Thrombocytopenia and neutropenia in Epstein–Barr virus infectious mononucleosis: A retrospective cohort study

TL;DR

This study finds that low platelet and neutrophil counts occur in some patients with Epstein-Barr virus infection, including those without acute symptoms.

Contribution

The study shows that thrombocytopenia and neutropenia are not exclusive to acute EBV-IM cases.

Findings

14% of acute EBV-IM patients had thrombocytopenia and absolute neutropenia.

Non-acute EBV-IM patients with atypical lymphocytes had similar rates of these conditions.

Patients without atypical lymphocytes had significantly fewer hematological complications.

Abstract

Thrombocytopenia and absolute neutropenia are recognized manifestations of Epstein–Barr virus infectious mononucleosis (EBV-IM). This study conducted a retrospective analysis of laboratory results from patients clinically suspected of having EBV-IM and tested over a two-year period (2018–2019) at a single testing center in Ireland, aiming to determine the prevalence of these hematological complications. A cohort of 51 confirmed acute EBV-IM cases was established, and the incidence of thrombocytopenia and absolute neutropenia within this group was assessed. These findings were then compared to the frequencies observed in non-acute EBV-IM patients, both with and without atypical lymphocytes. Among the 51 patients diagnosed with acute EBV-IM, 14% presented with thrombocytopenia and absolute neutropenia, including instances of severe cases. A comparable prevalence of these conditions was noted in non-acute EBV-IM patients with identifiable atypical lymphocytes; however, a significantly lower incidence was found in non-acute EBV-IM patients lacking atypical lymphocytes. These results suggest that thrombocytopenia and absolute neutropenia occur in patients with viral infections and are not exclusive to acute EBV-IM.

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