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Haematology – Full Blood Count – Case Study B

Haematology – Full Blood Count – Case Study B. Case History. Ms FBC, 50 years old female History Diabetes mellitus HIV Chronic renal failure Haemodialysis 3x weekly Zidovudine (AZT) for a few years. What Are Eosinophils?. Granular leukocytes Produced in bone marrow

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Haematology – Full Blood Count – Case Study B

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  1. Haematology – Full Blood Count – Case Study B

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

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

  4. 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

  5. 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

  6. 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. Crohn’s) • Skin disease (eg. psoriasis) • Long-term dialysis • Immunodeficiency state (eg. HIV/AIDS)

  7. Most likely causes of mild eosinophilia in Ms FBC • Drug reaction from AZT • Haemodialysis • HIV infection

  8. 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.

  9. 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

  10. 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

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