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Our patient has mild eosinophilia (eosinophils 1.5×109/L (0-0.5)) with the rest of the count being rather unremarkable and no other systemic features. He has had some hay fever which may be responsible. He is advised to make an appointment for three months time for a repeat full blood count.
The most common causes of eosinophilia are reactive – allergy/atopy, parasites, medications, autoimmune conditions and also malignancy. It is important to undertake a history into any systemic features in order to avoid missing something potentially serious. Although serious conditions are likely to be rare compared to common causes of eosinophilia it is still important to ask some general ‘red flag’ symptoms and perform a baseline chest and abdominal examination.
Unfortunately our patient fails to attend follow up appointments with his GP at three months. However eight months later makes an appointment as he has been feeling generally unwell and short of breath.
A full blood count shows:
- WCC 19.6×109/L (4-11)
- Neuts 7.2×109/L (1.7-7)
- Lymphocytes 2.2×109/L (1.5-4.5)
- Monocytes 0.9×109/L (0.2-1)
- Eosinophils 9.2×109/L (0-0.5)
- Basophils 0.1×109/L (0-0.1)
- Hb 125g/L (130-180)
- MCV 89fL (82-98)
- Platelets 411×109/L (150-450)
Here are some pictures from the film
- What does the blood film show? Does it help?
- What are you worried about? – any differential diagnoses possible at this point?
- How would you investigate the patient now?
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