II. Physiology

  1. Maturation
    1. Forms in Bone Marrow from Myeloblasts as with other Granulocytes (Basophils, Neutrophils, Monocytes)
    2. Matures in Bone Marrow over 8 days
    3. Moves to peripheral blood where it spends 8-12 hours
    4. Moves to target tissue where it spends 1-2 weeks
  2. Function: Response to Allergy and Parasitic Infection
    1. Responds to Mast Cell, Basophil chemotactic factors
    2. Type 1 Hypersensitivity Response - Late Phase (hours after exposure)
    3. Phagocyte (engulfs extracellular pathogens)
    4. Parasite (e.g. Helminth) response
    5. Antigen Presenting Cell
  3. Eosinophil granule contents (Proteins)
    1. Antiparasitic agents with tissue toxicity effect
      1. Major Basic Protein (MBP)
      2. Eosinophil Cationic Protein (ECP)
      3. Eosinophil Peroxidase (EPO)
    2. Neurotoxins
      1. Eosinophil-Derived Neurotoxin (EDN)
      2. Eosinophil Peroxidase (EPO) - also listed above
    3. Markers of Eosinophil activity in Asthma
      1. Major Basic Protein (MBP) - also listed above
      2. Eosinophil Cationic Protein (ECP) - also listed above
    4. Other Proteins
      1. Charcot-Leyden Crystals
      2. Lysophosphatase
      3. Cytokines
  4. Surface Receptors
    1. IgE Receptors
      1. IgE-Antigen complex binding results in Eosinophil activation and degranulation
    2. IgG Receptors
    3. Complement Receptors

III. Labs: Morphology on Blood Smear

  1. Granulocyte stains brightly with Eosin Stain (due to Major Basic Protein or MBP)
  2. Bilobed nucleus
  3. Diameter: 12-17 microns

IV. Interpretation: Normal

  1. Range: 1-4% of peripheral blood cells

V. Types: Eosinophilia

  1. Familial Eosinophilia (Familial Hypereosinophilic Syndrome)
    1. Rare autosomal condition (most Hypereosinophilic Syndromes are not inherited)
  2. Acquired
    1. Primary Eosinophilia
      1. Idiopathic
        1. Hypereosinophilic Syndrome (>1500 Eosinophils/uL x6 months without known cause)
      2. Clonal Eosinophilia
        1. Acute Myeloid Leukemia and other malignancies (see below)
    2. Secondary Eosinophilia
      1. See below

VI. Causes: Increased (Eosinophilia)

  1. See Hypereosinophilic Syndrome
  2. Allergy
    1. Allergic Rhinitis
    2. Atopy
    3. Asthma
  3. Dermatologic Disorders
    1. Pemphigus
    2. Pemphigoid
    3. Polyarteritis Nodosa
  4. Parasitic or Tropical infection (esp. worm infestation)
    1. Trichinosis
    2. Aspergillosis
    3. Hydatidosis
    4. Angiostrongylus
    5. Ascaris lumbricoides
    6. Capillariasis
    7. Cysticercosis
    8. Echinococcus
    9. Fascioliasis
    10. Filariasis
    11. Gnathostomiasis
    12. Paragonimiasis
    13. Schistosomiasis
    14. Strongyloidiasis
    15. Toxocara
    16. Trichuris trichiura
  5. Bacterial Infection
    1. Scarlet Fever
    2. Leprosy
  6. Viral Infection
    1. Human Immunodeficiency Virus (HIV)
    2. West Nile Virus
  7. Fungal Infection
    1. Allergic Bronchopulmonary Aspergillosis (ABPA)
  8. Myeloproliferative disorders and other Malignancies (primary clonal Eosinophilia)
    1. Chronic Myelogenous Leukemia
    2. Hodgkin's Lymphoma
    3. Non-Hodgkin's Lymphoma
    4. Polycythemia Vera
    5. Myelofibrosis
  9. Collagen-vascular diseases
    1. Rheumatoid Arthritis
    2. Periarteritis
    3. Systemic Lupus Erythematosus
    4. Eosinophilia-Myalgia Syndrome
      1. Linked to L-Tryptophan and 5-Hydroxytryptophan (5-HTP) usage in 1989 (suspected contaminant)
  10. Medications
    1. Antibiotics
      1. Ampicillin
      2. Penicillin
      3. Minocycline
      4. Nitrofurantoin
      5. Erythromycin
      6. Sulfonamides
    2. NSAIDS and antiinflammatory agents
      1. Acetylsalicylic acid (Aspirin)
      2. Ibuprofen
      3. Naproxen
      4. Methotrexate
    3. Psychiatric Agents
      1. Imipramine
      2. Trazodone
      3. Fluoxetine (Prozac)
    4. Miscellaneous
      1. Chlorpropamide (hypoglycemic agent)
      2. Procarbazine (Chemotherapy)
  11. Miscellaneous
    1. Radiation Therapy
    2. Eosinophilic Gastroenteritis
    3. Sarcoidosis
    4. Addison's Disease
    5. Loffler's Syndrome

VII. Evaluation: Eosinophilia (Eosinophils >500/mm3)

  1. See Leukocytosis
  2. History and potential causes
    1. Travel history
    2. New medications
  3. Diagnostics (consider)
    1. Dermatitis biopsy (if present)
    2. Consider allergy and immunology Consultation or testing
    3. Consider Parasite testing (e.g. stool Ova and Parasites)

VIII. References

  1. Mahmoudi (2014) Immunology Made Ridiculously Simple, MedMaster, Miami, FL
  2. Saiki in Friedman (1991) Medical Diagnosis, p. 227
  3. Abramson (2000) Am Fam Physician 62(9):2053-60 [PubMed]
  4. Riley (2015) Am Fam Physician 92(11):1004-11 [PubMed]

Images: Related links to external sites (from Bing)

Related Studies

Ontology: Eosinophilia (C0014457)

Definition (MSH) Abnormal increase of EOSINOPHILS in the blood, tissues or organs.
Definition (CSP) disordered formation of eosinophils or an abnormal accumulation or deficiency of these cells.
Concepts Disease or Syndrome (T047)
MSH D004802
ICD9 288.3
ICD10 D72.1
SnomedCT 418928000, 191363000, 165524009, 27955006
English Eosinophilia, Eosinophilias, EOSINOPHILIA, Eosinophilia NOS, eosinophilic leukocytosis (diagnosis), eosinophilia, eosinophilia (diagnosis), eosinophilic leukocytosis, Eosinophilia [Disease/Finding], eosinophilias, increased eosinophils, eosinophils increased, high eosinophil count, Eosinophilic leucocytosis, Eosinophilia (disorder), Eosinophilia NOS (disorder), Eosinophilia, NOS, Eosinophilia (disorder) [Ambiguous], Eosinophilic leukocytosis
French EOSINOPHILIE, Eosinophilie, Éosinophilie
Spanish EOSINOFILIA, leucocitosis eosinófila, leucocitosis con eosinofilia, eosinofilia, SAI (trastorno), eosinofilia, eosinofilia (hallazgo), recuento elevado de eosinófilos, eosinofilia, SAI, eosinofilia (trastorno), eosinofilia (concepto no activo), Eosinofilia
German EOSINOPHILIE, Eosinophilie
Swedish Eosinofili
Japanese コウサンキュウゾウカショウ, 好酸球増加症, エオシン好性細胞増加症, 好酸球増加症-熱帯性, 熱帯性好酸球増加症, 好酸球増加, 好酸球性白血球増多症, 好酸球増多, 好酸球増多症
Czech eozinofilie, Eozinofilie
Finnish Eosinofilia
Portuguese EOSINIFILIA, Eosinofilia
Korean 호산구증다증
Polish Eozynofilia
Hungarian eosinophilia
Norwegian Eosinofili
Dutch eosinofilie, Eosinofilie
Italian Eosinofilia

Ontology: eosinophil (C0014467)

Definition (MSHCZE) Eozinofilní granulocyt. Druh bílé krvinky (leukocyt) svýznamem v obraně proti parazitům a při alergii. Při těchto stavech je množství e. v krvi zvýšeno – eozinofilie. (cit. Velký lékařský slovník online, 2013 http://lekarske.slovniky.cz/ )
Definition (NCI_NCI-GLOSS) A type of immune cell that has granules (small particles) with enzymes that are released during infections, allergic reactions, and asthma. An eosinophil is a type of white blood cell and a type of granulocyte.
Definition (NCI) Granular leukocytes with a nucleus that usually has two lobes connected by a slender thread of chromatin, and cytoplasm containing coarse, round granules that are uniform in size and stainable by eosin.
Definition (MSH) Granular leukocytes with a nucleus that usually has two lobes connected by a slender thread of chromatin, and cytoplasm containing coarse, round granules that are uniform in size and stainable by eosin.
Definition (CSP) granular leukocyte readily stained by eosin; granules are coarse, round, and uniform in size; the nucleus usually has two lobes connected by a slender thread of chromatin; these cells are thought to play a specialized role in immunity to helminth infections.
Concepts Cell (T025)
MSH D004804
SnomedCT 14793004
LNC LP28567-3, LP14539-8, MTHU009211, LA12895-1
English Eosinophils, Eosinophil, segmented, eosinocyte, acidophilic leukocyte, eosinophilic granulocyte, eosinophilic leukocyte, Eosinophil leukocyte, Eosinophil leucocyte, Blood eosinophils, eosinophils, blood eosinophils, Eosinophil, Eosinophil, segmented (cell), Blood Eosinophil, eosinophil
Spanish eosinófilo, segmentado, Eosinófilos en sangre, eosinófilo, segmentado (célula), eosinófilo, Eosinófilos
Dutch bloed eosinofielen, eosinofielen, Eosinofyl, Eosinofylen
French Eosinophiles, Eosinophiles sanguins, Granulocytes éosinophiles, Granulocyte éosinophile, Éosinophiles, Polynucléaire éosinophile, Polynucléaires éosinophiles, PNE (Polynucléaire éosinophile), Granulocyte acidophile
German Eosinophile im Blut, Eosinophile Granulozyten, Eosinophile Leukozyten, Eosinophile
Italian Esinofili ematici, Eosinofili
Portuguese Eosinófilos no sangue, Eosinófilos
Japanese 好酸球, 血中好酸球, ケッチュウコウサンキュウ, コウサンキュウ
Swedish Eosinofila leukocyter
Czech granulocyty eozinofilní, eozinofily, Eozinofily v krvi, Eozinofily
Finnish Eosinofiilit
Latvian Eozinofili
Polish Granulocyty eozynofilne, Granulocyty kwasochłonne, Komórki kwasochłonne krwi, Eozynofile
Hungarian Eozinofil vérszint, Eozinofilek
Norwegian Leukocytter, eosinofile, Granulocytter, eosinofile, Eosinofile granulocytter, Eosinofile leukocytter, Eosinofile celler

Ontology: Eosinophil count procedure (C0200638)

Definition (NCI_CDISC) A measurement of the eosinophils in a biological specimen.
Definition (NCI) The determination of the number of eosinophils in a blood sample.
Concepts Laboratory Procedure (T059)
SnomedCT 165525005, 71960002, 365601007
Italian Conta eosinofila
Japanese 好酸球数, コウサンキュウスウ
English Eosinophil Count, blood eosinophil count (lab test), blood eosinophil count, eosinophil count, Eosinophil count procedure, counts eosinophil, eosinophil count test, count eosinophil, Eosinophil count NOS, Eosinophil count NOS (procedure), Eosinophils, EOS, Eosinophil count, Eosinophil count (procedure), Eosinophil count - observation
Czech Počet eozinofilů
Hungarian Eozinofil szám
Spanish recuento de eosinófilos, SAI, recuento de eosinófilos, SAI (procedimiento), recuento de eosinófilos (procedimiento), recuento de eosinófilos, Recuento de eosinófilos
Portuguese Número de eosinófilos
Dutch eosinofielentelling
French Eosinophiles
German Eosinophilenzahl