Eosinophilia Workup

  • Author: Michaelann Liss; Chief Editor: Emmanuel C Besa, MD   more...
 
Updated: Aug 25, 2011
 

Laboratory Studies

  • Complete blood cell (CBC) count with differential to quantitate the percentage eosinophils and absolute number of eosinophils (AEC).
  • Blood chemistries can indicate specific organ involvement (ie, liver, kidney).
  • Spinal fluid examination to assess the cerebrospinal fluid (CSF) eosinophilia due to worm infections (eg, Angiostrongylus cantonensis), drug reactions (eg, Dilantin), and coccidioidomycosis fungal meningitis.
  • Patients with allergic symptoms should have a nasal smear for eosinophilia and Gram stain. Patients with asthma symptoms should have sputum examination for eosinophilia.
  • In suspected cases of medication and some parasitic infections, evaluation of urine sediment may be helpful. Stool samples should be evaluated for ova and parasites if indicated by history.
  • If reactive causes are unlikely, a bone marrow biopsy should be done. Clues of clonality in peripheral blood include macrocytosis, thrombocytosis, left-shifted granulopoiesis and circulating blasts. In the bone marrow, myeloproliferation with dyshematopoiesis and reticulin fibrosis are suggestive of clonality. Staining for tryptase and immunophenotyping should be done. If primary eosinophilia is suspected, fluorescent in situ hybridization (FISH) or reverse transcriptase-polymerase chain reaction (RT-PCR) is sent to detect fusion genes. FISH for the CHIC2 gene deletion can also give a presumptive diagnosis of a fusion gene. T-cell receptor gene rearrangement can be evaluated by flow cytometry. Elevated serum levels of tryptase (seen in systemic mastocytosis [SM]), IL-5 (common in clonal T-cell disorders) and IgE can also be measured for elevation.
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Imaging Studies

  • Computed tomography (CT) scanning
    • CT scans of the lungs, abdomen, pelvis, and brain evaluate for focal defects due to diverse causes of eosinophilia.
    • Worm infections of the liver (eg, Fasciola hepatica) can cause focal hepatic lesions.
    • A coccidioidomycosis fungal infection can cause focal lesions in the lung, which are visible on a chest radiograph or CT scan.
    • Hodgkin or non-Hodgkin lymphoma can cause adenopathy in the abdomen, which is visualized on a CT scan.
  • Echocardiogram to assess for thrombi (eg, mural, endocardial) due to hypereosinophilic syndrome (HES).
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Procedures

  • A bone marrow biopsy may be helpful (see Laboratory Studies).
  • A lumbar puncture may be performed to evaluate spinal fluid for CSF eosinophilia. CSF eosinophilia may be due to worm infections (eg, A cantonensis), drug reactions, or coccidioidomycosis fungal meningitis.
  • Schistosoma hematobium typically causes eosinophilia and hematuria due to infection of the bladder. All patients with blood eosinophilia who have lived or traveled in Africa and have either gross or microscopic hematuria should have their urine examined for the eggs of S hematobium. Cystoscopy is usually necessary to make the diagnosis, because the terminal-spined eggs of this species of schistosome can often be found in the urine if specifically sought. Egg of Schistosoma hematobium, with its typical teEgg of Schistosoma hematobium, with its typical terminal spine.
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Contributor Information and Disclosures
Author

Michaelann Liss  DO, Consulting Staff, Department of Hematology/Oncology, The Vancouver Clinic/South West Washington Medical Center

Michaelann Liss is a member of the following medical societies: American College of Physicians, American Medical Association, American Osteopathic Association, American Physical Therapy Association, American Society of Hematology, and Pennsylvania Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

Erik Zeger, MD  Consulting Staff, Main Line Oncology Hematology Associates

Erik Zeger, MD is a member of the following medical societies: Alpha Omega Alpha, American Association for Cancer Research, and American Society of Hematology

Disclosure: Nothing to disclose.

Daniel R Lucey, MD, MPH  Chief, Fellowship Program Director, Department of Internal Medicine, Division of Infectious Diseases, Washington Hospital Center; Professor, Department of Internal Medicine, Uniformed Services University of the Health Sciences

Daniel R Lucey, MD, MPH is a member of the following medical societies: Alpha Omega Alpha and American College of Physicians

Disclosure: Nothing to disclose.

Palaniandy Kogulan, MBBS, MD  Assistant Director of Internal Medicine, Synergy Medical Education Alliance; Assistant Professor of Medicine, Michigan State University College of Human Medicine

Palaniandy Kogulan, MBBS, MD is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America, and Michigan State Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Pradyumna D Phatak, MBBS, MD  Chair, Division of Hematology and Medical Oncology, Rochester General Hospital; Clinical Professor of Oncology, Roswell Park Cancer Institute

Pradyumna D Phatak, MBBS, MD, is a member of the following medical societies: American Society of Hematology

Disclosure: Novartis Honoraria Speaking and teaching

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Marcel E Conrad, MD  Distinguished Professor of Medicine (Retired), University of South Alabama College of Medicine

Marcel E Conrad, MD is a member of the following medical societies: Alpha Omega Alpha, American Association for the Advancement of Science, American Association of Blood Banks, American Chemical Society, American College of Physicians, American Physiological Society, American Society for Clinical Investigation, American Society of Hematology, Association of American Physicians, Association of Military Surgeons of the US, International Society of Hematology, Society for Experimental Biology and Medicine, and Southwest Oncology Group

Disclosure: No financial interests None None

Rajalaxmi McKenna, MD, FACP  Southwest Medical Consultants, SC, Department of Medicine, Good Samaritan Hospital, Advocate Health Systems

Rajalaxmi McKenna, MD, FACP is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology, and International Society on Thrombosis and Haemostasis

Disclosure: Nothing to disclose.

Chief Editor

Emmanuel C Besa, MD  Professor, Department of Medicine, Division of Hematologic Malignancies, Kimmel Cancer Center, Jefferson Medical College of Thomas Jefferson University

Emmanuel C Besa, MD is a member of the following medical societies: American Association for Cancer Education, American College of Clinical Pharmacology, American Federation for Medical Research, American Society of Clinical Oncology, American Society of Hematology, and New York Academy of Sciences

Disclosure: Nothing to disclose.

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Indurated edematous plaques of hypereosinophilic syndrome on a patient's legs.
Erythroderma in a patient with hypereosinophilic syndrome.
Granuloma with a central core of eosinophilic debris surrounded by a peripheral palisade of epithelioid histiocytes and eosinophils from a patient with Churg-Strauss syndrome (allergic granulomatosis).
Magnified view of papules and nodules with central necrosis in a patient with Churg-Strauss syndrome (allergic granulomatosis).
High-power photomicrograph of fascia shows heavy inflammatory infiltration with numerous eosinophils, lymphocytes, and occasional plasma cells in a patient with eosinophilic fasciitis.
Lower back part of the legs in a patient with eosinophilic fasciitis shows hypopigmentation, induration, biopsy site, and asymmetric involvement.
Egg of Schistosoma hematobium, with its typical terminal spine.
 
 
 
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