Eosinophilia symptoms. Causes, diagnosis and treatment features of eosinophilia
Eosinophilia is a marker various pathologies, and during laboratory testing it is detected in the patient’s blood.
In the blood of a child’s body, this marker appears much more often than in an adult.
What are eosinophil molecules?
The standard rate of eosinophils in the blood is no more than 5.0% of the total number of leukocytes.Eosinophils in the blood are a type of white blood cell molecule. Eosinophils get their name from the pink tint of the cytoplasm, and they are clearly visible in laboratory blood tests using microscopy techniques.
At laboratory determination it is necessary to know not only the percentage ratio, but also their quantitative volume, which should not be more than 320 in one milliliter of blood plasma.
A quantitative increase in eosinophils in the blood plasma signals that tension is occurring in the body immune system. Neutralization of histamine in allergies relies on eosinophils, since they penetrate the localization of the pathology and reduce the effect of histamine, so their number in the blood plasma is large.
Eosinophilia
This pathology is not a primary disease, but its primary etiology; this is a very rare anomaly in the body and it occurs in cancer malignant neoplasms(cancer).
With malignant neoplasms, eosinophils appear in an abnormally increased volume in the bone marrow cells.
The etiology of the disease eosinophilia is quite broad, so it is necessary to establish main reason illness is possible only with comprehensive laboratory testing clinical examination body, using instrumental research damaged organs. 
Therapy for eosinophilia as an independent disease is not provided, and it is necessary to treat the pathology that provokes an increase in eosinophil molecules in the blood plasma.
ICD 10 code
By international classification diseases of the tenth revision of ICD-10 - this pathology belongs to class D 72.1, “Eosinophilia”, and is also classified as a secondary pathology of attraction immune mechanism from code D 80 to D 89.
In some situations, the etiology cannot be determined, as with eosinophilic syndrome. High index eosinophil molecules in the syndrome remain constant, then they are classified according to the ICD this syndrome– eosinophilia, and a regimen is prescribed for it drug therapy.
Standard indicators of eosinophil molecules
The norm is significantly different for an adult and a child; there are also slight differences by gender:
- normal index in an adult male body- 0.50% - 5.0% of the volume of all leukocytes in the blood plasma;
- the relative norm in the female adult body is from 0.50% to 5.0%, but the difference from male indicators is that in menstrual period These indicators deviate slightly. The first phase of the menstrual cycle - an excess of eosinophils is recorded, and after ovulation of the egg - they are reduced;
- the standard for children from birth to 5 calendar years is 0.50% - 7.0%;
- The normative indicator for children from 5 years of age to 14 calendar years is from 1.0% - 5.0%.
The absolute normative value in adults is 0.15-0.450X10.0⁹ per liter of blood plasma. From the results of a general analysis of peripheral capillary blood, the pathology of hypereosinophilic syndrome is indicated by the value of eosinophils in the blood plasma greater than 15.0% of the total volume of leukocytes.
Eosinophilia is divided according to the level of percentage increase in eosinophil molecules in the plasma blood composition:
- mild degree of pathology - no more than 10.0% of the total number of leukocytes;
- degree of moderate course of the disease - from 10.0% - 20.0% of the total volume;
- severe degree of the disease - more than 20.0% of the total concentration in the plasma of leukocytes.
General symptoms of eosinophilia pathology and why they are increased
Symptoms of eosinophilia pathology are determined by primary diseases that provoke an increase in eosinophils in the blood:
Symptoms of eosinophilia
With this pathology, an increase in eosinophils is observed, as well as pronounced symptoms of eosinophilia pathology:
Allergic etiology and Loeffler's syndrome
It is manifested by an excess of the normative units of eosinophils and leukocytes, and is also expressed in the following symptoms:
Gastric pathologies
With these pathologies, a high level of eosinophil molecules in the blood plasma provokes eosinophilic diseases and is expressed in the following symptoms:
- nausea, which leads to vomiting, after eating;
- pain in the abdomen, in the navel area;
- prolonged diarrhea;
- limb spasms;
- systematic constipation;
- jaundice;
- increased size of the liver and its painful condition.
Symptoms of blood pathology - a provocateur of eosinophilia
A lot of things are talked about increased performance with histiocytosis, which provokes eosinophilia, the characteristic symptoms are:
Symptoms of cancer tumors with eosinophilia
With malignant tumors in the peritoneum with eosinophilia, these symptoms appear:
- constant thirst;
- increase in abdominal volume;
- not intestinal functionality.
In the human nervous system
From the authorities nervous system appear following signs and symptoms:
What test should you take? To make an initial diagnosis, it is necessary to pass general analysis blood. Peripheral capillary blood is suitable for this analysis.
If the CBC transcript showed high eosinophil indices, then the doctor collects anamnesis, examines the patient and makes a differential diagnosis.
Role specialized methods additional diagnostic studies is to establish an accurate diagnosis.
To test for eosinophilia, peripheral capillary blood is taken for a general analysis. For biochemistry, venous blood is required. All material (blood, urine, feces) for research must be freshly collected.
More information about venous blood -.
In order to get the maximum correct value this study, it is necessary to properly prepare the body for the procedure of blood sampling and urine analysis:
- It is recommended to donate blood in the morning on an empty stomach;
- urine for the study of eosinophils must be collected and submitted in a sterile container;
- Urine collection should be carried out early in the morning;
- The last urination before collection for analysis should preferably be no less than 6 - 8 hours before this urine collection procedure;
- in front of the fence biological fluid urine, you need to wash the genitals and urinary organs with water without using gel or soap;
- correct collection of urine for general analysis - you need the first portion of urine when urinating, and the rest of it is drained, and the middle portion of urine is taken for study;
- the last meal should be at least 12 hours before blood collection and urine collection;
- within 48 hours before blood sampling and urine collection, follow a diet - do not eat fried, salty, fatty foods, and do not eat sweet foods;
- do not drink alcohol in the last 48 hours before submitting the material for analysis;
- stop smoking;
- stop taking medications, at least 7 calendar days in advance.
Eosinophilia in children's bodies
The norms for the eosinophil count differ from the birth of the child to his adulthood stage. For a newborn infant, the normative index is not higher than 8.0%, and for a 5-year-old child - 6.0%.
Etiology of eosinophilia in children's body similar to the etiology of this pathology in adults. Fluctuations in the concentration of eosinophils in the blood plasma are associated with weak immunity, which is only at the stage of formation, and the baby’s body is daily subject to attack by infections and the influence of allergens.
The child is faced with the root cause of allergies from the moment of birth. In its first year of life, the digestive system is formed and adapted to a variety of food products. IN this period and the child’s first encounters with food allergens occur.
The child’s mucous membrane is too weak in the first years of life, and allergens affect it and provoke pathologies in the child’s body:
- diathesis - skin reaction to food allergen, manifested by rash and itching;
- obstruction of bronchial type;
- urticaria disease.
During this period, eosinophilia manifests itself as a secondary pathology of such diseases of the child’s body:
- infectious scarlet fever;
- tuberculosis;
- infectious enterobiasis;
- infectious giardiasis.
By the age of 2, a child’s allergies to food go away, unless the baby has a congenital allergic pathology.
When eosinophilia manifests itself in children, it is necessary to carry out a differential diagnostic technique in order to exclude from the list the root causes of this pathology, hematopoietic diseases.
What are the reasons for increased eosinophils in children:
- drug allergy - a common childhood allergy to drugs;
- infections that entered the baby during intrauterine development;
- worms;
- defeats skin;
- entry into the body of fungal pathogens;
- influence of staphylococci on the body;
- infectious vasculitis;
- lack of the microelement magnesium in the body.
Eosinophilia in a child’s body does not require special therapy. It is necessary to remove the root cause of the pathology and the disease will go away automatically.
Treatment
To treat eosinophilia, it is necessary to begin treatment for the underlying cause of the disease.
The drug course depends on the primary source of the pathology, its scale of damage and the stage of development. - Vermox medication;
- Dekaris remedy;
- drug Vermakar.
- medication Fenkarol;
- medicine Pipolfen;
- vitamin complex;
- preparations containing iron for anemia.
To reduce the levels of eosinophilia caused by an allergic root cause, you need to be treated with antihistamines:
- the drug Diphenhydramine;
- Parlazin;
- antihistamine Claritin;
- Fenkarol.
Also for more severe allergic manifestations Hormonal medications are prescribed:
- Prednisolone;
- Dexamethasone.
In addition to drug therapy, infusion treatment is performed.
Infants with diathesis are prescribed ointments on the skin or creams that have antihistamine effect and hormonal components:
- Advantan cream;
- Celestoderm ointment;
- Epidel.
In order to reduce the allergic effect on the body, it is necessary to take sorbents - activated carbon.
In case of allergies to food products, it is necessary to remove from the diet those foods that cause attacks of an allergic reaction.
To treat eosinophilia in malignant neoplasms, the following groups of drugs are prescribed:
- cytostatics;
- hormonal drugs;
- immunosuppressants.
The entire medication course is prescribed according to the scheme, the dosage is calculated individually by a hematologist.
To prevent infections and bacteria from entering the body, treatment is supplemented antibacterial drugs, as well as antifungal medications.
For treatment of infection and immunodeficiency eosinophilia, in addition to general therapy apply vitamin complexes and a balanced diet.
Folk remedies
For therapy folk remedies secondary eosinophilia, as well as eosinopenia, fees are used medicinal herbs and drugs that are based medicinal plants.
Treating eosinophilia with raspberry tea. In order to use traditional medicine, it is necessary to establish the root cause of the pathology. And then use medicinal plants in order to reduce or increase the concentration of eosinophils in the blood.
To treat the allergic root cause, decoctions and infusions of the following plants are used:
- raspberry;
- wormwood grass;
- sage;
- rose hip plant;
- cabbage leaves;
- grass succession;
- creeping wheatgrass;
- viburnum.
To eliminate the root cause of helminthiases, the following are used:
- pumpkin seed kernels;
- blue iodine solution.
Low eosinophil index - eosinopenia
A decrease in the eosinophil index is detected during a general blood test.
Root causes low index eosinophils in the blood are:
- surgical surgical interventions into the body;
- inflammation that occurs in chronic stage with constant relapses;
- burns over a large area of skin;
- infections that are in the body long period time and have passed the adaptation stage;
- intoxication of the body, especially alcohol poisoning reduces the concentration of eosinophils;
- body overload;
- constant stressful situations;
- state of shock;
- severe injuries to the body;
- malignant oncological tumors;
- sepsis in internal organs;
- insomnia;
- long-term use of corticosteroid medications.
Pregnancy and birth process can cause a decrease in the eosinophil index, as well as increase their level.
The danger of eosinophilia
The danger of this pathology is its negative consequences and in a complicated form. A complicated form of eosinophilia occurs if for a long period it is not possible to diagnose and identify the root cause of the pathology.
Complicated eosinophilia affects internal organs life support of the body:
- brain - causing hypoxia, which leads to stroke;
- lungs - causes oxygen starvation organ cells, which leads to pulmonary edema;
- heart organ - provokes coronary insufficiency which can lead to ischemia of the heart muscle and myocardial infarction;
- cause disturbances in the gastrointestinal tract and pathologies in the digestive system;
- deviations in the functioning of all centers of the nervous system.
During pregnancy, eosinophilia can cause a number of serious complications:
- inflammation in the kidneys - pyelonephritis;
- inflammatory process in bladder- cystitis;
- interruption by the body of the intrauterine formation of the fetus - fetal fading;
- miscarriages;
- premature birth of a child - premature baby;
- obstructed passage of the baby through the birth canal.
Prevention
Required preventive measures, preventing deviations from the norm in the eosinophil index, which provoke the development of eosinophilia pathology in the body, are aimed at preventing the occurrence of primary eosinophilia pathologies.
Prevention of diseases that provoke this disease is:
- observe the rules of personal and intimate hygiene;
- be sure to wash your hands after visiting public places: after traveling to public transport, after visiting a market or store, after passing preventive examination in the clinic and so on;
- prohibit small child take a toy picked up from the floor into your mouth, and also put your fingers into your mouth;
- healthy image accommodation;
- accustom the child to body hardening procedures;
- food culture is products that are as rich in vitamins as possible, as well as cooking methods. If possible, avoid the frying method of preparing food. It is recommended, especially for children, to steam, bake and boil foods;
- timely preventive diagnostics of the body and identification of provoking diseases at the initial stage of their development;
- timely treatment of diseases that can cause an increased eosinophil index, as well as a decrease in their composition in the blood plasma.
Forecast
Eosinophilia is a blood pathology that signals many diseases in the body. Eosinophilia is a marker that shows disturbances in the functioning of the immune system, or overexertion of the immune system. Even a slightly increased eosinophil ratio indicates penetration of an infectious agent into the body.
Timely diagnosis and treatment of primary diseases leads to the fact that the disease is completely cured and therefore the prognosis is favorable.
Complicated form of eosinophilia, with damage to vital important organs, as well as pathology that is provoked by oncological tumors - the prognosis in 80% of cases is unfavorable.
According to the international classification of diseases ICD 10, eosinophilia is primary (idiopathic) and secondary (symptomatic). In most cases, this is not a separate disease, but a symptom of various pathologies. In some cases, its causes remain unclear, as, for example, in idiopathic eosinophilic syndrome, in which there is a stable high level these leukocytes.
Normal eosinophil count
The norm is different for adults and children:
- In an adult male, the level of eosinophils should be from 0.5 to 5% of all leukocytes.
- In women, the relative content, like in men, is from 0.5 to 5%, but during the month, depending on the phase of the menstrual cycle, it can change. More high values observed in the first phase, after ovulation the level drops.
- The norm for children under five years of age is from 0.5 to 7%, after five years - from 1 to 5%.
The normal absolute level for an adult is 0.15-0.45X10⁹ per liter.
How is it determined?
The level of eosinophils in the blood is determined during a general analysis. The material is taken in the morning on an empty stomach from a finger. They evaluate both the absolute value and the relative value, that is, total quantity cells, and percentage relative to other leukocytes. If their level is above normal, then we're talking about about eosinophilia. Hypereosinophilia is said to exist if the content exceeds 15%.
Relative eosinophilia is classified as follows:
- mild – if the level does not exceed 10%;
- moderate – from 10 to 20%;
- heavy – over 20%.
In what cases does it occur?
Eosinophils begin to actively form in the bone marrow if a foreign protein has entered the body. Eosinophilia is of two types: reactive and conditioned.
Eosinophil levels increase during allergic reactions
Among the blood diseases that cause an increase in eosinophils are:
- leukemia,
- polycythemia,
Slight blood eosinophilia may be observed in healthy people. Typically, this feature of the body is inherited and is not a pathology.
The most severe eosinophilia develops with schistosomiasis, trichinosis, and filariasis. With these diseases, there is a simultaneous enlargement of the spleen and liver, as well as an increase and change in the shape of the lymph nodes. In this regard, differential diagnosis with eosinophilic syndrome is required.
After treatment has been started, the number of eosinophils in the blood increases and remains at a fairly elevated level. long time. This indicates that recovery has begun, while at the peak of the disease the number of these cells may decrease.
Allergies
Eosinophil levels always increase during allergic reactions. It must be said that in in this case moderate eosinophilia is observed - the absolute number of these leukocytes ranges from 0.6X10⁹/l, but not more than 1X10⁹/l. If the level is higher, then the reasons are not allergies, but something else.
Malignant tumors
High level of eosinophils without visible reasons– always a reason to be examined for the presence of cancer. Eosinophilia is especially characteristic of colon cancer, thyroid gland, stomach, uterus, bronchi, nasopharynx, acute eosinophilic leukemia, acute myeloblastic and lymphoblastic leukemia. If after successful treatment oncological diseases an increase in the level of eosinophils is again observed, this indicates that the disease is progressing and metastasis has begun.
Hypereosinophilic syndrome
One of the causes of severe eosinophilia is idiopathic hypereosinophilic syndrome. The disease is characterized by a high content of these cells in the blood for 6 months or more. At the same time, others possible reasons there are no high eosinophils. Symptoms of the disease are varied, because pathological process a variety of organs are involved. Heart damage is often noted. Most dangerous complication syndrome - endomyocardial thrombosis. The affected area can include the lungs, skin, gastrointestinal tract, liver, brain, spleen, and gastrointestinal tract. Treatment with corticosteroids is aimed at reducing the number of eosinophils. The cause of the pathology has not been established. With severe organ damage, as well as in cases where the disease cannot be treated, the percentage of deaths is high - up to 75% within 3 years.
Elevated eosinophils in children
When eosinophilia is detected in children, the first step is to carry out differential diagnosis to rule out blood disease.
Reactive eosinophilia in a child most often has following reasons:
- Allergy to medications. It should be said that an allergic reaction is one of the most common reasons eosinophilia in children. In this case, pronounced is observed when acute allergies, moderate – for chronic.
- Intrauterine infections.
- Worm infestation.
- Skin lesions.
- Fungal diseases.
- Staphylococcal infection.
- Vasculitis.
- Magnesium ion deficiency.
The reactive form does not require specific treatment. Usually when eliminating primary disease leukocytes return to normal.
Symptoms
Eosinophilia itself has no manifestations. These are usually symptoms of the diseases that caused the increase in the level of these cells.
When hypereosinophilia is detected in children, a thorough examination is required
With autoimmune systemic diseases, weight loss, joint pain, anemia, inflammation of the vascular walls, and skin manifestations are usually observed.
With allergic reactions, skin rashes, itching, weeping elements, blisters, and detachment of the epidermis appear.
Treatment
Treatment of eosinophilia is carried out by a hematologist. Therapy depends on the cause of the pathology, the severity of the course, the general health of the person and his age. If eosinophilia is caused by an allergy to drugs, it is enough to stop the medication.
In some cases, it is not possible to find out the cause of the pathological condition. In this case, the person becomes worse, in which case he may be prescribed a course of glucocorticosteroids. Eosinophilia can cause damage to some organs. The skin, digestive organs, lungs, as well as the nervous and cardiovascular system.
With acute eosinophilia, a person requires immediate help. He is admitted to a hospital, where a thorough examination is carried out to urgent diagnostics.
Conclusion
Eosinophilia is a pathological condition associated in most cases with the development of diseases in the body. The production of new cells indicates the penetration of a harmful agent into the body. Even if there are no signs, an examination and determination of the causes are still required. Elevated eosinophils may be a symptom serious illnesses Therefore, it is important to conduct a timely examination and begin treatment.
There are eosinophils in human blood - special cells, the increased content of which is called such a definition as eosinophilia. It is worth noting that this word is suitable to describe not separate disease, but a symptom of other ailments. Increased levels of eosinophils cause these cells to infiltrate other tissues. For example, in the secretion discharged from the nose, eosinophils can be found during a runny nose of an allergic nature, and in asthma in combination with bronchitis, they accumulate in the lungs.
For an adult normal level the number is considered to be from 0.02x109/l to 0.3x109l of eosinophils. In infections, eosinophilia can be considered a favorable sign, as it indicates the patient's recovery. However, in other cases it can indicate unfavorable processes occurring in the body. Understanding the reasons will help you figure this out. high content of these cells in the blood.
Reasons
The causes of eosinophilia are varied. In general, twelve prerequisites for this condition can be identified:
- Lung diseases: sarcoidosis, pulmonary infiltrate, eosinophilic pneumonia.
- Malignant tumors: cancer of the vagina or penis, Williams tumor, skin cancer, and so on.
- Rheumatic diseases: rheumatoid arthritis, eosinophilic fasciitis and so on.
- Immunodeficiency conditions, for example, immunoglobulin deficiency.
- Taking certain medications, for example, aspirin, antibiotics penicillin series, sex hormone drugs and so on.
- Other diseases: scarlet fever, liver cirrhosis, chorea, congenital heart defects and others.
Symptoms
Eosinophilia manifests itself depending on the disease or process that caused it. For example, with autoimmune and reactive diseases symptoms such as anemia, joint pain, fever and weight loss are observed.
For skin and allergic diseases Characterized by the appearance of a rash, itching, blisters, dry skin and detachment of the epidermis. Damage to the gastrointestinal tract leads to disruption of the intestinal microflora, and this, in turn, slows down the process of cleansing of toxins, which affects the content of eosinophils. In this case, symptoms such as nausea, vomiting, cramps, pain near the navel, signs of hepatitis and diarrhea are observed.
The external manifestation of blood disease is skin and frequent infectious diseases. If a person has developed lymphogranulomatosis, he complains of joint pain, fever, weakness, cough and other symptoms. Eosinophilia in lymphomas manifests itself as a decrease motor activity, increased temperature and decreased body weight. As you can see, the causes of eosinophilia and symptoms are closely related.
Diagnostics
In order to identify deviations in the number of eosinophils, it is necessary to take a general blood test. Such a study will allow us to calculate the ratio of these cells, which will help make a diagnosis.
The pathological condition may manifest itself as signs of anemia, that is, when the number of red blood cells is reduced. It is very important to immediately identify the disease that caused eosinophilia. This will help biochemical analysis urine, feces and blood.
Treatment
It is clear that eosinophilia is not curable separate disease. Treatment is aimed at the cause that led to this blood condition. Therefore, the doctor, after clarifying it, will prescribe effective scheme therapy aimed at the underlying disease.
Dosage and types medicines also depend on the causes of the increased number of eosinophils and on the stage and severity of the disease. The person may have to give up the medications he was previously using.
Prevention
Since eosinophilia is not independent disease, you can avoid it if you follow general condition the body and its individual organs. Therefore it is necessary to carry out timely diagnosis and adhere to the prescribed treatment. Of course, a healthy lifestyle significantly reduces the risk of many diseases, and therefore increases the level of eosinophils in the blood.
Elevated eosinophils in an adult may indicate the presence of a disease in the body, so the specialist prescribes additional examinations to identify the cause of this process. Increased quantity eosinophils in the blood or eosinophilia is not an independent pathology. It results from certain disorders and diseases.
Why do eosinophil levels increase?
Elevated eosinophils in an adult are caused by the following reasons:
IN in rare cases Eosinophils are elevated in patients diagnosed with . The disorder also occurs in people with vegetative-vascular disorders.
Symptoms of elevated eosinophils and diagnosis
For elevated eosinophils An adult has the following symptoms:
- difficulty breathing.
An increase in eosinophils in a patient’s blood is diagnosed using the following research methods:
- Complete blood count: detects high levels of eosinophils, but does not determine the final diagnosis.
- Ultrasound examination of the abdominal organs.
- Urine and stool analysis.
- Radiography and others additional research to confirm the diagnosis.
After the doctor has determined the cause of the increase in the number of eosinophils, he prescribes a course of treatment for the disease that provoked this phenomenon.
Pay attention! Eosinophils can reside not only in lymph, but also in tissues. This localization is characteristic of pulmonary eosinophilia. This disease occurs due to allergies or bronchial diseases.
Sometimes increased level eosinophils occur in women during pregnancy. This sign should alert the patient, as it may indicate an existing intestinal infection. Treat helminthic infestations in this case, it is problematic, since all drugs are toxic and have a negative effect on the fetus. In addition to eosinophilia, a pregnant woman can be diagnosed with other serious kidney diseases. All these factors often cause premature birth.
Nuance! A blood test should be taken at morning hours on an empty stomach. You should not consume alcohol, citrus fruits or sweets for 2 days before the examination.
Eosinophils and lymphocytes
Eosinophils along with lymphocytes increase during the virus in patients diagnosed with chronic allergies. The same indicator occurs in people taking antibiotics and sulfonamides.
It is worth noting that the norm for eosinophils is 1-5% of the total volume of all types of leukocytes. The norm does not depend on the gender and age of the person, therefore it is the same for both an adult patient and a child.
The following pathologies lead to an increase in the level of lymphocytes in the blood:
- infectious diseases;
- allergic reactions;
- benign and malignant tumors;
- autoimmune disorders.
In children, an increase in eosinophils occurs during scarlet fever. A common case for people different ages Mononucleosis is a change in the number of monocytes with eosinophils. This process occurs in patients during fungal pathologies and viral infections, as well as in sarcoidosis.
Why do eosinophil levels decrease?
The following disorders can reduce the number of eosinophils:
- purulent pathologies;
- inflammatory process in the body;
- pain shock;
- injuries;
- heavy metal poisoning;
- diseases of the thyroid gland or adrenal glands.
A reduced level of eosinophils is observed in patients on the first day of myocardium. The phenomenon is also typical for people with chronic stress.
In patients with severe leukemia, the level of eosinophils decreases to 0.
A sharp decrease in the number of eosinophils may indicate the development of dysentery, typhoid fever or acute appendicitis.
The volume of eosinophils tends to change in patients with Down syndrome and in those people who have disrupted sleep and rest patterns.
If eosinophils are elevated, you should consult a hematologist. How is the treatment carried out?
Elevated eosinophils in adults are treated by a hematologist. He selects an individual course of therapy, focusing on the disease that provoked the increase in eosinophils.
Treatment methods depend on the following factors:
- age;
- patient's gender;
- type of pathology;
- severity of the disease;
- general well-being;
- associated diseases.
In some cases, eliminating eosinophilia does not require the prescription of drugs, but rather the abolition of certain medications taken.
If the patient is detected, treatment is carried out in several stages:
At autoimmune pathologies you cannot do without taking cytostatics.
If the patient has severe allergic reactions, he requires emergency hospitalization and therapy using hormonal drugs or drugs.
If a woman is Rh negative, she should regularly donate blood during pregnancy to check for antibodies. If she came to the doctor for later, then up to 28 weeks she is injected with anti-Rhesus serum. The manipulation is repeated in the first 3 days after birth if it is detected in cord blood baby positive analysis for the Rh factor.
During pregnancy, women are prescribed the following medications:
- painkillers;
- drugs to relieve swelling;
- antiallergic medications.
The course of therapy can have different durations, be regularly adjusted and replaced in case of ineffectiveness. Often in combination with drug treatment pregnant women are prescribed special diet, according to which you should exclude foods that provoke allergies. Sometimes to the expectant mother you need to stop taking certain medications.
What are neutrophils?
Neutrophils are blood cells that are produced in the bone marrow. They protect the body from bacteria, viruses and fungal diseases. If they enter the body harmful substances, then it begins to respond by increasing the level of neutrophils. This process is called neutropenia.
Experts distinguish 2 types of neutrophils:
- stab young;
- segmented mature.
Neutrophils decrease for the following reasons:
- A viral infection that is difficult for the patient to tolerate.
- Radiation exposure.
- of different nature.
- Inflammatory pathology;
- Human presence in hazardous ecological zones.
- Taking certain medications (Penicillin, and others).
Important! With acute neutropenia, which appeared after chemotherapy, the patient is more likely to catch an infection than with chronic course neutropenia.
In most cases, neutropenia is caused by the use of immunosuppressants and cytostatics. Such drugs are used during the course of therapy malignant tumor and autoimmune pathologies.
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Eosinophils and eosinophilia
Eldar Khuseevich Anaev Senior Researcher, Research Institute of Pulmonology, Ministry of Health of the Russian Federation, Moscow
Eosinophils are granular white blood cells found in small quantities in the blood and tissues of healthy people. Normally, the number of eosinophils in the blood is less than 350 cells/μl (up to 6% of all leukocytes). The functions of these cells are still completely unknown.
In clinical practice, there are diseases and conditions in which the content of eosinophils in peripheral blood and tissues increases (eosinophilia). An increase in the number of eosinophils over 1500 cells/μl is classified as hypereosinophilia.
The eosinophil as a separate cellular element was first described by Paul Ehrlich in 1879. It was he who used the acidic dye eosin, named after greek goddess morning dawn, for histological staining of blood and tissues. Ehrlich showed that eosinophils constitute 1 to 3% of leukocytes peripheral blood in healthy individuals.
Over the next 40 years, much information has accumulated about eosinophils: increased numbers of cells have been associated with bronchial asthma (BA) and helminth infestation. Also, the number of eosinophils increased significantly in animal tissues after anaphylactic reaction. This suggested that eosinophils mediate hypersensitivity during anaphylaxis. This hypothesis remained the main explanation for eosinophil function from the turn of the century until the 1980s. In the 1950s, the function of eosinophils was so little known that they were thought to be the precursors of red blood cells.
Morphology of eosinophils
In light optical examination, the diameter of eosinophils is 12–17 μm; they are usually somewhat larger than neutrophils. Unlike mature polymorphonuclear leukocytes (PMNL), whose nuclei have about four lobules, the nuclei of eosinophils, as a rule, consist of two lobules connected by a thread. The main peculiarity of their cytoplasm is the presence of two types of specific granules (large and small), which are red or orange. Even in poorly stained smears they can be distinguished from neutrophil granules, as they are more numerous and distinctly larger. The large granules contain essential proteins that are unique to eosinophils.
These include: large basic protein (LBP), eosinophil cationic protein (ECP), eosinophil peroxidase (EPO), eosinophil neurotoxin (EN), formerly called eosinophil protein X, and BOP homologue. The small granules contain the enzymes arylsulfatase B and acid phosphatase, also found in the azurophilic granules of neutrophils. Lysophospholipase B (Charcot-Leiden crystals) - an enzyme in eosinophil membranes - does not play a role important role in the pathogenesis of diseases and has no diagnostic value.
In activated eosinophils, the number of granules is significantly reduced and the cells often vacuolate, becoming less dense than non-activated eosinophils.
Functions of eosinophils
The functions of eosinophils are not precisely known. They share many of the functions of other circulating phagocytes such as PMNs and monocytes. Although eosinophils are capable of phagocytosis, they kill bacteria within them less efficiently than neutrophils.
Eosinophil kinetics
Eosinophils are nondividing granulocytes that, like other PMNs, are continuously formed in the bone marrow from a single stem cell. Eosinophilopoiesis and differentiation of eosinophils from progenitor cells are regulated by T lymphocytes through the secretion of granulocyte-macrophage colony-stimulating factor (GM-CSF), interleukin-3 (IL-3) and IL-5. In addition, IL-5 and GM!CSF activate eosinophils, inducing a transition of cells from normal to low density (less than 1.085).
The lifespan of eosinophils is 10–12 days. After leaving bone marrow, where they are formed and mature within 3–4 days, eosinophils circulate in the blood for several hours (their half-life is 6–12 hours). Then, like neutrophils, they leave the bloodstream and enter the perivascular tissues, mainly the lungs, gastrointestinal tract and skin, where they remain for 10–14 days. For every peripheral blood eosinophil, there are approximately 200–300 eosinophils in the bone marrow and 100–200 in other tissues.
Eosinophils in normal smear blood comprises from 1 to 5% of leukocytes. In absolute numbers, 120–350 eosinophils per 1 μl (120–350 106/l) of peripheral blood are considered normal. A level from 500 to 1500 eosinophils/μl is considered mild eosinophilia, and over 1500 cells/μl is considered hypereosinophilia: moderate (1500–5000 cells/μl) and severe (more than 5000 cells/μl).
The absolute number of eosinophils in peripheral blood varies in healthy people. Daily fluctuations in the number of eosinophils are in inverse relationship on the level of cortisol in plasma, with the maximum occurring at night and the minimum in the morning.
Causes of eosinophilia
Table 1. Main causes of eosinophilia
Allergic diseases
The most common cause of eosinophilia is allergic diseases, primarily diseases of the respiratory tract and skin. BA is a chronic inflammatory disease characterized by eosinophilia of peripheral blood, bronchial tissue and sputum. The content of eosinophils in the blood of patients with asthma varies and rarely exceeds 500–1000 cells/μl.
A comparison of various forms of BA shows that the number of eosinophils in the atopic form is higher than in the non-atopic form, and even higher in patients with aspirin-induced BA. In asymptomatic patients, especially those receiving basic treatment with glucocorticosteroids (GCS), eosinophil counts are often normal.
In patients with severe exacerbation of asthma, eosinopenia was observed, associated with the migration of eosinophils into the respiratory tract, which is associated with a deterioration in lung function and a parallel increase in serum ECP concentrations. Studies of biopsies taken from the bronchi of asthma patients during or shortly after an attack have also shown significant eosinophilia.
Laboratory signs of the disease: anemia, leukocytosis of more than 100,000 cells/μl, 80–90% of which are eosinophils, hyperglobulinemia and hypoalbuminemia. The prognosis is favorable, recovery occurs spontaneously after 6–18 months. Treatment is carried out with thiabendazole and diethylcarbamazine in the presence of myocarditis. High eosinophilia in peripheral blood, often with pulmonary infiltrates, also occurs in strongyloidiasis, ascariasis, trichinosis, opisthorchiasis and schistosomiasis.
Leukemia
A rare cause of hypereosinophilia (more often in children) can be eosinophilic leukemia. It manifests itself with symptoms of acute myeloid leukemia; characteristic feature– rapid development of heart failure due to damage to the endocardium and heart valves. Treatment includes hydroxyurea and vincristine. If the heart valves are damaged, surgical treatment is indicated. A quarter of patients with lymphogranulomatosis exhibit hypereosinophilia, which may be associated with an increase in IL-5 levels; In most patients, IgE levels are also elevated.
Idiopathic hypereosinophilic syndrome
IHES is a rare condition of unknown etiology, first described in 1968. This syndrome is characterized by three features: peripheral blood hypereosinophilia (more than 1500 cells/μl) persisting for at least 6 months, the absence of other causes of eosinophilia, changes in organs or their functions that are directly related with eosinophilia or find no other explanation. Mostly men over 30 years of age are affected. Eosinophilia in rare cases can reach 50,000 cells/μl.
Characterized by damage to the skin (rash), brain (convulsions), heart (endocardial fibroelastosis) and liver (hepatitis). If left untreated, restrictive heart failure may develop. Treatment with corticosteroids, vincristine, hydroxyurea and interferon can slow the progression of the disease.
Periarteritis nodosa
This disease is characterized by segmental inflammation and necrosis of the middle arteries of the muscular type. Middle-aged men are more likely to get sick. At the onset of the disease, the most common symptoms are fever, abdominal pain, symptoms of mononeuritis multiplex, skin rash, weakness, weight loss, arthralgia and renal failure. Blood tests show leukocytosis up to 20,000–40,000 cells/μl, increased immunoglobulins in the serum, often proteinuria and hematuria. Although leukocytosis is usually neutrophilic, in some patients more than 50% of leukocytes are mature eosinophils. The diagnosis is made only when signs of necrotizing vasculitis are detected in a tissue biopsy from typical areas of damage during acute inflammation. Treatment with corticosteroids and immunosuppressants prevents disease progression and can induce remission.
Exposure to toxins
During the last 20 years, two major epidemics have occurred. In 1981, an outbreak of the so-called toxic oil syndrome was reported in Spain. The source of the epidemic was the consumption of food intended for industrial purposes. rapeseed oil, which was labeled as olive. About 20 thousand people fell ill, the mortality rate was more than 1.5%. On early stage the disease was manifested by fever, cough, skin rash, myalgia and eosinophilia up to 20,000 cells/μl; at a later stage - swelling of the extremities, scleroderma-like skin changes, polyneuropathy, muscle weakness and flexion contractures.
Eosinophilia-myalgia syndrome was first described in 1989 in patients who took large doses of L-tryptophan for a long time as a sedative. In patients, along with generalized myalgia and eosinophilia more than 1000 cells/μl, lung damage was noted, manifested by nonproductive cough, shortness of breath and pain in the chest. X-ray examination revealed bilateral pulmonary infiltrates and sometimes pleural effusion. Treatment with GCS led to rapid relief of clinical manifestations of eosinophilia-myalgia syndrome and normalization of eosinophil levels.
Eosinophilic pulmonary infiltrates
Eosinophilic infiltrates of the lungs, or eosinophilic pneumonia, cover several pathological conditions of different etiologies, which are characterized by eosinophilic infiltration of the lungs and, as a rule, eosinophilia of peripheral blood.
Simple pulmonary eosinophilia was first described by Loeffler in 1932. Its causes are unknown. Volatile pulmonary infiltrates are characteristic, accompanied by low fever, minimal respiratory distress, moderate peripheral blood eosinophilia, and rapid spontaneous resolution.
Chronic eosinophilic pneumonia has features of a systemic disease, with cough, shortness of breath, fever, weight loss, anemia, hepatomegaly, and diffuse lymph node enlargement. Mostly women over 30 years of age are affected.
Characterized by high eosinophilia in peripheral blood, an increase in the number of PMNs, and a slight increase in IgE levels. On radiographs there are one- and two-sided shadows located in the apices of the lungs and along the periphery.
Lung biopsy reveals eosinophilia without associated arteritis. Treatment with GCS gives good results, although after their cancellation, infiltrates may appear again.
Allergic bronchopulmonary aspergillosis (ABPA) is one of the common causes of eosinophilic pneumonia in patients with asthma. To clarify the diagnosis, it is necessary to perform a skin prick test with Aspergillus fumigatus. The number of eosinophils in the blood is usually above 1000 cells/μl; Simultaneously with the appearance of transient infiltrates detected by chest X-ray, eosinophilia becomes more than 2000 cells/μl. Level of total IgE and specific IgE to A. fumigatus can be very high. Also, ABPA is characterized by peculiar bronchiectasis of the central type. Treatment is carried out with GCS and other anti-asthmatic drugs. Treatment success and favorable prognosis are assessed by a continuous fall in serum IgE levels. Lung infections by other fungi ( Candida albicans, Curvularia lunata, Dreschlera hawaiiensis) are rarely combined with eosinophilic pulmonary infiltrates.
Tropical pulmonary eosinophilia is caused by microfilariae, which are not usually found in the blood. Persistent eosinophilia is observed, which can reach 50,000 cells/μl, with a simultaneous rise in IgE levels and a high titer of antifilarial antibodies.
Allergic granulomatosis, or Churg–Strauss syndrome, was described in 1951 and includes severe asthma with hypereosinophilia, eosinophilic infiltrates, necrotizing eosinophilic vasculitis and granulomas in various organs.
Men and women get sick with the same frequency. AD often precedes vasculitis. The number of eosinophils in the peripheral blood is increased from 1500 to 30,000 cells/μl (more than 10%), and the level of serum IgE is often increased. Treatment is carried out high doses GCS (30–80 mg/day), in case of resistance to which azathioprine is indicated.
Drug-induced eosinophilia
Taking a large number of drugs can lead to the development of moderate eosinophilia. An eosinophilic drug reaction can be asymptomatic and be the only manifestation of hypersensitivity to the drug or be combined with a variety of syndromes: interstitial nephritis, fever, skin rash, lymphadenopathy, hepatosplenomegaly, arthritis, Stevens-Johnson syndrome. The main groups of drugs, the use of which can lead to eosinophilia, are given in Table. 2.
Table 2. Drugs that cause eosinophilia
It is most often caused by antibiotics, antimicrobial agents, cytostatics, NSAIDs and psychotropic drugs. 7–10 days after stopping the drug, the number of eosinophils returns to normal. So, the clinical, diagnostic, treatment and prognostic signs of various pulmonary eosinophilias vary significantly. Further research is needed to fully understand these disorders.
