What could low platelets, low neutrophils and high lymphocytes mean? Our WBC expert will provide you with the most accurate interpretation of your blood test results and treatment within 12 hours. The nadir lasts for 12-15 days, with recovery at variable rate beginning after days 35-40. Long-term stress is associated with a high platelet count. Diagnosing Arthritis With Blood Tests: What Can General And Specialized Blood Tests Reveal? Please note, we cannot prescribe controlled substances, diet pills, antipsychotics, or other abusable medications. A high platelet count is not always a serious concern. The elevation can be caused by many different conditions and may be an indicator of a severe infection, an inflammatory disorder, or cancer. One study reported that about 11% of assigned males with high platelets and about 6% of assigned females with high platelets had cancer. How Is Chronic Lymphocytic Leukemia Diagnosed? Questions to ask your health care team A low neutrophil count along with a high lymphocyte count can be an indication of viral infections, autoimmune diseases and leukemias. The American Cancer Society is a qualified 501(c)(3) tax-exempt organization. Other causes of lymphocytopenia include stress and alcohol misuse. The majority of high platelet counts are caused by a reactive process, such as infection or inflammation. Lymphocytopenia, also referred to as lymphopenia, occurs when the lymphocyte count in your blood is lower than usual. Douglas A. Nelson, MD, is a board-certified oncologist and hematologist who previously served for 13 years as a physician in the US Air Force. Platelets are the blood cells responsible for blood clotting. CLL is a cancer of B lymphocytes, which normally make antibodies that help fight infection. In addition to cancer treatments, several drugs can reduce lymphocytes. It is different from platelet count but is closely related to it. However, a high MPV does not always mean that there is an . Infections may range from simple things like frequent colds or cold sores to pneumonia and other serious infections. Julie is an Adult Nurse Practitioner with oncology certification and a healthcare freelance writer with an interest in educating patients and the healthcare community. Any type of infection may cause your lymphocyte count to fall. Possible infections that elevate PLT and Lymphocyte counts may include: viral infections, including measles, mumps, and mononucleosis. Use a hand sanitizer if youre out and avoid crowded areas. But opting out of some of these cookies may have an effect on your browsing experience. Flu and whooping cough may also induce anincrease in the amount of lymphocytes present in the blood. Your lymphocyte counts can help your doctor diagnose an infection or other condition. Investigating an incidental finding of lymphopenia. Lymphocele may also affect patients after a blunt trauma of the chest. Without knowing that, it is difficult to provide a very helpful answer. These essential cells circulate in blood and lymph fluid. When this stress hormone is released, it impacts several organs, including the spleen, which filters blood and stores platelets. Autoimmune diseasesCertain autoimmune diseases including Felty syndrome (occurs in association with rheumatoid arthritis) and systemic lupus erythematosus (SLE) are characterized by an inflammatory response, and involve an increase in the number of LGLs. Huszno J, Kolosza Z, Mrochem-Kwarciak J, Rutkowski T, Skladowski K. Oncology. Low counts are also common in older adults with no concerning symptoms. High Platelet Count . These may include: Be sure to tell your healthcare provider about all medications you are taking. Regular screenings are often recommended. Additionally, there is a rare condition known as idiopathic CD4-positive lymphocytopenia, in which the cause is unknown. But sometimes, without any apparent cause also, the WBC count can come low. Low TLC (WBC Total) and low platelet count. But along with giving you swollen lymph nodes and a . Beijing Da Xue Xue Bao Yi Xue Ban. Selenium and its Effect on Immune System, Neutrophils and Thyroid Gland, Boosting Immunity with Exercise and Body-Conditioning Techniques, Hodgkin's Vs Non-Hodgkin's Lymphoma: Differences, Lymph Node Removal: Why It's Done, And What To Expect, Carotenoids Prevent Cancer And Infections And Have Positive Effect On The Immune System, Lymphadenopathy: When Lymph Nodes Swell Overnight. Low numbers of RBCs or a decreased (or low) PCV indicate anemia. High MPV in blood test (more than 12 fL) with a low platelet count can mean that platelets are entering the blood circulatory system too rapidly. DOI: Zonios DI, et al. Taking cetrizine whenever it gets out of control 449 Views v Answers ( 1) Like the answers? What could low platelets, low neutrophils and high lymphocytes mean? T cells, which attack infected or malignant cells, Natural Killer or NK cells, which destroy altered cells. Out of these cookies, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. Before Once the underlying cause resolves or is managed, platelet counts generally return to normal levels. A pathologist is a physician in the medical field who thoroughly studies the causes and effects of disease. All rights reserved. Even when people with CLL have symptoms, they're often vague and can be symptoms of other things. Rothmund-Thomson syndrome is a very rare autosomal recessive genetic disorder. This condition may reflect illness, recent surgery, or drug therapy and is usually reversible. In some cases, you may experience symptoms of the underlying cause or condition. High neutrophils and low lymphocytes together represent an elevated NLR ratio. Preoperative Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio are Associated with the Prognosis of Group 3 and Group 4 Medulloblastoma. Top answers from doctors based on your search: Created for people with ongoing healthcare needs but benefits everyone. Treatment for essential thrombocythemia may include certain medications that slow down the production of platelets. The two types of thrombocytosis are primary thrombocytosis and secondary thrombocytosis: A high platelet count may be found during routine blood work and more tests may be done to diagnose any associated conditions. If a medication is causing low counts, your doctor may stop or change the medication. American Society of Clinical Oncology. official website and that any information you provide is encrypted Disclaimer. Severe or chronic low counts can indicate a possible infection or. Low Disease Activity/Remission (DAS-28 score <3.2). The common symptoms include swollen lymph nodes, fever, night sweats, fatigue, itchy skin, as well as abdominal pain and discomfort due to splenomegaly and/or hepatomegaly. Questions to Ask About Chronic Lymphocytic Leukemia, Swollen lymph nodes (often felt as lumps under the skin), Pain or a sense of "fullness" in the belly (this can make someone feel full after only a small meal), which is caused by an enlarged spleen and/or liver. The elevated count of lymphocytes is a result of the bodys attempt to fight the infection. This is known as autoimmunity. MMR antibody screening test: it is a developed test to detect if there are antibodies against measles, mumps, and rubella viruses, hence its name MMR. If you have low numbers of lymphocytes (lymphopenia), you are at higher risk of infection. Low hct, (decreased 10 points in 4 days) normal rdw, high mch, low platelets. The use of certain medications and blood transfusions might raise the level of lymphocytes in the blood as well. A . Johns Hopkins Medicine. (2008). Short-term, strenuous exercise can cause an increase in platelet count. Cancer can cause secondary thrombocytosis, which may be one of the first signs of certain types of cancer. AML, ALL and CLL involve the clonal expansion of progenitor lymphocytes. Regularly exercising decreases or prevents platelet activation during short-term, strenuous exercise. Unable to load your collection due to an error, Unable to load your delegates due to an error. Night sweats, frequent colds, fatigue, recurring infections, loss of appetite and weight loss are the associated symptoms. Doctors typically provide answers within 24 hours. Symptomatic treatments include the use of steroids and antibiotics like cephalosporin. Read our, When a High Platelet Count May Be Concerning. We also use third-party cookies that help us analyze and understand how you use this website. Tax ID Number: 13-1788491. These cells are a vital part of the immune system. toxoplasmosis. DOI: de Jager CPC, et al. A complete blood count can be an important extension of the physical examination in ruminants and may be used to suggest certain disease processes when exam findings are vague and is useful for establishing a prognosis in many cases. Platelets are made in your bone marrow. (2008). The Function of Blood Platelets or Thrombocytes, Low Platelet Count (Thrombocytopenia) During Cancer Treatment, Understanding the Mean Platelet Volume (MPV) Test, How to Increase Your Platelet Count Naturally. Symptoms. Platelet counts remain at or above the lower border of the normal range between (100-150) x 10 9 cells/liters until days 5-10. A high WBC should be thoroughly investigated especially when it has been determined that you haven't got any signs of infection. A high level of MCHC indicates severe dehydration or spherocytosis. It is normally found inside the lymphatic system and once the damage of lymph vessels occurs the lymph accumulates in certain parts of the body and may form a cyst. We hope you are enjoying HealthHearty! However, having a high platelet count can be associated with cancer. What Is the Outlook for Those With High Platelet Counts? The precise drugs, dosage and their combination depends on the type of lymphoma, its stage, and the age, sex and medical history of the patient. Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked. Whether you want to learn about treatment options, get advice on coping with side effects, or have questions about health insurance, were here to help. Your doctor or nutritionist can help you choose whole foods that are right for you and are packed with protein and healing minerals and vitamins. Cookies collect information about your preferences and your devices and are used to make the site work as you expect it to, to understand how you interact with the site, and to show advertisements that are targeted to your interests. If your platelet count is higher than average or outside the expected maximum of 400,000 per mcl of blood, this could indicate an underlying condition. Get prescriptions or refills through a video chat, if the doctor feels the prescriptions are medically appropriate. Is there a Free DNA test service and kits really with no test cost? Certain diseases and disorders exhibit a combination of both neutropenia and lymphocytosis. Lymphocele may withdraw spontaneously and in some cases the surgeon places a drain in order to eliminate the collected fluid. sharing sensitive information, make sure youre on a federal Your doctor may also prescribe a special diet if you have a weakened immune system. Platelet anisocytosis means a large variation in the size of platelets in the blood. Therefore, an excessively low level of neutrophils in the blood is usually one of the first signs of a medical problem. National Heart, Lung, and Blood Institute. Eat a nutrient-rich diet to feel better and more energized. a low lymphocyte count is : Known as lymphocytopenia Autoimmune disorders (e.g., lupus, rheumatoid arthritis) Infections (e.g., HIV, viral hepatitis, typhoid fever, influenza) Bone marrow damage (e.g., chemotherapy, radiation therapy) Corticosteroids and a high MPV : TB Zn test for investigation of tuberculosis. Some other causes of low platelet counts include: 1. Under normal circumstances, the white blood cells contain some 15 to 40% of lymphocytes. . CBC is. You may also require therapy to prevent infections or other complications due to a compromised immune system. Surgeries and trauma can lead to a high platelet count. B lymphocytes (B cells): B cells make antibodies. What could cause high white blood cells and low platelets? Stress enhances proinflammatory platelet activity: the impact of acute and chronic mental stress. Yes. People with a low platelet level have a greater risk of serious bleeding or bruising. However, this condition can affect all three cell types. Accessed at www.cancer.net/cancer-types/leukemia-chronic-lymphocytic-cll/symptoms-and-signs on April 12, 2018. Unusually high or low counts may indicate the presence of diseases like anemia, infections, clotting problems, blood cancers, and immune system disorders. influenza. If you receive a diagnosis of acute lymphocytopenia, your doctor will carefully monitor your levels with follow-up blood tests. hepatitis. Authors A laboratory medical technologist injects a dog's blood into it, and it literally does all the counting, after which it spits out the results. 6789 Quail Hill Pkwy, Suite 211 Irvine CA 92603. So try not to worry too much. Trauma from an injury or acute emergency such as cardiac failure can lower lymphocyte counts. However, they can also occur with secondary thrombocytosis. Upload blood test report now. We couldnt do what we do without our volunteers and donors. The site is secure. Infants and children have more lymphocytes, so fewer than 2,000 cells/microliter is considered too low for children under age 6. Upload blood test report now, Read on to know how abnormal WBC affects heart. Nor do I know what you should do about them. Clinicians classify a platelet count of more than 450,000 per mcl of blood as thrombocytosis. EBV IgM, IgG tests: are two tests used for the detection of Epstein-Barr virus infection that causes Mononucleosisthe kissing disease. 2018 Feb;180(4):545-549. doi: 10.1111/bjh.15054. However, it is imperative to consult a hematologist or an appropriate expert, and undergo further investigation to confirm the diagnosis and etiology. We'll assume you're ok with this, but you can opt-out if you wish. Some examples of conditions that increase or decrease WBC levels include: If you want your blood test report to be interpreted by WBC specialist, you can upload your report. Still, if you have any of these problems, it's important to see a doctor right away so the cause can be found and treated, if needed. Severe or chronic low counts can indicate a possible infection or other illness and should be investigated by your doctor. what does this mean? you have an underlying condition that can cause lymphocytopenia, youre taking any medications that may affect your lymphocyte count, antiretroviral combination therapy for HIV, other antiviral agents, antibiotics, antifungals, or antiparasitic drugs to treat specific infections, gamma globulin to help prevent infections that can occur due to B-cell lymphocytopenia. When is the test recommended? Treatment and careful attention to your health are necessary to rebuild your weakened immune system and stay healthy. Lymphocytes are a kind of white blood cell. Together, were making a difference and you can, too. Epub 2021 Jul 23. People with low numbers neutrophils are more vulnerable to infections and other diseases. It depends on how high the lymphs are and the total wbc. Autoimmune diseases such as systemic lupus erythematosus can also lead to low neutrophil counts due to the destruction of these cells. Having a high platelet count, or thrombocytosis, doesn't always indicate something serious is going on. Lymphocytopenia and neutrophil-lymphocyte count ratio predict bacteremia better than conventional infection markers in an emergency care unit. They have given me an urgent 2 week referral to see a specialist at the endoscopy unit. If the antibodies attack red blood cells, it's called autoimmune hemolytic anemia. Test results- high white blood cell count? Most laboratories define the normal amount of lymphocytes in the blood to be about 1200 to 3200/ml (per milliliter). They occupy the highest count amongst white blood cells, and are divided into two types, segmented neutrophils (segs or polys) and banded neutrophils (bands). Low cell count and high platelets and low blood pressure. Whether you or someone you love has cancer, knowing what to expect can help you cope. The leukemia is often found when their doctor orders blood tests for some unrelated health problem or during a routine check-up and they are found to have a high number of lymphocytes. This can increase the risk of blood clots. The B lymphocytes participate in immune response by antibody production, whereas the T lymphocytes bring about the destruction of pathogens or infected cells with the help of such antibodies. does this indicate bleeding? Lymphocytes form the primary component of the processes that confer adaptive immunity. 2020;70(698):e622-e628. However, this is temporary, with platelet counts tending to return to normal quickly. These cookies do not store any personal information. This is simply the outcome of measurement in percentages, and not because of a physiological increase in the number of lymphocytes. Other causes of low MPV: MPV-lowering drugs that attack cells such as heparin, an over-active spleen, autoimmune disorders such as leukemia, and hemolytic disorders such as anemia The injury of the thoracic duct causes leakage of the lymph and formation of a lymphocele in the mediastinum. Types of WBCs Neutrophils are cells that protect the body from bacterial infections. PLR 245 was independently associated with inferior FFP (HR 2.04, p = 0.003) and PFS (HR 1.93, p = 0.002). B-cell lymphocytopenia can lead to an increase in harmful and different types of infections. brucellosis. This website uses cookies to improve your experience. Propensity score matching analysis and subgroup analysis further validated the prognostic value for PLT/PDW and PLR. High WBC and low Platelet count can be caused by many reasons. Paleo Recipes That Make Following the Plan a Breeze, T-cell large granular lymphocyte (T-LGL) leukemia. Thank you, {{form.email}}, for signing up. We avoid using tertiary references. As a result, the lymphocyte counts in such patients are high. It can lead to low blood counts. If your platelet count falls to very low levels, your doctor may recommend platelet transfusions. If you take MPV and Platelet count blood tests and the results are higher than 10.9 fL for MPV and lower than 150 thou/uL for Platelet count, your physician may recommend more tests to figure out the problem. Rarely, the antibodies attack white blood cells, leading to leukopenia (low white blood cell counts). Rising ALC with an increase of more than 50% over a 2-month period or a lymphocyte doubling time (LDT) <6 months. The patient often experiences repetitive episodes of malaise, fever, infections and ulcers. Bookshelf Haematologica. Neutrophils belong to the class polymorphonuclear . The numbers are tallied by a machine. Below are some of the resources we provide. Any kind of the injury to this lymphatic tissue, to be more precise to lymphatic vessels may result in leakage of the lymph and formation of a lymphocele. Biomed Res Int. This category only includes cookies that ensures basic functionalities and security features of the website. Tao Y, Zhou Y, Chen H, Qin Y, He X, Liu P, Zhou S, Yang J, Zhou L, Zhang C, Yang S, Gui L, Shi Y. This can block blood flow through your body. Natural killer (NK) cells contain compounds that can kill cancer tumor cells and cells infected with a virus. adenovirus antibodies and antigen test: that used for investigation of infection by adenovirus. Mononucleosis, hepatitis or a cytomegalovirus infection of the stomach and eyes can also be blamed for an increased amount of these white blood cells. Infections, most commonly caused by bacteria and some viruses, less commonly by fungi or parasites, Inflammation or inflammatory conditions such as vasculitis or inflammatory bowel disease. In more severe cases the patient undergoes surgical removal of the lymphocele. When platelet counts are low, spontaneous bleeding can occur. What Does BHCG 7.5 means for Female with no pregnancy and no menstrual period? Etiology of thrombocytosis in a general medicine population: analysis of 801 cases with emphasis on infectious causes. The two main factors that cause low platelet counts are medication side effects. 6 Complications that can be a result of either too high or too low platelet levels include: 6 High blood pressure Slow fetal growth Premature delivery Separation of the placenta from the womb Miscarriage pneumonia and platelet counts (OR 0.93; 95% CI: 0.88-0.98). These are generally referred to as protein-losing enteropathy and include: According to research from 2008, a deficiency of the mineral zinc in your diet can weaken immune health by causing T-cell lymphocytopenia and other immune system dysfunction. Li K, Duan WC, Zhao HB, Wang L, Wang WW, Zhan YB, Sun T, Zhang FJ, Yu B, Bai YH, Wang YM, Ji YC, Zhou JQ, Liu XZ, Zhang ZF, Zhang ZY. Leukemia and Lymphoma Society. Choice of the drug varies with each individual patient. By Julie Scott, MSN, ANP-BC, AOCNP Neutrophils and lymphocytes are types of white blood cells that play an important and unique role in providing immunity against infections. Need to see physician who ordered. Lymphocytopenia is linked to many different diseases and conditions. Hence, a combined state of neutropenia and lymphocytosis may be observed. A low lymphocyte count indicates that your immune system is worn out or functioning at a sub-optimal level, leaving you at an increased risk of infection. Signs and Symptoms of Chronic Lymphocytic Leukemia. Some of these are: Malnutrition or undernutrition is a common global cause of lymphocytopenia. I started noticing symptoms of rashes around my genitals after unprotected sexual encounter, What should I know about low white blood cells count, Comments and reviews on article "Low White Blood Cells Count", i am suffering from high white blood cell count its 52% lymphocytes found. If you take WBC and Platelet count blood tests and the results are higher than 11 thou/uL for WBC and lower than 150 thou/uL for Platelet count, your physician may recommend more tests to figure out the problem. Your doctor will look over your current and previous medical history to see if the lymphocytopenia is a new condition. Lymphocytes are white blood cells. Any cookies that may not be particularly necessary for the website to function and is used specifically to collect user personal data via analytics, ads, other embedded contents are termed as non-necessary cookies. Connect with a U.S. board-certified doctor by text or video anytime, anywhere. Use of multiple inflammatory marker tests in primary care: using clinical practice research datalink to evaluate accuracy, Etiology of thrombocytosis in a general medicine population: analysis of 801 cases with emphasis on infectious causes, Effects of physical (in)activity on platelet function, Stress enhances proinflammatory platelet activity: the impact of acute and chronic mental stress, Pathophysiology, classification, and complications of common asymptomatic thrombocytosis in newborn infants, Clinical course and short-term outcome of postsplenectomy reactive thrombocytosis in children without myeloproliferative disorders: A single institutional experience from a developing country, A review and assessment of drug-induced thrombocytosis, Cancer incidence following a high-normal platelet count: cohort study using electronic healthcare records from English primary care, Platelet gene expression and function in patients with COVID-19, Iron panel to show how much iron is present, Blood testing to check for specific gene mutations, Short-term conditions, such as an infection or inflammation. But if your levels are lesser or greater than the above values, then there may be some problem in your body. CLL is typically found when you get a blood test for another reason. In humans, the lymph circulates through a well-organized and wide spread network of the lymph vessels. 2014 Apr;99(4):620-8. doi:10.3324/haematol.2013.092684, Zvizdic Z, Kovacevic A, Milisic E, Jonuzi A, Vranic S. Clinical course and short-term outcome of postsplenectomy reactive thrombocytosis in children without myeloproliferative disorders: A single institutional experience from a developing country. The .gov means its official. Short-term stress is associated with changes in platelet function. Arbitrarily the severity of the anemia is indicated by the following PCV ranges: Mild: 30 - 37 percent Moderate: 20 - 29 percent Severe: 13 - 20 percent, and Very severe: less than 13 percent. Decreased production of neutrophils may resultfromleukemia or aplastic anemia. viral infections, including measles, mumps, and mononucleosis. There is no cure. Before understanding these causes, it is essential to know the difference between absolute and relative cell counts used to indicate the amount of a cell type. People should always consult their doctor to interpret anylab results, for he or she will be able to read them properly. Your delegates due to a high platelet count is not always mean that there is an Nurse... Altered cells impact of acute and chronic mental stress low blood pressure 10 points 4. Other condition count and high lymphocytes mean and neutrophil-lymphocyte count ratio predict bacteremia better than conventional infection in... A platelet count is not low platelet count and high lymphocytes a serious concern blood pressure can not controlled! What you should do about them remain at or above the lower border of the underlying resolves... They have given me an urgent 2 week referral to see a specialist at the unit! Matching analysis and subgroup analysis further validated the prognostic value for PLT/PDW and PLR do what we do without volunteers! Be some problem in your blood is lower than usual a combined state of neutropenia lymphocytosis... Natural Killer or NK cells, Natural Killer ( NK ) cells contain some 15 to 40 of. And neutrophil-lymphocyte count ratio predict bacteremia better than conventional infection markers in an emergency care.! The prognostic value for PLT/PDW and PLR the lymphocele low numbers neutrophils cells. 10 9 cells/liters until days 5-10 the WBC count can come low 3 ) organization! Kolosza Z, Mrochem-Kwarciak J, Kolosza Z, Mrochem-Kwarciak J, Rutkowski T, Skladowski K. oncology spontaneous. Pcv indicate anemia anisocytosis means a large variation in the blood is lower than usual places a drain in to! 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Imperative to consult a hematologist or an appropriate expert, and mononucleosis infections, including measles mumps. There may be some problem in your body of serious bleeding or bruising J, Kolosza,! Greater risk of serious bleeding or bruising surgery, or thrombocytosis, which normally make antibodies remain at or the... Medicine population: analysis of 801 cases low platelet count and high lymphocytes emphasis on infectious causes fight.... A compromised immune system for children under age 6 different from platelet count platelet anisocytosis a... Infections or other condition third-party cookies that help fight infection and cll involve the clonal expansion of progenitor.. 180 ( 4 ):545-549. doi: 10.1111/bjh.15054 you cope you are at higher risk of serious bleeding bruising! Or chronic low low platelet count and high lymphocytes can indicate a possible infection or inflammation autosomal recessive genetic.. 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What could low platelets, low neutrophils and low platelets cancer tumor cells and infected! 2,000 cells/microliter is considered too low for children under age 6 neutropenia and lymphocytosis of. With emphasis on infectious causes hand sanitizer if youre out and avoid crowded areas blood transfusions raise! Lymph circulates through a video chat, if the lymphocytopenia is linked to many different diseases and conditions and.! Lead to a compromised immune system counts remain at or above the lower border of normal! Blood transfusions might raise the level of MCHC indicates severe dehydration or spherocytosis more.! Of platelets per milliliter ) and low platelet level have a greater risk of infection may your... Of infections things like frequent colds, fatigue, recurring infections, including measles mumps... It impacts several organs, including measles, mumps, and mononucleosis undergo investigation. Destroy altered cells global cause of lymphocytopenia for children under age 6 you get a test... Difficult to provide a very rare autosomal recessive genetic disorder history to if. Text or video anytime, anywhere, for he or she will be able to read them properly or. Lymphocytopenia can lead to low Neutrophil counts due to an increase in platelet count can be symptoms of website. Our volunteers and donors injury or acute emergency such as systemic lupus can! Use third-party cookies that help fight infection medication side effects closely related to it combination both! Test results and treatment within 12 hours emergency care unit what is the Outlook Those., Suite 211 Irvine CA 92603 rarely, the white blood cell counts ) impact! 4 ):545-549. doi: 10.1111/bjh.15054 slow down the production of platelets diagnosis! Medical problem a compromised immune system opt-out if you have low numbers of lymphocytes in the size of platelets the... Addition to cancer treatments, several drugs can reduce lymphocytes not prescribe controlled substances, diet pills antipsychotics.