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Raised Eosinophill Count : Clinical Significance. Dr Rajesh Swarnakar MD,DTCD,DNB,FCCP(USA) Consultant Pulmonologist &Director Getwell Hospital & Research Institute, NAGPUR.

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Raised Eosinophill Count :

Clinical Significance

Dr Rajesh Swarnakar


Consultant Pulmonologist &Director

Getwell Hospital & Research Institute, NAGPUR

-Two-lobed, polymorphonuclear leukocyte 12 to 15 um diameter- Created by IL-3, Il-5 and GM-CSF -Three granule types, largest made up of MBP (major basic protein)- Kills Parasites, tumor cells, -Circulates <18 hours- 100-400 x more in tissues than in blood

Eosinophil – our friend or foe ?

can happen in blood tissue
Can happen in Blood&Tissue

Raised Eosinophill Count:

  • Bronchoscopy(BAL) EOS Percentage (%) rather than absolute number

Normal volunteers = < 1%

  • Blood Eosinophillia : Sampling peripheral blood
  • Pulmonary Eosinophillia:Measured in BAL

Eosinophils count: What’s Normal?

  • Blood EOS (#) = up to 600/cmm
The degree of Blood eosinophilia can be categorized into :

Mild 500 to 1500 cells/microL

Moderate 1500 to 5000 cells/microL

Severe >5000 cells/microL

Categories of Eosinophilia

Peripheral eosinophilia can be divided into categories of ,

or idiopathic eosinophilia



Primary eosinophilia

Usually occurs in the context of hematologic malignancies, such as acute leukemias or chronic myeloid disorders, when there is evidence of clonal expansion of eosinophils

Eosinophils can also be seen in Hodgkin's and non Hodgkin lymphoma and other metastatic cancers, but the associated eosinophils are not of a clonal nature in this situation

The most common cause for secondary eosinophilia :

is parasitic lung infection. Noninfectious causes of secondary eosinophilia include allergic disorders, medications, toxins, autoimmune diseases, and endocrine disorders such as Addison's disease.

A diagnosis of idiopathic eosinophilia is considered when a thorough evaluation does not identify either a primary or secondary cause of eosinophilia
diseases associated with blood pulmonary eosinophilia
Diseases Associated with Blood & Pulmonary Eosinophilia
  • Pulmonary Eosinophilic Syndromes of Known Cause:

Parasitic-induced eosinophilic pneumonias (including Loeffler’s syndrome) Drug-or toxin-induced eosinophilic pneumonias Tropical pulmonary eosinophilia Allergic bronchopulmonary mycosis.

  • Pulmonary Eosinophilic Syndromes of Unknown Cause:

Idiopathic acute eosinophilic pneumonia Chronic eosinophilic pneumonia Churg-Strauss syndrome (allergic granulomatosis and angiitis) Idiopathic hypereosinophilic syndrome

Other Lung Diseases Variably Associated with Eosinophilia:Asthma/allergy

Bronchocentric granulomatosis Bronchiolitis obliterans-organizing pneumonia Infections – Fungal (esp.Coccidioidomycosis, Aspergillus,Pneumocystis jirovecii) -Tuberculosis

Interstitial lung disease -Idiopathic pulmonary fibrosis -Collagen-vascular disease associated -Sarcoidosis -Eosinophilic granuloma (pulmonary histiocytosis X) Malignancy -Non–small-cell cancer of lung -Non-Hodgkin’s lymphoma -Myeloblastic leukemia Miscellaneous (e.g., lung transplantation, ulcerative colitis

Treatment of primary disease suffices to bring down raised eosinophil count.

Algorithmic approach to evaluation patients with pulmonary/blood eosinophillia :
  • ( Am J Respir Crit Care Med 150:1423-138,1994.)
CollagenVascular Disease

HIV Risks


Asthma History

Travel History

History & Physical Exam





Stool Ova & Parasite Exam

Pulmonary Function Tests



Non- Pulmonary

Organ Involvement

Pulmonary Involvement Only


Chest x-ray Normal

IgE < 1.000

Chest x-ray Abnormal

IgE > 2.000







> 20% Eosinophils

< 20% Eosinophils

Allergic Bronchopulmonary Aspergillosis

Bronchocentric Granulomatosis

Blood Eosinophil Count

Interstitial Lung Disease

Drug Reaction




Hypereosinophilic Syndrome

Acute Eosinophilic Pneumonia

Chronic Eosinophilic Pneumonia Simple Pulmonary Eosinophilia

thank you for your kind attention
Thank you for your Kind attention

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Email : [email protected]

ICONIC - 2014

International Conference on Insights and Management of COPD

1st -2nd February, 2014

Hotel Hyatt Regency, Pune, India

Dear friends and colleagues,

On behalf of the organising committee, it gives us immense pleasure to welcome you to the first international conference on COPD – ICONIC 2014, to be held on 1st and 2nd February, 2014 at “Hotel Hyatt Regency”, Pune.

The scientific programme will cover insights on the burden, pathophysiology, risk factors for COPD, advances in disease management and new directions for research in COPD, and a discussion on the much needed policy change in the management of COPD practices in India.

Come listen to some of the internationally acclaimed leaders in Respiratory Medicine from across the globe including Prof. P. J. Barnes, Prof. James Hogg, Dr. John Walsh, Dr. Robert A. Wise, Dr. Sonia Buist, Dr. John R. Balmes and others.

Once again we extend a cordial welcome to you all and look forward to your active participation in ICONIC – 2014!!!

ICONIC is Endorsed by:

Organized by: Chest Research Foundation, India and Johns Hopkins University, USA

Organizing committee office:

Chest Research Foundation, Kalyani Nagar, Pune 411014, INDIA

Secretariat contact: Telephone (Contact): +91 22 2494 0518  Fax: +91 22 2494 0517 

Email: [email protected] Website: :