Eosinophil granulocytes are cellular components of the blood. They are a subset of leukocytes (white blood cells) that have eosinophilic vesicles in their cytoplasm (total living contents of a cell). They are considered part of the nonspecific cellular immune system. Eosinophil granulocytes are determined as part of the differentiation of leukocytes (see “Differential Blood Count” below).
The procedure
Material needed
- 4 ml EDTA blood (mix well! ); for children, at least 0.25 ml.
Preparation of the patient
- Not necessary
Disruptive factors
- None known
Indications
- Allergies
- Autoimmune diseases
- Dermatoses (skin diseases)
- Infections (esp. parasitic diseases)
- Malignant (malignant) neoplasms
Normal values
| Age | Absolute values | Percentage(of total leukocyte count) |
| Infants | 90-1,050/μl | 1-7 % |
| Children | 80-600/μl | 1-5 % |
| Adults* | <500/µl | < 5 % |
Interpretation
Interpretation of elevated values (eosinophilia).
- Allergies
- Bronchial asthma (allergic asthma) [see “Further notes” below].
- Autoimmune diseases
- Dermatomyositis
- Eosinophilic granulomatosis with polyangiitis (EGPA).
- Panarteritis nodosa
- Chronic obstructive pulmonary disease (COPD) (20-30%; correlated with increased risk of exacerbations and death).
- Dermatoses (skin diseases)
- Dermatitis herpetiformis
- Erythema exsudativum multiforme
- Pemphigus vulgaris
- Psoriasis (psoriasis)
- Infections
- Infectious diseases
- Bacteria:
- Tuberculosis (Mycobacterium tuberculosis).
- Mycoses:
- Disseminated coccidioidomycosis (causative agent: Coccidioides immitis).
- Histoplasmosis (pathogen: Histoplasma capsulatum) (endemic to the Mississippi and Ohio river valleys of the USA).
- Cryptococcosis (causative agent: Cryptococcus neoformans and C. gattii).
- Mucor spp.
- Molds → pulmonary (and peripheral) eosinophilia.
- Allergic (allergic bronchopulmonary aspergillosis, ABPA).
- Hypersensitivity reactions (hypersensitivity pneumonitis).
- Bacteria:
- Parasitic diseases such as.
- Acute Fasciola hepatica infection.
- Schistosomiasis * (Schistosomiasis; causative agent: larvae of sucking worms of the genus Pärchenegel (Schistosoma)).
- Echinococcosis (causative agent: Echinococcus multilocularis (fox tapeworm) and Echinococcus granulosus (dog tapeworm)).
- Filariasis (infection with parasitic nematodes).
- Hookworm infections* caused by Necator americanus and Ancylostoma duodenale (tropics and subtropics).
- Helminthoses (worm infections)
- Katayama fever (= immune response to acute schistosomiasis infection; typically occurs two to ten weeks after exposure).
- Larva migrans visceralis syndrome (toxocariasis; causative agent: canine roundworm Toxocara canis or feline roundworm Toxocara mystax).
- Löffler syndrome (pulmonary symptoms, volatile infiltrates and eosinophilia in peripheral blood; e.g., due toAncylostomatidae (hookworms)).
- Muscular sarcozystosis
- Pulmonary sparganosis* (causative agent: cestodes of the species Spirometra and Sparganum mansoni-caused) (Southeast Asia).
- Strongyloidiasis * (Pathogen: Strongyloides stercoralis/dwarf nematode).
- Trichinellosis (Pathogen: Trichinella).
- Cysticercosis (infestation of humans with larvae of the pork tapeworm (Taenia solium); larvae are also called cysticerci).
- Infectious diseases
- Post-infectious convalescence/recovery period after infection (“the dawn of recovery”).
- Malignant (malignant) neoplasms.
- Carcinomas, mostly advanced (bronchial, hepatic, mammary, ovarian, pancreatic, thyroid, and cervical).
- Hematologic neoplasms with “concomitant” eosinophilia (CML, CMML, MDS, T-cell/Hodgkin’s lymphoma (approximately one-third of cases), plasmacytoma/multiple myeloma, etc.).
- Addison’s disease – primary adrenocortical insufficiency (NNR insufficiency; adrenocortical insufficiency).
- Medications
- Acetylsalicylic acid (ASA)
- Antibiotics (cefoxitin, penicillin).
- Ajmaline
- Dapsone
- Glucocorticoids – e.g., inhaled steroids (ICS): COPD patients with higher eosinophil counts benefit more from ICS than those with low counts
* Frequent diagnoses in long-distance travel.
Further notes
- The number of eosinophils is inversely proportional to the level of cortisol in the body, thus the lowest number occurs in the morning and the highest at night.
- In the presence of eosinophilia with the threshold value from 500/μl, medical clarification is recommended. In healthy people is usually the eosinophil count < 450 eosinophils/µl.
- According to the S2k guideline: diagnosis and therapy of patients with asthma, “detection of more than 300 eosinophils/μl of blood at least twice should be aimed for to verify the presence of eosinophilic asthma.” Note: Thresholds for eosinophilia differ by antibody-based therapy, depending on criteria in pivotal trials (mepolizumab ≥ 150, benralizumab ≥ 300, reslizumab ≥ 400 eosinophils/μl blood).
- Note: Oral cortisol therapy, as well as high doses of inhaled corticosteroids (ICS), may result in undetectable eosinophilia in blood and tissue.
Classification of eosinophilia
| Designation | Definition (absolute values) | Associated diseases of the lung |
| Eosinophilia | > 500/µl (> 0.5 × 109 cells/l; usually > 5 % of all leukocytes) | |
| Mild eosinophilia (hypereosinophilia). | > 500-1,500/µl (> 0.5-1.5 × 109 cells/l) |
|
| Moderate eosinophilia | > 1,500-5,000/µl (> 1.5-5.0 × 109 cells/l) | |
| Severe eosinophilia | > 5,000/µl (> 5.0 × 109 cells/l) |
|
* Regular occurrence with high-grade eosinophilia* * Occasional occurrence with mild-to-moderate eosinophilia.
