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Diagnostic testings at an eosinophilia - the Eosinophilia

Table of contents
Eosinophilia
Clinical displays of an eosinophilia and related diseases
Anamnesis of an eosinophilia
Physical inspection
Diagnostic testings at an eosinophilia
Diagnostic approach

Laboratory methods

Hematologic researches. By definition the eosinophilia means laboratory confirmation of existence in the general blood test more than 0,35 × 109/l. In addition, for statement of certain diagnoses (for example, OEL) needs research of punctate of marrow and biopsy material, first of all for the purpose of their differential diagnosis from other diseases proceeding with anemia and very high content in blood of eosinophils (for example, ES). In marrow of sick ES granulotsitarny shift and normal megacaryocytes are observed too. On the other hand, OEL is connected with lowering of function of marrow, and at this disease normal cells of marrow are substituted with blast forms of eosinophils.

Existence of anemia also is a characteristic symptom and for some other diseases. Anemia is caused by a parasitic invasion of a digestive tract helminths. Besides, signs of a pseudorheumatism can include both an eosinophilia and anemia. Existence of anemia often is a harbinger of more considerable general diseases and indicates diseases of the polysystem nature.

Persons with the allergic anamnesis have a detection in the smear of a secret of cells painted according to Wright mucous a nose of a considerable eosinophilia represents a valuable diagnostic find. In spite of the fact that further allergic testing can be required, this simple research can exclude need for carrying out expensive laboratory researches for the purpose of an exception of other possible diagnoses.

Biochemical blood analyses. Definition of electrolytic structure of a blood plasma for an assessment of extent of hydration, and also level of serumal transaminases for detection of hepatic pathology are necessary components of diagnosis in the presence of symptoms of defeat of bodies of a digestive tract in combination with an eosinophilia. The routine general analysis of urine can reveal existence of erythrocytes and protein that is compatible to a possibility of a gelmintny invasion of a bladder. In rare instances of egg of helminths, for example, shistosoma, can be found both in excrements, and in urine; any of these finds helps to establish the final diagnosis of a helminthic invasion. Quantitative definition of serum protein is important at some diseases and first of all at an allergic eosinophilic gastroenteritis and a coloenteritis which frequent manifestation is the hyperproteinemia. Such special immunofluorescent tests as research for anti-nuclear antibodies and a rhematoid factor are of great importance for difference of classical kollagenoz, for example, of a system lupus erythematosus and a pseudorheumatism, from rare eosinophilic diseases, for example, of an eosinophilic fasciitis to ES.

Microbiological research. All question is that the most important microbiological research which can be made in the presence of an eosinophilia consists in research of a chair on eggs of helminths and parasites. Even in the United States of America where the helminthic invasion is widespread less, than in other regions of the world, any case of a considerable eosinophilia when the number of eosinophils exceeds 1 × 109/l, obliges the clinical physician to exclude helminthosis. For such diseases as a dochmiasis. In addition to eggs and adult forms of parasites the chair should be investigated on existence of crystals of Sharko — Leyden. If the studied material has eosinophilic coloring, it testifies to the expressed eosinophilic infiltration of a digestive tract.

As existence in cerebrospinal fluid even of one eosinophil is considered pathology if it is found, it is necessary to consider the possibility of an eosinophilic infiltration of TsNS or a disease of an unusual form of viral meningitis. In even more exceptional cases the eosinophilia in cerebrospinal fluid can be manifestation of malignant new growths of TsNS.

The visualizing methods

X-ray analysis of bodies of a thorax. The usual X-ray analysis of bodies of a thorax is, perhaps, the most important radiological method which the patient can rutinno appoint with an eosinophilia, especially with at least minimum symptoms from lungs. Many parasitizing helminths have a pulmonary phase of development. Leffler's filariasis and a pulmonary fluke cause characteristic changes in a type of sites of the increased radiological density; the form of these changes varies from cysts before dense nodal blackouts (fig). Discussion of differential diagnosis of these radiological changes is not included into tasks of the present article.

Рентгенограмма органов грудной клетки
The roentgenogram of bodies of a thorax in front and lateral projections.

 

Computer tomography. At any patient with TsNS diseases for detection of dense educations or abscesses the computer tomography is shown. Besides, at patients with a diffusion lymphadenopathy and a gepatosplenomegaliya to carry out differential diagnosis of two possible diagnoses in this situation (i.e. ES and OEL) can be helped by performance of a limfangiografiya. Defects of filling by a contrast agent are most of all characteristic of malignant new growths.

Special methods

For the identification of a cause of illness proceeding with an eosinophilia performance of invasive procedures, for example, of an artrotsentez can be required at a pseudorheumatism for definition of existence of an eosinophilic infiltration, or a bronkhoskopiya with an endobronchial biopsy for differentiation of pulmonary infiltrates at ES from those at Leffler's syndrome. At patients with pathology symptoms from heart to define prevalence of an endocarditis or myocarditis the echocardiography can help. Further as ES accompanies a tendency to development of a thromboembolic syndrome, such procedures as ultrasonic Doppler research of the location of blood clot, scanning with use 125 fibrinogens and a venografiya, can render advantage in an explanation of a thromboembolic phenomenon.

At defeat of bodies of a digestive tract often there is a need for performance of endoscopic researches of a stomach and a large intestine. If the disease progresses and symptoms of intestinal impassability appear, for the purpose of diagnosis and treatment, naturally, performance of a laparotomy is required.
In the presence of symptoms of damage of a bladder or upper parts of an uric path the tsistoskopiya is shown.

Pathoanatomical research (biopsy of fabrics)

In many cases the final diagnosis can be made only on the basis of histologic research of the struck fabrics. It is undoubted that in cases of an eosinophilic miositis the muscle biopsy with research of a membrane of a sarcolemma on deposits of IgG is an exact diagnostic method. For diagnosis of malignant new growths the biopsy is sine qua non, be the struck fabric marrow or a lymph node.

Besides, the skin biopsy quite often can be necessary for identification of parasites at suspicion on a skin form of migration of larvae or the allergic infiltration observed at allergic dermatitis.

The biopsy of direct and sigmoid guts can be necessary for identification of characteristic changes mucous in the form of "saw teeths" with a diffusion thickening of proctal gates which patognomonichna for an eosinophilic gastroenteritis.
Elektronnomikroskopichesky confirmation of existence in a bioptata of a fascia of fibroblasts, accumulations of protocollagenic threads and a large number of the degranulated mast cells is defining for an eosinophilic fasciitis.



 
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