Collectively, these enzymes are responsible for the eosinophil's tissue effects. Other granule contents include eosinophil cationic proteins, activators of Hageman factor and plasmin, and eosinophil-derived neurotoxin, an inflammatory mediator of central and peripheral neural tissue damage. The surrounding matrix contains eosinophil peroxidase, an enzyme similar in function to myeloperoxidase within neutrophil primary granules. The core consists of major basic protein, a cytotoxic protein. Its crystalloid core is surrounded by a matrix housing the enzymes and cytokines responsible for the cell's actions. Unlike neutrophils, which have both primary and secondary (specific) granules, eosinophils have a single granule. The eosinophil has a bilobed nucleus with cytoplasm containing specific granules that stain strongly with acid dyes (see Figure 1). Defining the eosinophil's physiologic role has opened the door to understanding its presence in certain diseases. The other member of the differentialĪlthough its presence alone is rarely diagnostic, eosinophilia may serve as a harbinger of disease. See the box at the end of the article for the correct categories and likely diagnoses. His hemoglobin is 11.2 g/dL and his platelets are 585,000/µL.
His total white blood cell count is 5,500 cells/µL with 42% neutrophils, 35% lymphocytes, 3% monocytes, and 20% eosinophils. His current physical exam reveals left supraclavicular fullness and a hard 3 x 3 cm left axillary lymph node. Since a physical examination before camp six months ago, he has lost seven pounds. Recently, he has had night sweats heavy enough to completely saturate his bedding.
#EOS AUTO LAB TEST SKIN#
Her physical exam reveals a moderately uncomfortable female with pedal and perianal pruritic skin lesions.Ĭase 3: An 8-year-old male presents with intermittent fevers that began a month ago. However, she had to wade through floodwaters on several occasions. She states that she only drank bottled water and ate thoroughly cooked food. She has recently returned from a trip to North Carolina with her youth group to help flood victims of a recent hurricane. His hemoglobin is 9.8 g/dL and his platelet count is 47,000/µL.Ĭase 2: An adolescent female presents with abdominal cramping and diarrhea. His total white blood cell count is 4,500 cells/µL with 75% neutrophils, 5% lymphocytes, and 20% eosinophils. A physical examination reveals height and weight below the fifth percentile, clear nasal discharge, and scattered petechiae on his head and chest. Do you think the underlying process is neoplastic, infectious, or immunologic?Ĭase 1: A 6-month-old boy presents with severe eczema, nosebleeds, and a moist cough.
Each patient in the following clinical scenarios has a white blood cell differential with 20% eosinophils. Try your hand at unraveling the eosinophil's mystery, which lies in its unique structure and association with a variety of clinical diseases. Little wonder a finding of eosinophilia often leaves pediatricians scratching their heads. The eosinophil can either enhance or suppress immune function, and it's associated with a wide variety of diseases. The other member of the differential Too much of a good thing?īy Jeffery J.