Low white blood cell count (WBC), or leukopenia is a potentially dangerous condition.
Low white blood cell counts mean the immune system’s first line of defense is compromised and the body is more vulnerable to infection.
In this article, we’ll dive deeper into low WBC and why it matters, as well as treatment options.
Understanding White Blood Cells and Their Role
The body produces around 100 billion leukocytes, or white blood cells, every day.
White blood cells only make up about 1% of the blood’s overall volume, but they are a powerful force against pathogens that could harm the body. Together, these five types of white blood cells detect and destroy foreign invaders like bacteria and viruses, among other things. Each type of white blood cell is essential for keeping the body safe.
Types of White Blood Cells
There are five different types of white blood cells. Each performs a specialized function including tissue repair and immune functions, as follows.
Neutrophils make up about 50-70% of white blood cells. Their role is to fight bacterial and fungal infections.
Lymphocytes, including T cells, B cells, and “natural killer cells” protect the body against viruses, cancer cells, and other pathogens.
Monocytes are the precursors to macrophages, which spring into action to destroy debris, dead cells, and bacteria.
Basophils are central to the allergic response. They release histamine and other chemicals to protect the body from foreign substances like pollen or animal dander.
Eosinophils combat foreign substances as well. They also activate to protect the body from parasites.
The body needs all five types of leukocytes in healthy amounts in order to maintain balance.
Causes of Low White Blood Cell Counts
Leukopenia can be caused by underlying medical conditions, including bone marrow disorders such as aplastic anemia and multiple myeloma. Bone marrow disorders may be genetic or may develop due to other causes.
Autoimmune diseases including lupus or rheumatoid arthritis can cause leukopenia, when the immune system mistakenly attacks its own cells.
Any infection, whether it’s viral, bacterial, fungal, or parasitic, can cause a drop in WBC.
Some individuals develop low WBC because of malnutrition (not enough of certain vitamins, minerals, and other micronutrients).
Others may develop this disorder as a result of taking certain medications, including chemotherapy drugs and corticosteroids.
It’s also important to consider chronic stress. Stress suppresses the immune system and lowers WBC.
Diagnosing Low White Blood Cell Counts
Normal WBC levels are somewhere in the range of 4,000 and 11,000 cells per microliter of blood. These numbers vary somewhat due to age and sex.
Although leukopenia doesn’t have any direct symptoms, it helps to look for signs of infection like fever, chills, sore throat, severe coughs, painful urination, swelling/redness, mouth sores, or diarrhea. Normally, these symptoms resolve fairly quickly in its immune system response and white blood cells act to kill viruses, bacteria, and other pathogens. Leukopenia is often characterized by chronic fatigue, slow healing, and recurring infections.
These symptoms may warrant a complete blood count (CBC) blood test with differential, which will show exact white blood cell levels. A medical professional may recommend urine tests, a chest x-ray (to show pneumonia), or a bone marrow biopsy.
Health Implications and Risks of Low WBC Counts
The most common health implication of low WBC is recurring infections and slow wound healing. This is particularly dangerous for more vulnerable people such as the elderly, cancer patients, or patients with autoimmune disorders.
Recurring infections may affect different bodily systems at the same time, for example viral infections can affect the lungs while bacterial infections could target the skin. As the body struggles to heal from these recurring, slow healing and sometimes multiple infections, it could become so overwhelmed that it goes into sepsis and even experiences organ damage.
Low White Blood Cell Count: Management and Treatment Strategies
Managing and treating leukopenia usually focuses on first identifying and then treating the underlying causes of low WBC.
Infections
If the cause is an infection, treatment may include antibiotics, antiviral or antifungal medications. Parasitic infections are treated with antimicrobial drugs.
Genetics
If the cause is genetic, doctors will look into genetic factors that may have given an individual a predisposition to low WBC counts. For example, some patients are genetically predisposed to poor folate absorption. Folate deficiency can lead to leukopenia. This knowledge will inform further treatment, given that a low WBC in certain individuals does not always indicate the presence of disease.
Medications
If leukopenia is caused by medications like corticosteroids or chemotherapy drugs, the dosage may be adjusted or temporarily stopped, or different medications may be administered instead of the ones causing the problem.
Bone Marrow Disorders
Emerging technologies like gene editing show promise in treating severe cases of genetic leukopenia. Gene editing intends to correct genetic mutations that cause leukopenia.
This process involves collecting and modifying the patient’s stem cells in vitro using CRISPR-Cas9 technology. The patient receives chemotherapy to destroy damaged stem cells, and then newly modified stem cells are reintroduced into the body.
Doctors may use hematopoietic gowth factors such as granulocyte colony-stimulating factors (G-CSFs) to stimulate white blood cell production in the bone marrow.
Meanwhile, in some cases, doctors are beginning to use near infrared and infrared red light therapy to stimulate hematopoietic stem cells in the bone marrow.
Bone marrow transplants may also be used in severe cases. Bone marrow transplants (BMT) use healthy stem cells from a donor to replace a patient’s damaged or diseased bone marrow. In some cases, the patient’s own stem cells are used (as described above), but in other cases, donated stem cells from a healthy donor may be preferable.
If stem cells are collected from a donor, the patient will also undergo chemotherapy to destroy diseased/damaged stem cells before infusing healthy donor stem cells into the patient’s bloodstream.
Self-Care & Hygiene
While receiving treatment for leukopenia, it’s important that patients practice excellent self-care, including good hygiene, to help prevent both viral and bacterial infections. Individuals with low WBC may want to wear a mask in public and sanitize their hands a bit more frequently.
Stress Management
Stress management helps to take the body out of a chronic stressed-out fight-or-flight state and put it back into a normal “rest-and-digest” state where the body can heal more efficiently. Meditation, Tai Chi, yoga, mindfulness practices, and gardening are great stress management tools.
Gut Microbiome & Nutritional Support
An important emerging field in the treatment of leukopenia centers around nutrition and the gut microbiome.
Nutrigenomics studies how nutrients and diet affect gene expression and metabolic functions. Research shows that diets rich in leafy greens may potentially promote white blood cell formation.
The gut microbiome is essential to health. Ancient Greek physician Hippocrates said, “All disease begins in the gut.” A person’s unique gut microbiome is a key factor in the health of their immune system, and directly affects WBC production.
Chemotherapy can disrupt the gut microbiome which can increase the risk of infection. Strategies that target gut health, including dietary modifications, red light therapy, probiotics, and even fecal microbiota transfer (FMT) can positively affect the gut microbiome.
Depending on the individual’s bloodwork results, leukopenia can also be treated with supplements including iron, copper, folate (vitamin B9), and vitamin B12. Treatment of individuals with very poor protein levels are also at risk of developing leukopenia can involve eating more protein and leafy greens.
Chemotherapy patients are often advised to eat a high-protein diet with thoroughly washed and cooked vegetables (to reduce risk of bacterial infection) bland, easily tolerated foods.
It’s important to keep in mind that nutrition has to be personalized based on the individual’s gut microbiome composition, their ability to absorb certain nutrients, and any existing deficiencies.
Monitoring and Preventive Measures
At-risk groups are advised to have regular CBC testing. Home CBC test kits are available. While convenient, they are less accurate than lab tests. At-home testing should not be relied on for diagnosing a condition. At-home tests are useful as screening tools, but all results must also be taken into context for an accurate diagnosis that will result in a doctor’s indication for prescriptions (pre-existing conditions, lifestyle, symptoms, etc.).
Preventative lifestyle modifications often include maintaining a healthy diet along with regular exercise. Intense or prolonged exercise temporarily decreases WBC so if you’re at risk of leukopenia, it’s best to stick with moderate exercise routines such as walking, casual cycling, yoga, Tai Chi, or bodyweight training.
Moderate exercise boosts the immune system, supports hematopoiesis, reduces systemic inflammation, increases treatment tolerance, and improves both physical and emotional well-being.
It’s important to pay attention to unusual symptoms, like extreme fatigue while exercising. This may indicate anemia (low iron). Avoid high-intensity or endurance exercise while WBC counts are low to support the immune system. Also, avoid high-impact or dangerous activities that increase risk of bruising or bleeding.
Patients are also advised to track symptoms and communicate with their doctor.
A low WBC is not always cause for concern. It’s normal for levels to fluctuate as the body deals with infections or wounds, during periods of intense or prolonged exercise, or because of a genetic predisposition.
However, a low WBC may indicate an underlying medical condition that requires treatment. If it shows up on a CBC, it’s important to do further testing to determine the cause before treating low WBC.
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