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

Patrick Naughton; James V. Harte; Brigid Lucey; Frances Enright

doi:10.17305/bb.2025.12998

Authors

Patrick Naughton Department of Biological Sciences, Munster Technological University, Rossa Avenue, Bishopstown, Cork, Ireland; Department of Haematology, Mercy University Hospital, Grenville Place, Cork, Ireland https://orcid.org/0000-0001-7274-2650
James V. Harte Department of Haematology, Cork University Hospital, Cork, Ireland https://orcid.org/0000-0002-3817-3658
Brigid Lucey Department of Biological Sciences, Munster Technological University, Rossa Avenue, Bishopstown, Cork, Ireland
Frances Enright Department of Paediatrics, Cork University Hospital, Cork, Ireland

DOI:

https://doi.org/10.17305/bb.2025.12998

Keywords:

Atypical lymphocytes, Epstein-Barr virus, heterophile antibodies, infectious mononucleosis, Monospot test, neutropenia, thrombocytopenia

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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