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Eosinophilia is defined as an abnormally high level of eosinophils in the blood, this is usually defined as >500 cells/μL (normal eosinophil level: <450 cells/μL). Hypereosinophilia is defined as >1500 cells/μL and is usually due to hematological malignancy 1,2.
This article includes recommendations and material from the "Guideline for the investigation and management of eosinophilia" published by the British Society for Hematology in 2017 2.
The number of eosinophils is increased in neonates, cf. adults, with a gradual tailing off of blood counts in advanced age; no gender/ethnic variation is known 2.
The known causes of elevation of the eosinophil count is very broad, and usefully the etiology can be subdivided into secondary, primary and idiopathic forms. Secondary (reactive) type is by far the commonest.
- non-allergic skin
- primary eosinophilic GI diseases
- chronic pancreatitis
- inflammatory bowel disease (IBD)
- celiac disease
- eosinophilic pneumonias: acute and chronic types
- solid organ malignancies
- lymphoma and acute lymphoblastic leukemia (ALL)
- systemic mastocytosis
- atheroembolic disease
- chronic graft-versus-host disease (GvHD)
- episodic angioedema with eosinophilia (EAE)
- rare immunoregulatory syndromes
A large number of primary hematological neoplastic conditions are associated with a clonal expansion of eosinophils.
myeloid and lymphoid neoplasms
chronic eosinophilic leukemia, not otherwise specified (CEL, NOS)
atypical chronic myeloid leukemia with eosinophilia (aCML-Eo)
chronic myelomonocytic leukemia with eosinophilia (CMML-Eo)
chronic myelogenous leukemia in accelerated phase or transformation
other myeloproliferative neoplasm in transformation
acute myeloid leukemia with eosinophilia (AML-Eo)
especially t(8;21)(q22;q22.1) or inv(16)(p13.1q22)
acute lymphoblastic leukemia, only if eosinophils demonstrated to be part of the neoplastic clone
- systemic mastocytosis
- 1. Ramirez GA, Yacoub MR, Ripa M, Mannina D, Cariddi A, Saporiti N, Ciceri F, Castagna A, Colombo G, Dagna L. Eosinophils from Physiology to Disease: A Comprehensive Review. (2018) BioMed research international. 2018: 9095275. doi:10.1155/2018/9095275 - Pubmed
- 2. Butt NM, Lambert J, Ali S, Beer PA, Cross NC, Duncombe A, Ewing J, Harrison CN, Knapper S, McLornan D, Mead AJ, Radia D, Bain BJ. Guideline for the investigation and management of eosinophilia. (2017) British journal of haematology. 176 (4): 553-572. doi:10.1111/bjh.14488 - Pubmed