Korean J Lab Med.  2009 Jun;29(3):185-193. 10.3343/kjlm.2009.29.3.185.

Incidence and Causes of Hypereosinophilia in the Patients of a University Hospital

• Kim DW
• Shin MG
• Yun HK
• Kim SH
• Shin JH
• Suh SP
• Ryang DW

• KMID: 1096968
• DOI: http://doi.org/10.3343/kjlm.2009.29.3.185

Abstract

BACKGROUND: Eosinophilia may be associated with various primary and reactive conditions. The incidence and the causes of eosinophilia might have been changed according to the changes in the incidence of diseases such as cancer, chronic degenerative diseases, etc. We have conducted a retrospective study to investigate the incidence and causes of eosinophilia.
METHODS
Eosinophilia and hypereosinophilia were defined when absolute eosinophil count was greater than 500/microL and 1,500/microL, respectively. Patient's clinical records were reviewed to find out the underlying clinical conditions responsible for causes of hypereosinophilia. Conventional chromosomal analysis, reverse transcriptase PCR and FISH for gene rearrangement were performed to check the presence of clonal eosinophilia.
RESULTS
Out of 41,137 patients who had a hematology profile performed, 5,019 (12.2%) and 373 patients (0.9%) were found to have eosinophilia and hypereosinophilia, respectively. Among patients with hypereosinophilia, 227 patients (60.9%) had identifiable and/or possible causes. The major causes of hypereosinophilia were malignancy (35.2%), allergy and skin diseases (18.1%), infectious diseases (15.4%), hepatobiliary diseases (7.5%), bone marrow clonal diseases (6.6%) and parasite infections (6.6%). We also found a rare case of FIP1L1-PDGFRalpha positive chronic eosinophilic leukemia combined with light chain multiple myeloma.
CONCLUSIONS
We found a difference in the distribution of causes of hypereosinophilia in comparison with previous Korean studies, and the most common cause of hypereosinophilia in the current study was malignancy. A rare case of clonal eosinophilia (chronic eosinophilic leukemia) associated with multiple myeloma was confirmed using molecular studies.

Keyword

Incidence; Cause; Eosinophilia; Hypereosinophilia

MeSH Terms

Adolescent
Adult
Age Factors
Aged
Aged, 80 and over
Bone Marrow/pathology
Child
Child, Preschool
Eosinophilia/epidemiology/*etiology/genetics
Female
Hospitals, University
Humans
Hypereosinophilic Syndrome/epidemiology/*etiology/genetics
Infant
Infant, Newborn
Male
Middle Aged
Receptor, Platelet-Derived Growth Factor alpha/genetics/metabolism
Retrospective Studies
Sex Factors
Young Adult
mRNA Cleavage and Polyadenylation Factors/genetics/metabolism

Figure

• 

  Fig. 1. Morphology and the FIP1L1-PDGFRα rearrangement in a patient with clonal eosinophilia associated with multiple myeloma. (A) The BM aspiration smear shows diffuse plasma cell infiltration (27%) and increased number of mature eosinophils and eosinophil precursors (10%) (Wright stain, 400). (B) The BM section biopsy shows a hypercellular marrow with plasma cell clusters (H&E stain, ×100). (C) Abnormal nucleus showed one fusion signal (red arrow) and deleted orange signal (white arrow) which indicates the 4q12 using LSI 4q12 tricolor rearrangement probe (Vysis). (D) Reverse transcriptase-polymerase chain reaction (RT-PCR) analysis of RNA isolated from the bone marrow of the patient. The amplified band for FIP1L1-PDGFRα transcripts is shown on the right side of the figure. (E) The detection of FIP1L1-PDGFRα using PCR-direct sequencing analysis in the patient. The sequence trace (reverse chromatogram) result shows the break and fusion point (indicated by the arrow) in exon 12 of PDGFRα and exon 12 of FIP1L1 based on the RT-PCR results. Abbreviation: MW, molecular weight marker (Boehringer, Ingelheim, Germany).

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