The mnemonic VINDICATE is most useful in developing a list of possible causes of leukopenia. V—Vascular disorders are not usually associated with leukopenia. I—Inflammation will help recall viral infections, typhoid fever, tularemia, brucellosis, and miliary tuberculosis, which are associated with leukopenia. Malaria and various rickettsial infections are also associated with leukopenia. N—Neoplasms and nutritional: Neoplasms that invade the bone marrow may cause leukopenia. Aleukemic leukemia is also a cause of leukopenia. Nutritional disorders under this category include B12 and folate deficiencies. D—Degenerative disorders are not usually associated with leukopenia. I—Intoxication and Idiopathic disorders will call to mind the leukopenia (agranulocytosis) of benzene, chemotherapy, sulfonamides, anticonvulsants, antibiotics, and many other drugs. It should also prompt the recall of aplastic anemia, myelofibrosis, and benign familial neutropenia. C—Congenital should bring to mind the reticuloendothelioses such as Gaucher disease. A—Autoimmune Collagen vascular disorders such as lupus erythematosus and autoimmune neutropenia should be remembered by this classification. T—Trauma mechanism is not usually a cause of leukopenia (with the exception of radiation). E—Endocrine disorders are not usually associated with a leukopenia. Addison disease is a notable exception. Unfortunately, this method of recalling the possibilities would leave out the leukopenia that occurs with splenomegaly of many causes.
The history may disclose the use of various drugs and exposure to radiation and other toxins. If there are associated anemia and thrombocytopenia, the possibility of aplastic anemia should be considered. An enlarged spleen suggests that hypersplenism is the cause. The initial laboratory workup includes a CBC, urinalysis, sedimentation rate, differential count, chemistry panel, febrile agglutinins, ANA, platelet count, serum B12 and folic acid levels, and serum protein electrophoresis. A bone marrow examination and hematology consult is next in line.
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Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2008 Williams & Wilkins.
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Title: Differential Diagnosis in Primary Care Authors: R. Douglas Collins MD, FACP Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 0-7817-6812-8 
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