Haematology

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Haematology Full Blood Count Case Study B
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Case History

• Ms FBC, 50 years old female
• History
• Diabetes mellitus
• HIV
• Chronic renal failure
• Haemodialysis 3x weekly
• Zidovudine (AZT) for a few years

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What Are Eosinophils?

• Granular leukocytes
• Produced in bone marrow
• Associated with allergic (eg asthma, hayfever,
  drug sensitivity) and parasitic conditions and
  some malignant diseases.

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What Are Eosinophils?

• Phagocytic BUT less effective than neutrophils
• Production promoted by a variety of
  T-lymphocytes, especially interleukin-5
• Major function cytotoxic cell, esp. against
  parasitic infection

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What Is Eosinophilia?

• Condition where abnormally high levels of
  eosinophils are found in blood or body tissues
• Mild eosinophilia defined as 0.7 to 1.5 x 109
  cells/L
• Moderate as 1.5 to 5 x 109 cells/L
• Severe as 5 x 109 cells/L

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When Does Mild Eosinophilia Occur?

• Wide range of conditions
• Parasitic infections (helminths)
• Allergic reactions (hay fever, allergic rhinitis)
• Asthma
• Drug reaction
• Neoplasm (eg. acute lymphocytic leukaemia)
• GI disease (eg. Crohns)
• Skin disease (eg. psoriasis)
• Long-term dialysis
• Immunodeficiency state (eg. HIV/AIDS)

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Most likely causes of mild eosinophilia in Ms FBC

• Drug reaction from AZT
• Haemodialysis
• HIV infection

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Drug-induced Eosinophilia

• Antiretroviral therapies are associated with
  serious adverse events
• Lor Liu (1993) reported a case of a patient
  taking AZT ? AZT-associated eosinophilia with
  acute thrombocytopenia
• Khudtson et. al. (2003) reported a drug rash with
  eosinophilia renal toxicity with a nevirapine
  containing regimen in a female with HIV.

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Eosinophilia With Haemodialysis

• Reactions to haemodialysis occur at a rate of 3.5
  of every 100,000 dialysers sold
• Allergic symptoms occur immediately after
  initiation of dialysis
• Thought to be due to inadequate rinsing of the
  dialysers

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Eosinophilia In HIV

• Cohen Steigbigel (1996) discovered a trend
  toward an absolute increase in eosinophils in HIV
  patients with advancing disease state ? greater
  ? eosinophilia
• ? eosinophilia as patients CD4 cell counts
  declined to 200 cells/mL or less, a point which
  the number of polymorphonuclear leukocytes
  lymphocytes are declining