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Eosinophilia

 

The common causes of eosinophilia are allergy (asthma, eczema, seasonal allergies) and medication (sometimes self-administered).

A more extensive list of causes is found here:

http://onlinelibrary.wiley.com/doi/10.1111/bjh.14488/full

 

Consider intestinal / other parasites if travel history, even long ago, suggests this as a possibility.

Sustainedly raised eosinophils are toxic especially at levels above 1.5x 109/l.

If there are associated new onset cardiac or pulmonary problems seek early advice.

 

History:

                Allergic disorders

                Skin rashes

                Medication including accurate start dates, and time correlation with blood counts

                Travel history

      Thrombotic history

      Cardiorespiratory                                                                                    

      Gastrointestinal                                               

                Constitutional                                   

                Red flag malignancy symptoms ( night sweats, unintentional weightloss, pruritus)

 

Examination:

                Signs of allergy

                Skin rash

                Cardiac and respiratory systems

 

Blood tests:

                FBC and blood film

                U+E, LFT, bone, LDH, CRP, vitamin B12 assay

 

According to above findings consider:

                Stool sample requesting Ova, Cysts and Parasites

    CXR, Pulmonary Function Test  and possible CT thorax

                Troponin T and possible Echocardiography

 

 

When to refer:

If

Eosinophil count is sustained above 1.5x 109/l

Systemic symptoms

Evidence of end organ damage

 

Then

Refer to Haematology if no detectable secondary cause

                or

Refer to secondary care, specialty according to clinical impression and site of pathology

 



References

BJH, Guideline for the investigation and management of eosinophilia: http://onlinelibrary.wiley.com/doi/10.1111/bjh.14488/full

 

Contributors:

Dr Richard Noble, Consultant Haematologist, RCHT

Dr Bridgitte Wesson, GP & Kernow RMS Haematology guideline lead

 

Review date: 13/07/2020

Next Review 13/07/2021