Elevated Eosinophil and Basophil Counts

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In accordance with their physiological role, an increase in eosinophils (> 400/^1, i.e. for a leukocyte count of 6000, more than 8% in the differential blood analysis) is usually due to parasitic attack (p. 5). In the Western hemisphere, parasitic infestations are investigated on the basis of stool samples and serology.

Strongyloides stercoralis in particular causes strong, sometimes extreme, elevation of eosinophils (may be up to 50%). However, eosinophilia of variable degree is also seen in ameba infection, in lambliasis (giardiasis), schistosomiasis, filariasis, and even malaria.

Bacterial and viral infections are both unlikely ever to lead to eosinophilia except in a few patients with scarlet fever, mononucleosis, or infectious lymphocytosis. The second most common group of causes of eosinophilia are allergic conditions: these include asthma, hay fever, and various dermatoses (urticaria, psoriasis). This second group also includes drug-induced hypersensitivity with its almost infinitely multifarious triggers, among which various antibiotics, gold preparations, hydantoin derivatives, phenothiazines, and dextrans appear to be the most prevalent. Eosinophilia is also seen in autoimmune diseases, especially in scleroderma and panarteritis. All neoplasias can lead to "paraneoplastic" eosinophilia, and in Hodgkin's disease it appears to play a special role in the pathology, although it is nevertheless not always present.

A specific hypereosinophilia syndrome with extreme values (usually > 40%) is seen clinically in association with various combinations of splenomegaly, heart defects, and pulmonary infiltration (Loeffler syndrome), and is classified somewhere between autoimmune diseases and myeloproliferative syndromes. Of the leukemias, CML usually manifests moderate eosinophilia in addition to its other typical criteria (see p. 114). When moderate eosinophilia dominates the hematological picture, the term chronic eosinophilic leukemia is used. Acute, absolute predominance of eosinophil blasts with concomitant decrease in neutrophils, erythro-cytes, and thrombocytes suggests the possibility of the very rare acute eosinophilic leukemia.

Elevated Basophil Counts. Elevation of segmented basophils to more than 2-3% or 150/^1 is rare and, in accordance with their physiological role in the immune system regulation, is seen inconsistently in allergic reactions to food, drugs, or parasites (especially filariae and schistosomes), i.e., usually in conditions in which eosinophilia is also seen. Infectious diseases that may show basophilia are tuberculosis and chickenpox; metabolic diseases where basophilia may occur are myxedema and hyperlipidemia. Au-tonomic proliferations of basophils are part of the myeloproliferative a b c

Reactive Bronchial Cells

Fig. 43 Eosinophilia and basophilia. a Screening view of blood cells in reactive eosinophilia: eosinophilic granulocytes (1), segmented neutrophilic granulocyte (2), and monocyte (3) (reaction to bronchial carcinoma). b and cThe image shows an eosinophilic granulocyte (1) and a basophilic granulocyte (2) (clinical osteomyelosclerosis). d Bone marrow in systemic mastocytosis: tissue mast cell (3), which, in contrast to a basophilic granulocyte, has an unlobed nucleus, and the cytoplasm is wide with a tail-like extension. Tissue mast cells contain intensely basophilic granules. 125

Fig. 43 Eosinophilia and basophilia. a Screening view of blood cells in reactive eosinophilia: eosinophilic granulocytes (1), segmented neutrophilic granulocyte (2), and monocyte (3) (reaction to bronchial carcinoma). b and cThe image shows an eosinophilic granulocyte (1) and a basophilic granulocyte (2) (clinical osteomyelosclerosis). d Bone marrow in systemic mastocytosis: tissue mast cell (3), which, in contrast to a basophilic granulocyte, has an unlobed nucleus, and the cytoplasm is wide with a tail-like extension. Tissue mast cells contain intensely basophilic granules. 125

a b d c pathologies and can develop to the extent of being termed "chronic basophilic leukemia." In the very rare acute basophilic leukemia, the cells in the basophilic granulocyte lineage mature in the bone marrow only to the stage of promyelocytes, giving a picture similar to type M3 AML (p. 98).

Being an expression of idiopathic disturbance of bone marrow function, elevated basophil counts are a relatively constant phenomenon in myeloproliferative syndromes (in addition to the specific signs of these diseases), especially in CML. Acute basophilic leukemia is extremely rare; in this condition, some of the dedifferentiated blasts contain more or less ba-sophilic granules.

The tissue-bound analogs of the segmented basophils, the tissue mast cells, can show benign or malignant cell proliferation, including the (extremely rare) acute mast cell leukemia (Table 21).

Table 21 Different forms of benign and malignant proliferation of tissue mast cells

Clinical picture

Clinical diagnosis

Evidence

In childhood, solitary or multiple skin nodules, some brownish

Localized mastocytosis

Histology

1 Sometimes transition

Diffuse brownish papules, with urticaria on irritation

Hyperpigmented spots, papules and/or dermo-graphism; histamine symptoms: flushing, headache, pruritus, abdominal spasms, shock

Malignant transformation, possibly with osteolysis, enlarged lymph nodes, splenomegaly, hepatomegaly

Migration of leukemic cells to peripheral blood

Urticaria pigmentosa

Typical clinical picture

Systemic mastocytosis

Histology

Malignant mastocyto-sis*

Histology

Acute mast cell leukemia

CBC (bone marrow)

* May occur de novo without preceding stages and without skin involvement.

* May occur de novo without preceding stages and without skin involvement.

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  • mimosa
    Is absolute basophilia seen in cml?
    7 years ago
  • Almaz Negassi
    Are eosinophils and basophils allergic response?
    7 years ago
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    7 years ago
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    7 years ago
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    6 years ago
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    6 years ago
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    6 years ago
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    6 years ago
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    5 years ago
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    5 years ago
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    Can an illness be differentiated with elevated neutrophils, basophils, or eosinophils?
    1 month ago
  • rasmus
    When eosinophils and basophils are high it means what?
    1 month ago
  • OFELIA
    Are blood eosinophils elevated in urticaria?
    25 days ago
  • medhanie
    What does an increase in Eosinophil and Basophils mean?
    25 days ago
  • antonio
    Are basophiles increased in burns?
    24 days ago
  • Semhar
    What virus causes basophils to increase?
    19 days ago
  • jaakko alatalo
    What means the basophuils high and neutrophil highs?
    11 days ago
  • ADELINDA
    Can mononucleosis cause an elevated basophil count?
    9 days ago
  • osvaldo
    What does increasing baso levels mean?
    4 days ago
  • patrizia
    What does the presence of basophils and immature granulocytes indicate?
    2 days ago

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