If you’re living with lupus, your blood test results may show a higher level of cells called immature granulocytes (IGs). If that’s happened to you, you’ve probably wondered what that means and whether it was caused by lupus.

Levels of white blood cells can be affected in many people with lupus, and this can signal a related health condition or infection that needs to be addressed. Learn how lupus can affect the levels of white blood cells in your body and what that means for your lupus symptoms.

What Are Granulocytes?

White blood cells are an important part of the immune system, responsible for defending the body against infections and diseases. The two classes of white blood cells are called granulocytes and agranulocytes. They protect our body from microorganisms, such as viruses, bacteria, and allergens.

Granulocytes are the most abundant type of white blood cells found in our body. They are called granulocytes because they contain small sacs called granules filled with special enzymes. Granulocytes release these enzymes to protect our immune system against foreign organisms. Granulocytes play an important role in defending our body and keeping our immune response strong.

There are three types of granulocytes:

• Neutrophils — Fight against bacterial infections
• Eosinophils — Most commonly act in allergic reactions and fight off parasites
• Basophils — Release histamine during allergic reactions

Granulocytes are produced and matured in the bone marrow, a spongy tissue found at the center of bones. Immature granulocytes live in the bone marrow, and once matured, they’re released into the bloodstream. From there, they travel until they’re called to sites of immune response.

Blood Cell Counts

The number of white blood cells in the body goes up or down depending on the state of your immune system. In many health conditions, the number of white blood cells rises as they prepare to attack the pathogens (harmful microorganisms that can cause disease).

In some cases, however, underlying conditions cause white blood cell counts to decrease. A complete blood count (CBC) test measures the number of different types of blood cells in your blood, which can help detect health problems.

Blood Cell Counts in Lupus

As a chronic (long-term) inflammatory disease that affects multiple organs, lupus causes changes in the composition of different types of blood cells. Changes in blood cell counts are often linked with worsening disease and may indicate additional health problems.

In about 50 percent to 60 percent of people with systemic lupus erythematosus (SLE), the most common form of lupus, the level of all white blood cells combined is lower than in people without SLE. This is called leukopenia, which is defined as a white blood cell count of less than 4,000 cells per microliter. Normal levels of white blood cells in adults range from 4,000 to 11,000 cells per microliter.

Mature Granulocyte Counts

While leukopenia is common in people with lupus, neutropenia occurs less often, affecting 20 percent to 40 percent of people with SLE. Neutropenia refers to a low number of neutrophils, a type of granulocyte, and is defined as a neutrophil count of less than 1,500 cells per microliter.

One member of MyLupusTeam shared, “My blood test results show lower than average lymphocytes and neutrophils.” They went on to ask if lupus alone can cause the decrease in these levels.

Neutropenia in people with SLE is usually mild and often doesn’t need treatment. However, it can increase a person’s likelihood of developing an infection and of having an infection that lasts a longer period of time. Severe, lasting neutropenia in people with lupus is also associated with more severe and invasive infections.

If you or a loved one experience neutropenia with a fever, seek immediate medical attention. Severe neutropenia can be treated with granulocyte colony-stimulating factor, a drug that stimulates the bone marrow to produce more white blood cells.

In very rare cases, a bone marrow transplant may be needed. It’s important to note that bone marrow transplants are usually only reserved for severe blood-related issues, such as blood cancers.

Immature Granulocyte Counts

Granulocytes are produced from stem cells in the bone marrow and go through a maturation process before being released. Sometimes, immature granulocytes are released into the bloodstream. While the exact cutoff varies from lab to lab, a normal number of IGs is generally less than 100 microliters.

During an infection, the number of granulocytes rises to fight off infection. In some cases, IGs may be recruited to be released into the bloodstream, leading to high levels of IGs.

What Level of Immature Granulocytes Is Concerning?

A person’s level of IGs is usually given as a percentage of total white blood cells. It’s normally less than 1 percent. Doctors generally aren’t concerned until that number is greater than 2 percent. There are some instances when the number of IGs is higher in the bloodstream.

One MyLupusTeam member shared that their immature granulocyte percentage was almost double the reference range and wanted to know what that means.

A high IG count often signals an early-stage infection in the body. High IG counts can be caused by:

• Bone marrow disorders, such as myelofibrosis
• Autoimmune diseases, including SLE and rheumatoid arthritis
• Cancer, such as chronic myeloid leukemia
• Tissue injury and inflammation, including sepsis
• Steroid use, which is common for treating conditions including SLE

Changes in the number of granulocytes can reflect changes in disease activity. In lupus, a rise in the number of immature granulocytes may happen with active disease or lupus flares.

If you have elevated immature granulocytes, your doctor will want to treat the underlying cause. This should help your IG levels improve.

Other Abnormal Blood Cell Counts in Lupus

Other abnormal blood counts found in people with lupus include:

• Lymphopenia (low lymphocyte count) — Found in 75 percent to 90 percent of people with SLE
• Anemia (low red blood cell count) — Found in about 50 percent of people with SLE
• Thrombocytopenia (low platelet count) — Found in 20 percent to 40 percent of people with SLE and thrombocytopenia and is also one of the hematologic clinical criteria for diagnosis in SLE

Blood cell counts are affected in many people with chronic inflammatory diseases such as SLE and can often signal that the disease is getting worse. Make sure to see your doctor for regular checkups that include blood cell counts to monitor your lupus.

You’ll want to have a hematologist (blood disease specialist) explain how lupus may affect your blood cells. A member echoed this, saying, “You definitely need blood tests to keep an eye on what’s going on with lupus symptoms to make sure it’s not affecting other organs.”

A hematologist can help you understand any changes or abnormalities in your CBC results that may be connected to lupus. They will also provide guidance, monitoring, and treatment options that are appropriate for your condition.

Join the Conversation

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