Eosinophilia

張貼日期：2017/11/23 下午 01:54:00

常見原因：NAACP; (Neoplasm, Addison disease, Allergy, Collagen vascular disease, Parasite)

Terminology

• Severity of eosinophilia: determined by absolute eosinophil count: mild(>500 /uL), moderate(500-1500/uL), severe(1500-5000/uL)

• Reactive eosinophilia: eosinophil上升, tissue damage(-), clonality(-) 通常是secondary etiology引起

• Idiopathic hypereosinophilia: (1) eosinophil > 1500 for 6 months; (2)reactive eosinophilia excluded; (3) AML, MPN, MDS, MDS/MPN, systemic mastocytosis excluded; (4)cytokine-producing immunophenotypically aberrant T-cell population excluded; (5)tissue damage(-)

• Idiopathic hypereosinophilic syndrome(HES): 同idiopathic hypereosinophilia 但 (5) tissue damage(+). 且clonality(-)

• Chronic eosinophilic leukemia, NOS: (1)eosinophil > 1500; (2)CML, PV, ET, PMF, CEL, CMMoL, atypical CML excluded; (3)No PDGFRA, PDGFRB, FGFR1, PCM1-JAK2, ETV6-JAK2 or BCR-JAK2; (4)Blast < 20%, no t(16;16) or t(8;21): AML related cytogenetics; (5)with evidence of clonality or increased blasts(PB>= 2% or BM >= 5%)

Approach(etiologies)

Primary hypereosinophilic syndrome(HES): eosinophilic expansion due to stem cell, myeloid or eosinophilic neoplasm. (ex:MPN with PDGFR-alpha/beta, FGFR1, JAK-2/V617, CALR)

Secondary hypereosinophilic syndrome

Allergy: Chinese herb, medications, occupational exposure, food, travel

Infection: parasite, fungus, virus(HIV/HTLV-I/II)

Systemic disease: rheumatology(p-ANCA/c-ANCA), hypoadrenalism, others(GI, Neurology, Renal, Cardiac)

Hematology disease

Primary hypereosinophilic syndrome(HES): MPN with PDGFR-alpha/beta, FGFR1, JAK-2/V617, CALR

Acute eosinophilic leukemia

CML(BCR-ABL1)

Systemic mastocytosis

Other lymphoid disease or solid tumor

Diagnostic test

• • 詳細的過敏接觸史：Chinese herb, medications, occupational exposure, food, travel

  • CBC/DC, Creatinine, Vitamin B12, 8AM cortisol/ACTH, lymphocyte flow cytometry, tryptase(for mastocytosis, 須送彰基驗)

  • Stool Ova

  • Organ involvement survey: Troponin-T, Bil-T/-D, AST/ALT, Urine analysis, PFT

  • Optional檢驗

    • Sinusitis, asthma, vasculitis: 驗ANA, p-ANCA, c-ANCA

    • MPN可能:

      • Inv(16) (用骨髓染色體檢驗)

      • Mutation: JAK2V617F, CALR, MPL (可以用周邊血驗)

      • Rearrangement of : PDGFR-alpha, PDGFR-beta, FGFR1 (可以用周邊血驗)

      • Fusion gene: PCM1-JAK2, Bcr-ABL1

    • 性病可能: HIV, HTLV-I/II

    • 淋巴瘤可能：CT scan

    • 誤食毒物：藥物濃度