What is eosinophilic blood disease

Eosinophilic hematopathy is a relatively rare blood disease. Its main feature is the abnormal increase of eosinophils in peripheral blood and bone marrow. This disease is very harmful to the heart, lungs and nervous system. It often causes progressive anemia and thrombocytopenia. There are many causes of the disease, including clonal chromosomal abnormalities and possible acute lymphoblastic leukemia.

Causes

In a small number of patients, the disease may be transformed from idiopathic hypereosinophilic syndrome, or it may be a late manifestation of acute lymphocytic leukemia or chronic myeloid leukemia in very rare cases.

The pathogenesis has not been elucidated, but there are reports that the patient's hematopoietic cells overexpress the Wilms tumor gene, resulting in inhibition of cell apoptosis. Patients may have clonal chromosomal abnormalities but no marker chromosomes.

Disease screening

1. Blood picture

Anemia and thrombocytopenia are common. The white blood cell count is significantly increased, which can reach (50-200)×109/L. Eosinophils account for 20% to 90% of the blood smear, and most are above 60%. Among them, the increase in eosinophilic granulocytes and metagranulocytes is the main one. Original grains and early small grains are rare.

⒉ Bone marrow

In addition to the increased proportion of granulocytes, the number of eosinophils increased significantly and shifted to the left. According to cell morphology, it can be divided into three types: ① Myeloblastic type: There is an increase in myeloblasts in both blood and bone marrow. ②Immature cell type: In addition to the significant increase in immature eosinophils in the bone marrow, this type of cells can also be seen in the peripheral blood. ③Mature cell type: mainly characterized by an increase in mature eosinophils, including an increase in eosinophilic and metamyelocytes, and normal or slightly increased myeloblasts.

⒊Chromosome examination

There are often trisomy of chromosomes 8 and 10, chromosomal abnormalities such as 4q and 45X, 49XY, etc.

4. Cell culture

The growth results of peripheral blood cell CFU-GM are similar to those of chronic myeloid leukemia. Its growth pattern combined with chromosome examination can be used to distinguish eosinophilic leukemia from eosinophilia due to other reasons.

⒌ Based on the clinical manifestations, symptoms, and signs, select chest X-ray, CT, B-ultrasound, electrocardiogram and other examinations.

Clinical diagnosis

The length and speed of the course of eosinophilic leukemia are related to the degree of maturity of eosinophils, so it is generally divided into two types clinically.

1. Acute

The difference between this disease and general leukemia is that there is less infection and bleeding. It is mainly caused by eosinophil infiltration of various organs, leading to functional disorders. In addition to the involvement of the liver, spleen, and lymph nodes, the heart, lungs, and central nervous system are also affected. Clinically, it often manifests as progressive heart failure, with gallop rhythm, pericardial friction sound, cough, and difficulty breathing. If there is infiltration of the central nervous system, it will manifest as mental disorders, delusions, blurred vision, ataxia, hemiplegia, etc. In addition, erythema, papules, nodules, etc. may appear on the skin.

⒉ Chronic type

The disease progresses slowly and can last from 2 to 8 years. There are fatigue, anemia, enlarged liver, spleen and lymph nodes.

Diagnostic analysis: EL is rare and the diagnosis must be made with great caution, and other causes of eosinophilia must be fully excluded. Hematological examination should show morphological abnormalities in addition to eosinophilia. The presence of immature eosinophils in the blood and >5% of primitive cells in the bone marrow are also necessary conditions. In case of suspected cases with insufficient conditions, we should continue to search for the primary disease and carefully observe changes in the condition.