Case 41 – update 2

For the start of the case and the first update scroll below (and also look at #teamhaem on Twitter for any relevant comments)…

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

Eosinophil2

Eosinophil4

Eosinophil5

Questions:

  • 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?

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.

About TeamHaem

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.

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