Blood Disorders

What Is Leukopenia?

Leukopenia is a diminished white blood cell count. When white blood cells are depleted, the immune system is weakened and people are at increased risk of infection. Leukopenia is associated with diseases, medications, and genetic deficiencies.

The most common form of leukopenia is neutropenia, or a reduced number of neutrophils. Neutrophils comprise about 45 percent to 75 percent of the total white blood cell count. They are responsible for fighting bacterial, fungal, viral, and parasitic infections. Neutropenia is associated with increased risk of bacterial infections. If not treated during the early infectious phase, and if the level of neutrophils falls too low, septic shock and death often occur (Corapcioglu F et al 2004; Ochs HD et al 1996).

Diagnosis is dependent on a CBC test. Neutropenia in adults is defined as an absolute neutrophil count of less than 500 cells per microliter (µL). However, even a neutrophil count of less than 1000 cells/µL of blood can raise the risk of infection (Beers MH 2003).

Treatment of neutropenia depends on the cause and any associated conditions. Neutropenia can occur when the neutrophils are destroyed faster than they are created (by an autoimmune response, for instance), or when the production of neutrophils in the bone marrow is reduced (as with cancer, diseases such as influenza, or vitamin B12 or folic acid deficiencies). Neutropenia is also associated with radiation treatment that has affected the bone marrow. In fact, the most common cause of neutropenia is drugs or therapies that are used to fight cancer or autoimmune disorders. Other drugs that have been associated with neutropenia are antibiotics (including penicillin) and antiretroviral drugs used in the treatment of HIV/AIDS. Drug-induced neutropenia can often be reversed by discontinuing use of the drug.

It is possible to resolve neutropenia associated with other conditions by addressing the underlying health concern. For instance, bacterial neutropenia may be treated with broad-spectrum antibiotics, while a fungal infection caused by neutropenia may be treated with antifungals. For viral infections such as herpes, the use of acyclovir is common (Steiner I et al 2005).

If the neutropenia is caused by a genetic disease or chemotherapy, it will typically be treated with granulocyte colony-stimulating factor and other bone marrow–derived growth factors (Bradstock KF 2002; Cario G et al 2005). These drugs, approved by the US Food and Drug Administration (FDA), stimulate the production of neutrophils by increasing the number of bone marrow–neutrophil precursors (Cario G et al 2005). Additionally, melatonin has been shown to reduce neutropenia in patients who have undergone chemotherapy to treat cancer (Viviani S et al 1990).

If the neutropenia is caused by an autoimmune disorder, it may be treated with glucocorticoids, cyclosporine, or (Kasper DL et al 2004).

Additionally, vitamin E may be recommended for patients who have chemotherapy-induced neutropenia. In a study of 49 women undergoing chemotherapy for breast cancer, neutropenia was common. Ingestion of vitamin E or multivitamins resolved the condition (Branda RF et al 2004).

What Is Thrombocytopenia?

Under normal circumstances, the blood contains about 150,000 to 350,000 platelets/µL. These platelets are involved in blood clotting. They circulate constantly in the bloodstream, looking for damaged areas. In response to an injury in a blood vessel, the platelets respond by sticking to the site and clumping together (platelet aggregation). This aggregation begins the clotting that prevents further bleeding (Troy GC 1988).

Thrombocytopenia occurs when the platelet count falls too low. At levels of 20,000 to 30,000 platelets/µL, bleeding can occur in response to relatively minor trauma. At platelet counts less than 20,000 cells/µL, spontaneous bleeding can occur, which increases the risk of bleeding that can result in shock and death (Rosthoj S et al 2003).

Like other blood disorders, thrombocytopenia can occur when the body either doesn’t produce enough platelets, or if too many platelets are destroyed. Thrombocytopenia is associated with leukemia or lymphoma, aplastic anemia, vitamin B12 or folic acid deficiency anemias, an enlarged spleen, infectious diseases such as HIV/AIDS, and massive blood transfusions.

Two diseases that occur because of increased destruction of platelets are:

• Idiopathic thrombocytopenic purpura (ITP)—This disease occurs when antibodies attack and destroy the body’s platelets for unknown reasons. In children, ITP can be an acute condition that occurs after infection. Acute ITP is rare in adults. More common is chronic ITP, a condition that may persist for years and most frequently affects women ages 20 to 40 years. If symptoms (such as bleeding or easy bruising) are present, a physician may prescribe prednisone to be taken for 4 to 6 weeks.
• Thrombotic thrombocytopenic purpura (TTP)—TTP is a life-threatening disease that occurs when small blood clots form suddenly throughout the body. It can result in cardiac hemorrhage and death (Burke AP et al 2005). It occurs more often in women and is associated with pregnancy, metastatic cancer, chemotherapy, HIV/AIDS, and some prescription drugs (such as ticlopidine). Patients with TTP experience kidney failure or decreased kidney function, fever, and neurological problems. The most common treatment is fresh-frozen plasma exchange, which is associated with a 90 percent survival for this once-fatal disease. Other therapies include vitamin E and kidney dialysis and transplant (Ruggenenti P 1990).

Supporting Healthy Blood Cells Through Nutrition

A number of nutrients have been studied for their ability to promote healthy blood and fight diseases of the blood cells, including thrombocytopenia and leukopenia. These include:

Antioxidant vitamins
In a series of animal studies, supplementation with vitamins C, E, and A was investigated to find out the effects of these vitamins on thrombocytopenia. Nutritional supplementation with vitamins C, E, and A diminished coagulation activation induced by surgery. In this series of studies, the use of vitamins C, E, and A diminished thrombocytopenia (Byshevskii AS et al 1994). Fewer deaths occurred after surgery in study animals pretreated with these vitamins (Byshevskii AS et al 1992a). The antioxidant effect of these vitamins is believed to diminish development of free radicals and thereby diminish platelet cell destruction (Byshevskii AS et al 1992b).

Omega-3 fatty acids
Dietary supplementation with omega-3 is associated with prolonged platelet viability, decreased platelet activation (and aggregation), and diminished production of free radicals. In a study comparing fish oil consumption to placebo, platelet survivability was shown to be significantly longer and platelet activation was diminished (Pirich C et al 1999). The results of this clinical study suggest that fish oil supplementation rich in omega-3 polyunsaturated fatty acids increases platelet survivability by decreasing cell loss due to platelet activation.

The extended platelet life span induced by omega-3 fatty acids may also be due to reduced generation of free radicals. In a study examining the effects of omega-3 on free radical production in neutrophils, the amount of free radical production was significantly lower in the group supplemented with omega-3 (Schneider SM et al 2001). Lipid peroxidation, a process that results in death of white blood cells and platelets, is promoted by free radical formation. Omega-3 diminishes free radical formation (Schneider SM et al 2001) and therefore diminishes destruction of platelets and white blood cells.

Shark liver oil
Shark liver oil is rich in a class of compounds known as alkylglycerols, which occur naturally in various mammalian tissues, including most organs responsible for producing blood cells. While most studies have focused on the ability of shark liver oil to fight cancer, it has also been shown to boost immunity by stimulating production of neutrophils and activating macrophages (another type of white blood cell) (Krotkiewski M et al 2003).

Copper and zinc
Leukopenia and thrombocytopenia can be caused by copper deficiency, which reduces production of red blood cells, white blood cells, and platelets. Effective copper replacement reverses leukopenia within 2 months (Takeuchi M et al 1993).

Zinc deficiency can result in leukopenia (Fraker PJ et al 2000). These findings are supported by murine studies in which a limited zinc diet was provided. Moderate zinc deficiency occurs in disorders such as sickle cell anemia, renal disease, and gastrointestinal disorders. The short-term use of zinc supplementation boosts the immune system and appears to protect against opportunistic infections (Fraker PJ et al 2000).

Melatonin
A number of studies have shown that melatonin can enhance blood health by supporting production of blood platelets and neutrophils.

In a pilot study, three patients with ITP were given melatonin for up to 46 months. All patients had an initial response after 1 month of treatment, and disease progression subsequently diminished. There were no manifestations of toxicity in any of the study subjects (Todisco M et al 2002). A follow-up case study of a patient with refractory ITP, which typically has a poor prognosis, showed that melatonin was able to successfully manage the symptoms of severe bleeding (Todisco M et al 2003). Melatonin has also been shown to enhance the production of platelets and resolve thrombocytopenia in a variety of patients (Lissoni P et al 1999).

In the newest melatonin research, scientists have delved into its ability to protect patients with cancer by boosting the health of bone marrow, among other benefits. Studies have reported that melatonin may decrease thrombocytopenia and neutropenia in patients with cancer (Abrial C et al 2005).