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If a person has developed leukopenia as a side-effect of long-term use of anti-convulsant medications and his/her immune system appears normal otherwise (does not get infections any more often than a healthy person, and bone marrow biopsy did not indicate anything abnormal), does the condition need to be treated? Is it even possible to treat leukopenia effectively as long as the person is on anti-convulsant medication?

Does leukopenia increase a person's chances of getting some non-infectious diseases too? I know WBC is primarily responsible for fighting infectious micro-organisms, but does it have any significant role in cleaning up body's own malfunctioning or ageing cells?

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  • $\begingroup$ What do you mean by "non-infectious diseases"? The white blood cells are part of the adaptive immune system and play a very important role to keep us healthy. $\endgroup$ – Chris Apr 10 '15 at 18:53
  • $\begingroup$ @Chris - By non-infectious diseases, I meant chronic and potentially degenerative diseases not caused by infectious microorganisms (bacteria, viruses etc.) but due to undesirable changes happening at a sub-cellular, cellular or organ level. If WBCs have a role in eliminating malfunctioning or degenerate cells of the human body, then they may be helping prevent some diseases caused by accumulation of such cells. Hope this clarifies. $\endgroup$ – so2 Apr 10 '15 at 19:31
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Leukopenia is just a definition. In medicine, there's a saying:

Treat the patient, not the numbers.

Numbers can mislead people, sometimes quite seriously. Definitions of leukopenia vary: some define it as less than 5,000 WBCs per µL of blood; others define it as less than 4,000.

Decreases in specific WBCs is usually described as neutropenia, lymphocytopenia, monocytopenia, etc. This, too, is important information, as each cell has a different function, and thus different results are possible.

In leukopenia, bone marrow biopsies are very informative. They reveal if the cause is a decreased production of WBCs due to destruction of precursor cells, replacement of marrow by other tissue, invasion of marrow by cancer, etc. If a bone marrow biopsy is normal, that is very comforting.

does the condition need to be treated?

Most people with anti-epileptic drug (AED) induced leukopenia are just fine. Some common-sense precautions (such as avoiding other drugs which might also cause leukopenia, and checking a white count if you fall significantly ill) should be heeded. If your doctor is a neurologist, they should be thoroughly versed in the side effects of AEDs, as this constitutes a very large patient population for them. Some of the newer AEDs have a lower incidence of leukopenia. Talk to your doctor about the potential benefits and drawbacks of switching.

Does leukopenia increase a person's chances of getting some non-infectious diseases too?

Theoretically possible, but not particularly likely.

If you are truly concerned, ask if you can get a referral to see a hematologist. They should be able to give you a real picture of the problems with long-term AED-induced leukopenia.

Remember: treat the patient, not the numbers. If you're healthy now, you're likely to continue to be so. Maybe you'll need more blood tests than others, but that doesn't mean you're not healthy. Talk to your doctors, not the internet.

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  • $\begingroup$ Thanks for the detailed answer! Biopsy done by a hematologist some years ago didn't provide any actionable diagnosis. Since an accompanying blood test coincidentally revealed liver enzyme imbalance, was redirected to a gastroenterologist to check if liver is affected and causing low WBC as side-effect. Liver found to be normal now but WBC still low as it was years ago. Went back to hematologist who recommends repeating the biopsy to reassess bone marrow function but he was unclear as to what treatment could be given if the result is again inconclusive and only AED is the cause $\endgroup$ – so2 Apr 14 '15 at 18:24
  • $\begingroup$ Particularly appreciate you advice on taking to doctors, not the internet - hope the message reaches all internet users! Unfortunately, have to take multiple AEDs as per neurologist's advice and there doesn't seem to be a way out of these for the next few years, Even though the main AED is the latest generation one, the informational leaflet in the package mentions leukopenia as a possible side-effect. $\endgroup$ – so2 Apr 14 '15 at 18:43
  • $\begingroup$ @so2 - biopsies are necessary until there are "data points" for predictability. Also, inferno's answers is theoretical - if you had a neutrophil abnormality - that is, the ones you had didn't phagocytize appropriately - you'd know it by now. That you've not been prone to dangerous infections is evidence that you have enough neutrophils and that they're working correctly. You are likely relatively neutropenic - you have the usual complement of lymphocytes. Your WBC is low because normally neutrophils = 75-80% of WBC count. You're probably closer to 40-50%. Again, treat the patient, not the #s. $\endgroup$ – anongoodnurse Apr 14 '15 at 20:38
  • $\begingroup$ Finally, one test you might consider is an ultrasound of the spleen, if you haven't already had one. Your hematologist will tell you why. $\endgroup$ – anongoodnurse Apr 14 '15 at 20:39
  • $\begingroup$ Thanks to you and @inf3rno! Hematologist said spleen seems normal (not through ultrasound though). Will let hematologist reassess bone marrow and advice on the next steps. $\endgroup$ – so2 Apr 15 '15 at 15:23
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I know WBC is primarily responsible for fighting infectious micro-organisms, but does it have any significant role in cleaning up body's own malfunctioning or ageing cells?

They kill the pathogens, infected, senescent, mutated or unnecessary cells, clean up the cell fragments, clean up the oxidized LDL from the surface or arteries, etc... So I think the shortage of leukocytes can cause for example cancer, cardiovascular diseases (dependent on the nutrient composition of the food), etc... in severe cases, but it is hard to find any evidence, since these people die because of infections caused by normally harmless (or well controlled) pathogens, for example HHV8 - causes a cancer type called Kaposi's sarcoma in immunodeficient patients, saccharomycosis (S. cerevisiae, S. boulardii, etc... members of the normal flora), aspergillosis (A. niger - it is everywhere in the air), etc...

I guess there are experiments with NOD/SCID mice (which lack T-cells, B-cells, and NK cells, so a huge part of their immune system is defective), but I cannot find anything about cancer or cardiovascular diseases by them. They are usually engrafted with human cancer, etc... in the experiments, which is not the same as naturally developing cancer. Maybe if you have time to google a day or two, you can find more.

Be aware that there are many different types of leukocytes (WBCs), which have their own role in the immune system. Some of the people with leukopenia have lack only of a single type of leukocytes and not all of them. For example HIV patients have helper T-cell deficiency, people with neutropenia have neutrophil granulocyte deficiency, and so on...

I don't know anything of the treatment, I guess bone marrow transplant is involved in the severe cases. If it is caused by medication as a side effect, or you are seeking for medical advice, I think you should consult a doctor.

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  • $\begingroup$ @inf3mo - Thanks for your response! Obviously, it is depressing to hear of these diseases, but then that seems to be nature's nature - design something very complex, make the complexity appear to be a boon, and make that very same complexity turn out to be a bane for many. Posted the question because the previous biopsy did not lead reveal anything actionable. Was wondering if a repeat biopsy suggested by the doctor would be useful at all, especially since he could not tell if any treatment is even possible if the result is the same and AED is the only suspect. Stopping AED is not an option :( $\endgroup$ – so2 Apr 14 '15 at 19:06
  • $\begingroup$ @so2 Using another AED is your doctor's choice. There are [many drugs](epilepsysociety.org.uk/list-anti-epileptic-drugs#.VS20r5MrqIo ), and I guess not all of them is immunotoxic. Your doctor should measure your WBC levels and decide what to do. I found only this article in the topic. AEDs increase the risk of relapse in patients with cancer according to this article. $\endgroup$ – inf3rno Apr 15 '15 at 0:53
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    $\begingroup$ Thanks for those links! Will let the hematologist do a reassessment & if he feels the condition warrants a change in prescribed AEDs then send his recommendation to the neurologist. Many specialists work in a silo-mode and don't take a holistic view of a patient's health - neurologist never ever told about the side-effects of AEDs & it was from the internet & later from medicines' informational leaflets that I came to realize they have hematologic side-effects. Site doesn't allow me to accept 2 answers. Chose anongoodnurse's answer on 1st-come basis but your replies were equally helpful! $\endgroup$ – so2 Apr 15 '15 at 15:12
  • $\begingroup$ @so2 No problem. $\endgroup$ – inf3rno Apr 16 '15 at 11:24

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