, such as in the case of chronic use of glucocorticoids. It is necessary to carry out therapy of the underlying pathology, against which monocytopenia has arisen. Since the etiology of a decrease in the number of monocytes is quite severe diseases, during treatment the patient must be in a hospital under the supervision of a physician. The following methods of conservative therapy are used:
Patients with abscesses, phlegmon are opened and drained purulent focus. With severe splenomegaly, the spleen is removed. Since after splenectomy the risk of infection with some bacterial infections increases, people who have undergone this operation must be vaccinated against pneumococcus, meningococcus, Haemophilus influenzae.
Transplantation of hematopoietic stem cells allows to achieve a complete cure for AA and ON. However, given the risk of developing a life-threatening graft-versus-host disease, this operation is not prescribed for all patients, but only for clear indications. Bone marrow transplantation is also performed in patients with GATA 2 deficiency.
Monocytopenia is considered an indicator of deep inhibition of leukopoiesis and impaired functioning of the reticuloendothelial system. Therefore, it is often a marker of the severe course of the disease and a predictor of an unfavorable prognosis. These factors determine the extreme importance of timely detection of the etiology of its occurrence, diagnosis and treatment.