Eosinophils represent one of the groups of leukocytes (white blood cells). Their production is activated when a foreign protein structure enters the body. The number of cells is determined during the usual general blood test, and not only the absolute value (the number of pieces in a unit of blood) matters, but also the ratio to the total number of leukocytes (it is expressed as a percentage). When our immunity is involved in intensive work and independently tries to defeat the disease, eosinophils are increased in the blood test. However, you should know that not every increase or decrease in the level of these blood cells indicates a pathological process. However, everything in order.
Degrees of eosinophilia in adults and children
The condition when eosinophils in the blood are elevated is called eosinophilia.
Normally, in an adult (regardless of gender), cells are present in an amount from 100–120 to 300–350 in one milliliter of the test blood, as a percentage of all leukocytes it is 1–5%. In children of different ages, the ratio to leukocytes varies from 1 to 6-7%.
The deviation of the blood cell level of the considered group from 10% from normal is considered significant, in which case a mild degree of eosinophilia is diagnosed; with the growth of eosinophils up to 15%, a moderate degree is determined;
exceeding the threshold above 15% indicates a severe pathology.
However, it is necessary to take into account physiological fluctuations in the number of cells and other factors affecting the indicator.
Non-pathological increases
- At night, eosinophilia can reach levels above 30%, especially in the beginning;
- An increase in the indicator is observed in the evening;
- The analysis reveals variations in the number of cells in women during the menstrual cycle: in the initial stages, their number increases, after ovulation it gradually decreases;
- Treatment with certain drugs can affect the indicator: aspirin, diphenhydramine, medicines for tuberculosis, penicillins, sulfonamide and gold preparations, complexes with vitamin B, imipramine, misclairon, papaverine, aminophylline, beta-blockers, chymotrypsin, chlorpropamide, hormonal other medications;
- Food regime: sweets, alcoholic beverages increase the likelihood that the analysis will be incorrect.
For the first time, elevated eosinophils detected in a blood test require a re-examination and study of changes in their number over time (several sequentially conducted analyzes).
Causes of pathology
If eosinophils are elevated, it is necessary to identify the cause, since pathology is a symptom of a disease, and not a separate disease. An increase in the number of these blood cells indicates an intensive work of the immune system, and does not always require treatment.
There are several prerequisites for the development of eosinophilia:
A blood test reveals eosinophilia when a person is infected with helminthiases. The following diseases may be the cause:
- Toxocariasis;
- Opisthorchiasis;
- Giardiasis;
- Ascariasis;
- Filariasis;
- Strongyloidosis;
- Malaria;
- Paragonimiasis;
- Echinococcosis;
- Trichinosis;
- Amoebiasis.
Allergy
An allergic reaction takes the leading place among the reasons for the increase in eosinophils. The condition develops when:
- Hay fever;
- Quincke's edema;
- Bronchial asthma;
- Allergic reaction to medications;
- Hay fever;
- Serum sickness;
- Rhinitis of an allergic nature;
- Hives;
- Fasciitis;
- Myositis, etc.
Internal diseases
Eosinophilia manifests itself in diseases of the following organs:
| Lungs | Digestive tract | A heart | Liver |
|---|---|---|---|
| alveolitis | gastritis | myocardial infarction | cirrhosis |
| pleurisy | colitis | congenital defects | |
| leffler's disease | ulcer | ||
| sarcoidosis | gastroenteritis | ||
| histiocytosis | |||
| aspergillosis | |||
| pneumonia | |||
| presence of infiltrates | |||
Blood diseases
An increase in eosinophils is observed with erythremia, myeloid leukemia, lymphogranulomatosis, polycythemia, pernicious anemia, Sesari's syndrome.
Dermatological pathologies
Almost any skin disease leads to increased eosinophils:
- Lichen;
- Pemphigus vulgaris;
- Contact or atopic dermatitis;
- Pemphigus;
- Eczema;
- Fungal disease.
Autoimmune conditions
Often, a blood test reveals an increase in eosinophils in scleroderma, SLE (systemic lupus erythematosus), and a large number of these cells are formed when the transplant is rejected.
Infections
The ingestion of infection always causes eosinophilia. The condition can be provoked by both the acute phase and the exacerbation of chronic diseases:
- Scarlet fever;
- Tuberculosis;
- Gonorrhea;
- Mononucleosis;
- Syphilis, etc.
Malignant tumors
Various forms of malignant tumors, including lymphomas and lymphogranulomatosis, cause an increase in eosinophil cells in the blood. Tumors can be localized in various organs: genitals or internal organs, thyroid gland, skin, stomach, etc., the condition worsens when metastases appear.
Features of eosinophilia in children
Diagnosis of the disease
To get a complete picture of the state of human health, it is first of all necessary to pass a biochemical blood test, such a study may indicate the reason why eosinophils are elevated. Further, according to the results, it is necessary to conduct a number of studies:
Eosinophilia treatment
You should also not be upset if eosinophils are moderately elevated, this may indicate the beginning of recovery and the formation of a healthy response of the immune system to the infection. Leave the doctor to do his job and strictly follow his recommendations.
Eosinophils are one of the groups of white blood cells (white blood cells). They belong to the neutrophilic series, but differ from neutrophils in some peculiarities. They are slightly larger. Their nuclei contain the smallest number of parts (usually 2-3).
Under a microscope in the cytoplasm of these cells, a corresponding abundant orange-pink granularity is visible. It consists of a huge number of homogeneous granules. When a blood test is done, eosinophils are counted in a smear under a microscope or determined on a hematology analyzer.
This is due to the fact that eosinophils are cells that instantly respond to the above problems, and together with basophils, they can be attributed to direct markers for hypersensitivity reactions in the body
The role of eosinophils in the body
The functions of eosinophils are varied, some of them very similar to those of other white blood cells. They are involved in numerous inflammatory processes, especially those associated with allergic reactions. In addition, eosinophils have specific physiological roles in organ formation (eg, breast development after childbirth).
Eosinophils in the blood can have not only a positive effect, but also a negative one. They prevent potentially dangerous microorganisms from entering the human body, but there are times when they are associated with pathological changes. Leffler's disease is a prime example.
Norm
In adults, the norm of eosinophils in the blood is 0.4x109 / l, the norm in children is slightly higher (up to 0.7x109 / l). However, relative to the content of other immune cells, the normal number of eosinophils in adults and children ranges from 1–5%.
Elevated eosinophils in blood and other body fluids can be caused by many factors.
The reasons for the increase in eosinophils in the blood
Why are eosinophils elevated in an adult, what does this mean? Eosinophils above normal cause a special state of the body called eosinophilia. There are various degrees of this ailment:
- Light - cell count reaches 10%
- Medium - 10 to 15% eosinophils
- Severe form - more than 15 percent. This degree of the disease can be expressed by oxygen starvation at the cellular or tissue level.
In medical practice, there is the most common and easy to remember abbreviation, which helps to quite easily remember the most famous causes of the development of eosinophilia.
In more rare cases, other diseases become the cause of an increase in eosinophils:
- Acute leukemia.
- Hereditary eosinophilia.
- Rheumatic fever ().
- Exudative reactions of various origins.
- Vagotonia (irritation of the vagus nerve),.
- Decreased functional ability of the thyroid gland ().
You need to know that these cells do not always benefit the body. While fighting infection, they can provoke allergies themselves. When the number of eosinophils exceeds 5% of the total number of leukocytes, not only eosinophilia is formed. In the place of accumulation of these cells, inflammatory tissue changes are formed. According to this principle, children often have laryngeal edema.
Physiological causes
- The highest rates of this cells can be observed exclusively at night, when a person is sleeping, and during the day, respectively, the lowest.
- The analysis reveals variations in the number of cells in women during the menstrual cycle: in the initial stages, their number increases, after ovulation it gradually decreases;
- Treatment with certain drugs can affect the indicator: medicines for tuberculosis, penicillins, aspirin, diphenhydramine, sulfonamide and gold preparations, complexes with vitamin B, chymotrypsin, imipramine, miscleron, papaverine, aminophylline, beta-blockers, chlorpropamide, hormonal drugs, etc. d;
- Food Regimen: Sweets or alcohol increases the likelihood that the analysis will be incorrect.
For the first time, elevated eosinophils detected in a blood test require a re-examination and study of changes in their number over time (several sequentially conducted analyzes).
Increased eosinophils in a child
Depending on the age of the child, the following factors may be the reason for exceeding the norm of the cell content:
- In newborns, a high rate of eosinophils can be caused by Rh-conflict, staphylococcus aureus, hemolytic disease, dermatitis, and allergic reactions to drugs or food.
- At the age of one and a half to three years, high rates of eosinophils can be caused by drug allergies, etc.
- In children over three years of age, eosinophils increase in the presence or, during an exacerbation of skin allergies, and with helminthiasis. Also, an increase in eosinophils in a child can cause malignant tumors.
Elevated eosinophils in the blood are not an independent disease, all efforts should be made to find the main cause of their increase and, if possible, eliminate it.
What to do?
If a general blood test showed that eosinophils have increased, it is imperative to additionally pass a biochemical blood test, so you can learn about the disease that led to the increase. Be sure to pay attention to the protein level of enzymes that are located in the liver, etc. Additionally, you need to pass a urinalysis, feces, to find out if there are worms or their egg deposition.
Hematologist treat eosinophilia, but remember, this is not a disease on its own, but only one with symptoms of some disease. It is imperative to determine the disease due to which the eosinophils have increased, then an effective treatment regimen, the necessary medications and physiotherapy procedures will be prescribed.
Eosinophilia - a condition in which there is an absolute or relative increase in the number of eosinophils.
Eosinophils (from eosin and Greek philo - I love), cells of vertebrates and humans, containing round granular structures in the cytoplasm, stained with acidic dyes (in particular, eosin).
The content of eosinophilic leukocytes in the bloodaverages in adults 100 - 350 per 1 μl (2 - 4% of all peripheral blood leukocytes). This value changes during the day: in the evening and in the morning, the content of eosinophils is about 20% less than the daily average, and at midnight - 30% more. These fluctuations are associated with the level of glucocorticoid secretion by the adrenal cortex.
A critical level that indicates a pathological processassociated with an increase in the number of eosinophils, is a level in excess of 450 in 1 μl.
There are 3 degrees of eosinophilia: light - 400-1500x109 / l, moderate - 1500-5000x109 / l, heavy - more than 5000x109 / l. Many hematologists consider eosinophilia to be moderate with 10-15% eosinophils present in the peripheral blood; pronounced, if their number exceeds 15%, and conditions in which the number of eosinophils is more than 15-20% is proposed to be called "large blood eosinophilia". They are usually associated with an increase in the total white blood cell count.
Blood hypereosinophilia may not correlate with tissue eosinophiliaand manifest itself only by eosinophilia in the peripheral blood or simultaneously by a combination of eosinophilia in the blood and eosinophilic tissue infiltration, or only by eosinophilic tissue infiltration.
Of all the mechanisms listed common to all clinical forms- the first (high blood level of interleukin-5), which is a factor in the growth and differentiation of B-lymphocytes and eosinophils, and also stimulates the synthesis of IgA. It is produced by type 2 T-helper lymphocytes.
Hypereosinophilia has a multifaceted effect on the macroorganism... Eosinophils are a source of a number of cytokines, some of which are involved in maintaining homeostasis, while others have a pro-inflammatory function. Eosinophils secrete transforming growth factor, their number increases sharply at the edges of the wound, and this suggests that they are involved in wound healing.
In rare cases, it occurs pseudo-eosinophilia syndrome: Granularity in neutrophils stains with eosin, and then neutrophils can be mistaken for eosinophils. Diagnosis is carried out using cytochemical enzyme analysis.
Assessment of the dynamics of changes in the number of eosinophils during the inflammatory process has prognostic value. Eosinopenia (a decrease in the number of eosinophils in the blood of less than 1%) is often observed at the onset of inflammation. Eosinophilia (an increase in the number of eosinophils\u003e 5%) corresponds to the onset of recovery. However, a number of infectious and other diseases with high IgE levels are characterized by eosinophilia after the end of the inflammatory process, which indicates the incompleteness of the immune reaction with its allergic component. At the same time, a decrease in the number of eosinophils in the active phase of the disease often indicates the severity of the process and is an unfavorable sign. In general, the change in the number of eosinophils in the peripheral blood is the result of an imbalance in the processes of cell production in the bone marrow, their migration and decay in tissues.
Reference values: in children and adults, depending on age:
(age) newborns - (eosinophils) 1 - 6%
<2 недель – 1-6 %,
2 weeks - 1 year - 1-5%,
1 - 2 years - 1 - 7%,
2 - 5 years - 1-6%,
6-7 years old - 1-5%,
8 years old - 1 - 5%,
9-11 years old - 1- 5%,
12-15 years old - 1-5%,
16 years old - 1-5%.
Decreased levels (eosinopenia):
the initial phase of the inflammatory process;
severe purulent infections;
shock, stress;
intoxication with various chemical compounds, heavy metals.
Determination of the number of eosinophils in the blood is determined by calculating the leukocyte formula, which is carried out with immersion microscopy of stained smears. Typically, the Romanovsky-Giemsa stain or the combined May-Grunwald-Romanovsky Pappenheim stain is used. Romanovsky-Giemsa staining (a mixture of azure II paint, water-soluble eosin, methylene alcohol and eosin) makes it possible to differentiate the nucleus and cytoplasm well. With combined coloring according to Pappenheim, May-Grunwald paint (a solution of eosinmethylene blue in methyl alcohol) and Romanovsky-Giemsa are successively used. This method is considered the best and is used for staining peripheral blood smears and bone marrow punctures.
Smear microscopycarried out according to the following method. The smear is moved from the top edge to the bottom, then pushed back by 2-3 fields of view along the edge and goes in the opposite direction to the top edge, etc. You can use other methods. However, in all cases, at least 100 leukocytes are identified and counted. If, at the same time, any deviations from the norm are found (the appearance of degenerative forms of cells that are not detected in a healthy person, a change in the normal ratio of various types of leukocytes), another 100 leukocytes are necessarily looked through according to the described method. The results obtained are recorded using a key counter or in another way. Differentiation of different types of leukocytes (including eosinophils) and counting the leukocyte formula requires a good knowledge of the general scheme of hematopoiesis (see article "Leukocyte formula" in the section "laboratory diagnostics" of the medical portal website) and morphological features of various leukocytes.
If eosinophilia is detected when calculating the leukocyte formula, it is recommended to perform an examination to identify its causes, including: a blood test for allergy diagnostics, a blood test for antibodies to helminths, a rheumatological blood test, a blood test for tumor markers, an x-ray examination of the chest organs. The need for further examination and consultation of other specialists (allergist, infectious disease specialist, pulmonologist, oncologist, etc.) will already depend on the results of these examinations.
Eosinophilic leukocytes are produced in the bone marrow from a single progenitor cell. The production of this population is accelerated by the release of interleukins IL4, IL5 by T-lymphocytes.
Mature eosinophils are stained with aniline dyes (eosin), for which they got their name. The size of the mature cell form is 12-17 microns.
Life cycle
- the formation of the population occurs in the bone marrow within 34 hours;
- mature forms enter the bloodstream, where it is about 2-10 hours;
- then they migrate to the submucosal spaces - the skin, intestinal mucosa, respiratory tract, oral cavity, paranasal sinuses;
- function in tissues for 8 - 10 days.
In increased quantities, eosinophils are concentrated in the skin tissues, mucous membranes, where they are contained 100 times more than in the blood. They are found in moderate quantities in the tissues of the spleen, mammary glands, thymus, lymph nodes, uterus.
The total blood flow of circulating blood contains no more than 1% of all human eosinophilic leukocytes.
Features of the structure
Eosinophil carries on its surface receptors (antigens) involved in immune processes. The cellular cytoplasm contains granules filled with enzymes, which, if necessary, are delivered to the site of inflammation and released into the extracellular space.
Surface antigens (AH) of eosinophilic leukocytes are able to interact with immunoglobulins IgG, IgE, components of the blood complement system C3, C4.
The rapid increase in the concentration of eosinophils in the focus of inflammation is explained by their ability to:
- to phagocytosis - the property of "devouring" small particles of destroyed cell walls of microorganisms;
- to chemotaxis - directed movement into the inflammation focus under the action of eotaxin protein, monocyte chemotaxis proteins, lymphocyte chemotaxis protein.
Under the influence of chemotaxis proteins, eosinophils can accumulate in the inflammatory focus in huge quantities, as, for example, in allergies. Elevated eosinophils show that pathogenic microorganisms, antigenic complexes, foreign toxic proteins are present in the blood.
Eosinophils are responsible for the reactivity of the immune system, phagocytizing the antigen-antibody immune complexes formed during immune reactions in the blood, which serves as a way to regulate inflammation in the lesion.
Due to surface receptors and active compounds contained in cytoplasmic granules, as well as the ability to phagocytosis and chemotaxis, eosinophil:
- is a factor of local immunity of the mucous membranes - it does not allow the penetration of foreign antigens into the general bloodstream, surrounds and destroys them in the submucosal spaces;
- enhances the immune allergic response of an immediate type, which is manifested by Quincke's edema, anaphylaxis;
- participates in an allergic reaction of a delayed type - increased rates accompany bronchial asthma, hay rhinitis, drug intolerance, atopic dermatitis;
- controls the work of basophils and mast cells, neutralizes the histamine released by them;
- participates in autoimmune processes, which is manifested, for example, cold urticaria;
- kills helminths and their larvae.
Norm, deviations from the norm
The norm of eosinophils in the blood in adults is 0.02 - 0.44 * 10 9 / l. The relative amount of eosinophils in the leukocyte blood count is normal 0.5% - 5%.
A condition where the eosinophils are more than 5% elevated is called eosinophilia. If eosinophils in the blood of an adult are elevated, reach values \u200b\u200bgreater than 6 - 8%, this indicates the possibility of infection, rheumatological disorders, and autoimmune processes.
When eosinophils in an adult are increased by more than 15 - 20% in a blood test, this condition is called hypereosinophilia, which is accompanied by a massive accumulation (infiltration) of eosinophilic leukocytes in the focus of inflammation. The tissues of the target organ, in which the inflammation has occurred, is, as it were, saturated with eosinophils.
The reason why eosinophils in adults are increased in hypereosinophilia or hypereosinophilic syndrome (HES) is a change in the ratio of lymphocytes in the blood. The content of B-lymphocytes decreases, and the number of T-lymphocytes in these conditions increases, which stimulates the production of eosinophilic cells in the bone marrow.
HPPs include diseases characterized by increased rates of eosinophils - eosinophilic inflammation of the lungs, heart (endocarditis), neurological disorders, leukemia.
Eosinopenia is a condition when the number of eosinophilic granulocytes is less than 0.5%, or in absolute terms - less than 0.02 * 10 9 / l. For more information about the normal values \u200b\u200bof eosinophils in the blood in adults and children, read the article "Norms of eosinophils".
When eosinophils are elevated
Penetration of an infection, a foreign protein (antigen) into the body triggers the activation of eosinophilic leukocytes. This stimulating effect is the reason for the massive migration of this population to the affected tissues.
An increase in the concentration of eosinophils in the blood is achieved by accelerating the maturation time of the cells of this population. The reasons for the increase in indicators in the general blood test for eosinophils may be:
- allergies of immediate and delayed type;
- infestation with worms - roundworms, echinococci, fascias, opisthorchomas, trichinella;
- infectious respiratory, intestinal diseases caused by viruses, bacteria, fungi;
- collagenoses - periarteritis nodosa, thrombovasculitis, Behcet's disease, dermatomyositis, scleroderma, lupus, fasciitis;
- rheumatological diseases - arthrosis, gout, arthropathy;
- scarlet fever;
- lymph node tuberculosis;
- esonophilic gastroenteritis, pneumonia, myalgia;
- chorea;
- churg-Strauss syndrome;
- ulcerative colitis;
- adrenal insufficiency;
- oncology - eosinophilic lymphogranulomatosis, myeloid leukemia, sarcidosis, erythremia, cancer of the liver, uterus, cervix, ovary.
When a woman has elevated eosinophils in her blood during pregnancy, this means that she is developing an allergic reaction. Allergies can occur both to food and to the invasion of viruses or bacteria with influenza or acute respiratory infections, or infection with worms.
Allergy symptoms are difficult to recognize if this condition appears in a woman for the first time, and it is masked by the features of pregnancy - toxicosis, nausea, skin rashes.
Changes in the leukocyte formula
An increase in the concentration of eosinophils is accompanied by changes in the content of other cells of the immune system. Both eosinophils and lymphocytes, elevated at the same time, are found in the blood when infected with the Epstein-Barr virus, helminths. A similar picture is observed with allergic dermatoses, treatment with antibiotics and sulfonamides (biseptol), scarlet fever.
Above the norm in the analysis of blood eosinophils and monocytes with mononucleosis, viral, fungal infections. Increased test rates for syphilis and tuberculosis.
Leukocytosis, increased eosinophils, the appearance of atypical lymphocytes in the blood is observed in DRESS syndrome - a systemic allergic reaction to taking a drug. It can take up to 2 months between taking the drug and the appearance of the first signs of an extensive allergic reaction of the body to the drug.
The symptoms of DRESS syndrome are:
- enlarged lymph nodes;
- skin rashes;
- temperature rise;
- prostration.
If the drug is not canceled, there may be lesions with granulocytes accumulated in the tissues of such organs as the lungs, liver, kidneys, and the digestive tract.
Complications with elevated eosinophils
The action of factors that stimulate the formation of eosinophils can cause an exaggerated response, a kind of "inflammatory" blood reaction - hypereosinophilia.
The number of eosinophils in hypereosinophilia can be increased hundreds of times compared to the norm. Leukocytes in a similar state are increased to 50 * 10 9 / l, while 60 - 90% of the total number of white blood cells may be eosinophils.
When proteolytic enzymes are released from granules, not only pathogenic microorganisms are damaged, but also their own cells. First of all, cells of the inner lining of blood vessels (endothelium) of the entire circulatory system are affected.
Severe eosinophilia lesions
The action of enzymes that enter the bloodstream from granulocytes provokes inflammation, which causes tissue cells in the lesion to die. With a massive accumulation of granulocytes, the damage is so significant that it disrupts the work of the target organ.
This means that if eosinophils in the blood are elevated for a long time, and their indicators are much higher than normal, then such important organs for life as, for example, the heart, suffer. Signs of damage to the endocardium and myocardium are found very often in conditions associated with prolonged increased levels of eosinophilic leukocytes in the blood.
Such a condition, when eosinophils are increased in the blood test, in children speaks of helminthic invasion, allergies, in adults it means that inflammation develops in the joints, skin, and the respiratory system.
With the accumulation of an increased number of granulocytes in the lung tissue, eosinophilic pneumonia develops. This condition has a high risk of pulmonary edema.
For children, the typical causes of increased test scores are atopic dermatitis and bronchial asthma. The increased content of granulocytes in tissues and blood in both adults and children has a damaging effect on the central nervous system.
According to the level of increase in eosinophilic granulocytes in the blood, it is not always possible to correctly assess the degree of tissue damage. In tissues, the number of eosinophilic granulocytes can be significantly higher than a blood test shows.
Eosinophils are cells that phagocytose antigen-antibody complexes, represented mainly by immunoglobulin E. After maturation in the bone marrow, eosinophils are in the circulating blood for several hours (about 3-4), and then migrate to tissues, where their lifespan is 8-12 days ... Unlike eosinophils, they do not contain lysozyme and alkaline phosphatase. For eosinophils, a diurnal rhythm of fluctuations in the blood is characteristic, the highest rates are noted at night, the lowest - during the day. Eosinophils respond to chemotactic factors secreted by mast cells and basophils, as well as antigen-antibody complexes. The action of eosinophils is actively manifested in sensitized tissues. They are involved in both immediate and delayed hypersensitivity reactions. The content of eosinophils in the blood is normally shown in the table.
The content of eosinophils (absolute and relative percentage) in the blood is normal in adults and children
Eosinophilia as a Sign of Allergy
In allergic conditions, eosinophilia is usually moderate - from 0.2 to 1.5 * 10 ^ 9 / l, but in some cases it can be higher, for example, in bronchial asthma or angioedema. Severe and stable eosinophilia (from 10 to 60%) can be with pemphigus and Duhring's dermatitis herpetiformis. In addition, eosinophilia is accompanied by periarteritis nodosa (about 18% of patients have a level of eosinophils reaching 84%), rheumatoid arthritis, complicated by vasculitis and pleurisy. There is also a hypereosinophilic syndrome, in which it reaches 138.0 * 10 ^ 9 / l, while eosinophils account for 93% of the cells.
The main causes leading to eosinophilia in the blood are shown in the table.
Diseases and conditions accompanied by eosiophilia
To decipher the values \u200b\u200bof the remaining analysis indicators, you can use our service: online.
