October 28, 2024, Immune Tolerance
White blood cells play a “primary” role in defending the body against infection. When bacteria invade, white blood cells, guided by various chemokines, converge at the site of bacterial invasion, surrounding and engulfing the pathogens. Leukopenia is a frequent complication following kidney transplantation. It typically indicates excessive suppression of the immune system. If not managed appropriately, it can easily lead to infections, potentially resulting in graft function loss and even life-threatening consequences.
Today, we will discuss leukopenia following kidney transplantation.
What Is Leukopenia?
White blood cells (WBCs) are a vital group of blood cells in peripheral blood. They are not a uniform group but a collection of granulocytes, monocytes, and lymphocytes. In healthy individuals, the number of white blood cells in peripheral blood ranges from (4.0–10.0) × 10^9/L. A persistently low count of white blood cells below 4.0 × 10^9/L is termed leukopenia. They are classified as mild, moderate, severe, and critical based on the degree of leukopenia: mild with a white blood cell count of (3.0–4.0) × 10^9/L, moderate with a count of (2.0–3.0) × 10^9/L, severe with a count of (1.0–2.0) × 10^9/L, and critical with a count below 1.0 × 10^9/L. The most common symptoms of leukopenia include fatigue and dizziness, as well as loss of appetite, limb weakness, low-grade fever, chills, and palpitations. Severe cases may present with high fever, chills, headache, profound fatigue or extreme weakness, and recurrent oral ulcers. A minority of patients exhibit no symptoms and are frequently overlooked by both doctors and patients. They may be misdiagnosed with other conditions. At this point, the total white blood cell count should be repeatedly monitored. If the total white blood cell count persistently falls below 4.0 × 10^9/L, it can be diagnosed as leukopenia.
What Are the Common Causes of Leukopenia After Kidney Transplantation?
The most common cause of leukopenia after kidney transplantation is myelosuppression induced by high doses of immunosuppressive drugs, primarily including mycophenolate mofetil (e.g., CellCept, Myfortic), alemtuzumab, and antithymocyte globulin, among others. Patients with high sensitivity and poor tolerance to these drugs are susceptible to myelosuppression, leading to leukopenia. Additionally, viral infections (e.g., cytomegalovirus [CMV], parvovirus B19, human papillomavirus [HPV], Epstein-Barr virus), antibiotics (e.g., linezolid, chloramphenicol), and antiviral drugs (e.g., valganciclovir, ganciclovir) can also contribute to leukopenia following kidney transplantation.
How Should Leukopenia After Kidney Transplantation Be Managed?
The key to managing leukopenia is to address its underlying cause. If leukopenia is caused by immunosuppressive drugs, these should be immediately adjusted or discontinued; if caused by antibiotics or antiviral drugs, those medications should be discontinued; if due to viral infections, aggressive anti-infective therapy should be initiated. Concurrently, various leukocyte-boosting drugs, such as leucogen, shark liver oil, lithium carbonate, and vitamin B, can be used; if necessary, granulocyte colony-stimulating factor (G-CSF) should be administered. For patients with a prolonged disease course, where leukopenia is not pronounced and bone marrow examination shows no significant suppression of granulopoiesis, regular follow-up is recommended, alleviating concerns without excessive reliance on medications.
We remind kidney transplant patients: upon noticing leukopenia or related symptoms, actively seek medical assistance for prompt diagnosis and treatment. When diagnosed with leukopenia, avoid overexertion, be mindful of weather changes, adjust clothing appropriately, and take precautions to prevent infections.
Written by | Sun Jiajia, Edited by | Sun Jiajia, Photography | Nico Ding
This article is an original publication of the “Kidney Transplantation, Zhongshan Hospital, Fudan University” WeChat public account. Reproduction requires authorization from this account and the original author, with proper attribution. To care for your kidneys, begin by following the “Kidney Transplantation, Zhongshan Hospital, Fudan University” WeChat public account. You can also click [Read the Original] to explore Nutritional Therapy and Dietary Management After Kidney Transplantation
