Anxiety and Low White Cell Count

Introduction

What is stress? Stress is your body's response (physical, emotional, physiological) to external and internal factors.1 It is also a feeling of inability to fulfill specific demands and events.16 Stress is a normal part of our lives and is not necessarily bad for us.

Depending on the factors, it can last for a few hours or even years. Stress does not condone favoritism, as it affects people of all ages. It can elicit different reactions from your body, including altering some processes in your body, producing life-threatening effects, and can be fatal.1 

Meanwhile, anxiety is a bodily response to a perceived threat triggered by an individual's beliefs, feelings, and thoughts.16 

This article will review the relationship between anxiety or stress and low white cell count. 

Stress and Anxiety

Symptoms

Stress and anxiety can be manifested in different ways, in different frequencies, for different durations of time, and with different severity.1 It is caused by various factors that can depend on the individual, such as work life, environment, etc. However, the most common symptoms of stress and anxiety are:1,2

  • High heart rate without physical activities
  • Change in appetite
  • Prone to sickness
  • Worrying about making a fool of oneself
  • Unable to relax 
  • Hard time getting things done due to some obstacles
  • Nervousness 

Anxiety is also often characterized by worrying thoughts, tension, high blood pressure, increased respiratory rate and pulse rate, sweating, difficulties in swallowing, dizziness, and chest pain.16  

How does stress affect the body?

Stress can affect us in many ways. However, this article will focus more on how stress impacts the immune system. 

The Immune System 

Several studies have shown the relationship between stress and the immune system.1 Chronic stress can suppress the function of the immune system, which might lead to malignancy17or cancer.1 Furthermore, stress can lessen the activity of cytotoxic T lymphocytes and natural killer cells that is essential to kill cancerous cells in our body. Thus, it can lead to the development of malignant cells and tumours.1 Stress also increases the production of norepinephrine.1,20 Norepinephrine is involved in the body’s flight or fight response. It is released when you are stressed or in a state of anxiety, dilating the pupils and increasing your heart rate.19 Experts suggested that the increased concentration of norepinephrine will jeopardize the immune function of phagocytes and lymphocytes.1 

Our body also releases catecholamines and opioids following stress which have the properties to suppress our immune system.1

White blood cells 

Have you ever heard of white blood cells?3 They are medically known as leukocytes, originating from Greek, where “leucko” means white and “cyte” means cell.4 There are several types of white blood cells, including granulocytes (neutrophils, basophils, and eosinophils), lymphocytes, and monocytes.4 These white blood cells are made in the bone marrow.5 They can be found in the blood, lymph tissue, and lung.4, 5 

Why are they important? 

White blood cells are essential for us. They are a part of the immune system that helps fight against germs and diseases. They also respond when you injure yourself or if pathogens enter your body.4 In other words, white blood cells act like soldiers in your body, detecting and destroying any foreign particles that enter your body. 

So, what would happen if there is a low level of white blood cells in your body? Well, you can envision your white blood cell as the lock to your house doors. If you don't have enough locks for your house, people can simply enter your house, destroying your property and weakening your house's strength. Thus, when your white blood cell count is low, your immune system will not work well, and you will get sick easily. 

What is a healthy white blood cell count? 

A complete blood cell (CBC) test is a clinical test that measures how many white blood cells are in your body.4 This test is vital to provide insight into disease processes and assess your overall health.4,6 

A healthy range of values for white blood cell count is typically between 4,000 to 11,000 /ml. 4 Anything below this normal range can lead to leukopenia.4,8 Leukopenia can co-exist with viral infections and other conditions such as systemic lupus erythematosus.4,7

On the other hand, if the white blood cell counts (primarily neutrophils) are higher than normal, this is referred to as leukocytosis.4 It can occur during parasitic infections or cancers such as leukaemia.4,9 An increase in white blood cells also might be due to stress.4 

Causes of low white blood cell count

Low white blood cell levels are primarily due to the reduction of neutrophils that comprise 50% to 70% of circulating white blood cells.10 Low levels of neutrophils may be due to hypoplastic12 bone marrow, an infection, exposure to radiation, a tumor in the bone marrow, myelofibrosis,13 long-term exposure to a drug, or a hereditary disorder.11

Drugs that are known to cause neutrophils are:11

  • Quinidine
  • Aminopyrine
  • Cephalosporin
  • Sulfonamides
  • Hydralazine
  • Penicillins
  • Heavy metals
  • Phenothiazine

Symptoms of a low immune system

Symptoms of a low immune system include:11

  • Skin infections
  • Gingivitis
  • Cough
  • Extreme tiredness
  • Poor wound healing
  • Sore throat
  • Coarse facial features
  • Fever

Low blood cell count treatments

One of the applications to treat low white blood cell count is granulocyte-colony stimulating factor (G-CSF).11 G-CSF can improve the functions and number of neutrophils.14,15 Another treatment called interferon-gamma has been shown to be successful in improving the quality of life of patients who suffer from neutropenia.11 Gene therapy is another option for treating patients with neutropenia. Furthermore, intravenous immunoglobins can be used as a treatment for this disorder.11

Treating anxiety and stress

Anxiety disorders include generalized anxiety disorder (GAD), panic disorder (PD), agoraphobia18 and social anxiety disorders. 

Cognitive-behavioural therapy (CBT) is one of the treatments used to treat anxiety disorders.21 Researchers have shown the efficacy of CBT in treating people with anxiety disorders. CBT is more effective if it is conducted face-to-face rather than performed online with minimal contact with a therapist.22 The combination of psychotherapy and medication has also shown to be effective in treating anxiety.21 

Generally, if you feel anxious and stressed, please contact your general practitioner.

Summary 

In conclusion, chronic stress and anxiety can lower your white blood cell count. When your levels of white blood cells decrease, your immune system will weaken, and you are more prone to sickness. However, do not worry! There are various treatments for low white blood levels and therapy to treat anxiety and stress. 

References

  1. Yaribeygi H, Panahi Y, Sahraei H, Johnston TP, Sahebkar A. The impact of stress on body function: A review. EXCLI J [Internet]. 2017 Jul 21 [cited 2022 Jul 12];16:1057–72. Available from:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5579396/ 
  2. Blanco V, Salmerón M, Otero P, Vázquez FL. Symptoms of depression, anxiety, and stress and prevalence of major depression and its predictors in female university students. Int J Environ Res Public Health [Internet]. 2021 May 29 [cited 2022 Jul 11];18(11):5845. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8198394/ 
  3. National Cancer Institute. White blood cell [Internet]. 2011 [cited 2022 Jul 12]. Available from: https://www.cancer.gov/publications/dictionaries/cancer-terms/def/white-blood-cell 
  4. Tigner A, Ibrahim SA, Murray I. Histology, white blood cell. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 [cited 2022 Jul 12]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK563148/ 
  5. Rosales C. Neutrophil: a cell with many roles in inflammation or several cell types? Front Physiol [Internet]. 2018 Feb 20 [cited 2022 Jul 12];9:113. Available from: https://www.frontiersin.org/article/10.3389/fphys.2018.00113/full 
  6. Nah EH, Kim S, Cho S, Cho HI. Complete blood count reference intervals and patterns of changes across pediatric, adult, and geriatric ages in korea. Ann Lab Med [Internet]. 2018 Nov [cited 2022 Jul 12];38(6):503–11. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6056383/ 
  7. CDC. Systemic lupuserythematosus (Sle) [Internet]. Centers for Disease Control and Prevention. 2022 [cited 2022 Jul 12]. Available from: https://www.cdc.gov/lupus/facts/detailed.html 
  8. Low white blood cell count [Internet]. nhs.uk. 2017 [cited 2022 Jul 12]. Available from: https://www.nhs.uk/conditions/low-white-blood-cell-count/ 
  9. Leukemia—patient version - nci [Internet]. [cited 2022 Jul 12]. Available from: https://www.cancer.gov/types/leukemia 
  10. Lam L, Mumford J, Keber B, Flanagan B. Hematologic conditions: leukopenia. FP Essent. 2019 Oct;485:11–6. 
  11. Justiz Vaillant AA, Zito PM. Neutropenia. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 [cited 2022 Jul 12]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK507702/ 
  12. Definition of hypoplasia [Internet]. [cited 2022 Jul 12]. Available from: https://www.merriam-webster.com/dictionary/hypoplasia 
  13. Myelofibrosis | cancer research uk [Internet]. [cited 2022 Jul 12]. Available from: https://www.cancerresearchuk.org/about-cancer/other-conditions/myelofibrosis 
  14. Pilatova K, Bencsikova B, Demlova R, Valik D, Zdrazilova-Dubska L. Myeloid-derived suppressor cells (Mdscs) in patients with solid tumors: considerations for granulocyte colony-stimulating factor treatment. Cancer Immunol Immunother [Internet]. 2018 Dec [cited 2022 Jul 13];67(12):1919–29. Available from: http://link.springer.com/10.1007/s00262-018-2166-4 
  15. Jolis L, Carabantes F, Pernas S, Cantos B, López A, Torres P, et al. Incidence of chemotherapy-induced neutropenia and current practice of prophylaxis with granulocyte colony-stimulating factors in cancer patients in Spain: a prospective, observational study: Incidence of neutropenia in Spanish cancer patients. Eur J Cancer Care (Engl) [Internet]. 2013 Jul [cited 2022 Jul 13];22(4):513–21. Available from: https://onlinelibrary.wiley.com/doi/10.1111/ecc.12057 
  16. Yeshaw Y, Mossie A. Depression, anxiety, stress, and their associated factors among Jimma University staff, Jimma, Southwest Ethiopia, 2016: a cross-sectional study. Neuropsychiatr Dis Treat [Internet]. 2017 Nov 8 [cited 2022 Jul 13];13:2803–12. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5685143/ 
  17. National Cancer Institute. Malignancy [Internet]. 2011 [cited 2022 Jul 13]. Available from: https://www.cancer.gov/publications/dictionaries/cancer-terms/def/malignancy 
  18. Overview - agoraphobia [Internet]. nhs.uk. 2021 [cited 2022 Jul 14]. Available from: https://www.nhs.uk/mental-health/conditions/agoraphobia/overview/ 
  19. Hussain LS, Reddy V, Maani CV. Physiology, noradrenergic synapse. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 [cited 2022 Jul 14]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK540977/ 
  20. National Cancer Institute. Norepinephrine [Internet]. 2011 [cited 2022 Jul 14]. Available from: https://www.cancer.gov/publications/dictionaries/cancer-terms/def/norepinephrine 
  21. Bandelow B, Michaelis S, Wedekind D. Treatment of anxiety disorders. Dialogues in Clinical Neuroscience [Internet]. 2017 Jun 30 [cited 2022 Jul 14];19(2):93–107. Available from: https://www.tandfonline.com/doi/full/10.31887/DCNS.2017.19.2/bbandelow 
  22. Bandelow B, Reitt M, Röver C, Michaelis S, Görlich Y, Wedekind D. Efficacy of treatments for anxiety disorders: a meta-analysis. International Clinical Psychopharmacology [Internet]. 2015 Jul [cited 2022 Jul 14];30(4):183–92. Available from: http://journals.lww.com/00004850-201507000-00002 

Sentia Racha Keyulong

Bachelor of Science - BSc, Psychology, The University of Edinburgh, Scotland, Scotland

Sentia is an experienced Research Assistant and Medical Writer.

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