Case 41 – update 1

Thanks for your great suggestions so far on #TeamHaem. The case started here and this is the first update.

Our patient has had a routine full blood count done as part of a ‘health check’. It should a mild eosinophilia (eosinophils 1.5×109/L (0-0.5)) with the rest of the count being rather unremarkable. He has been called back to see his GP to talk about the findings. Following advice from #TeamHaem we have found out the following information:

  • He is on carbamezapine for a history of partial seizures. He has been on this drug for over 15 years. His last seizure was four years ago.
  • He is on ramipril for hypertension for the past three years.
  • He has a blue inhaler for ‘asthma’ but hasn’t used it for a few years. He gets chest infections in the winter due to a long-term smoking history and the inhaler helps here.
  • Currently he feels well in himself, with no specific symptoms. Certainly no weight loss, rashes or fevers to think of the DRESS syndrome (this would be unusual after 15 years on a drug) – for a review on DRESS see here (sorry – TeamHaem aren’t the experts on this one! )
  • The last travel he went on was a package holiday to the Greek islands and hasn’t been anywhere too ‘exotic’.
  • We reviewed old blood tests and he has never had eosinophilia before – which most likely rules out the medications.
  • He does get seasonal hay fever and has had ‘the sniffles’ recently.

Due to the lack of specific symptoms we decide to take a conservative approach, although doe send a stool for culture, ova cysts and parasites (which was negative), with the most likely culprit a bout of allergic rhinitis/hayfever.

Questions:

  • When would you next do his blood tests?
  • What may you look for in the blood film of someone with eosinophilia – what important positive and negative findings are useful?
  • What serious disorders can cause esoinophilia which would be good to think about in primary care?

Please reply to us (@TeamHaem) on Twitter and always include #TeamHaem to allow others to follow your comments. Please join in the debate and learn about haematological problems along the way. The case will continue to  evolve over the coming week so keep checking #TeamHaem on Twitter for more information.

Please note – all cases on TeamHaem are entirely fictional to protect patient confidentiality.

TeamHaem are not a position of authority.  It is an educational platform to allow discussion and learning.

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Online education and discussion about all things haematological
This entry was posted in Laboratory morphology, Myeloproliferative neoplasm, Related to other specialities and tagged , , . Bookmark the permalink.

One Response to Case 41 – update 1

  1. This is very interesting! Why does the test need to be repeated at all? I wouldn’t have sent the stool samples either. To me, a GP, a conservative approach is to do nothing and wait and see- after all this was an incidental finding and the patient has a history of atopy. So I would not send stool samples or repeat blood tests. Is this suggested management from GPs or haematologists? And do we have any evidence-based guidelines on what to do in this scenario?

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