Scribd
Upload
25 views1 page

Eosinophilia Bone Marrow Diagnostic Algorithm

The document outlines a diagnostic algorithm for eosinophilia, starting from the identification of eosinophilia through routine evaluation to assessing secondary causes. It details specific disease workups based on the presence or absence of secondary causes, including various tests such as immunohistochemistry and chromosome analysis. The algorithm also highlights potential diagnoses and considerations for further testing depending on the findings in peripheral blood and bone marrow morphology.

Uploaded by

Ahmed Al-arapy
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
25 views1 page

Eosinophilia Bone Marrow Diagnostic Algorithm

The document outlines a diagnostic algorithm for eosinophilia, starting from the identification of eosinophilia through routine evaluation to assessing secondary causes. It details specific disease workups based on the presence or absence of secondary causes, including various tests such as immunohistochemistry and chromosome analysis. The algorithm also highlights potential diagnoses and considerations for further testing depending on the findings in peripheral blood and bone marrow morphology.

Uploaded by

Ahmed Al-arapy
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Eosinophilia:

Bone Marrow Diagnostic Algorithm

Eosinophilia identified via routine evaluation.


Evaluate for secondary causes of eosinophilia.
Was a secondary cause found?

YES NO

Disease-specific workup Assess peripheral blood/bone


marrow (BM) morphology

Morphologic features of other Increased eosinophils


hematologic disease: eg, mastocytosis, and precursors only
myeloid neoplasm, lymphoma

Order*:
■ Immunohistochemistry (IHC) for tryptase, CD117, and CD25.
Disease-specific workup
■ KITVS / KIT Asp816Val Mutation Analysis, Varies

■ CHRBM / Chromosome Analysis, Hematologic Disorders, Bone Marrow

■ EOSMF / Chronic Eosinophilia, Specified FISH, Varies and specify the

CHIC2 probe set


■ EXHR / Hematologic Disorders, DNA and RNA Extract and Hold, Varies

■ T-Cell panel by flow cytometry

Consider: TCGBM / T-Cell Receptor Gene Rearrangement, PCR, Bone Marrow

Chromosome and fluorescence in Abnormal T-cell phenotype Abnormal CD25 positive


situ hybridization (FISH) results** and clonal T-cell receptor mast cells and KIT
gene rearrangement Asp816Val alteration

FISH-positive for FIP1L1::PDGFRA Other clonal myeloid No clonal Consider Mastocytosis workup
Abnormal chromosome analysis abnormality abnormality lymphocytic variant See Mast Cell Disorder:
and confirmatory FISH showing hypereosinophilic Diagnostic Algorithm,
rearrangement of: syndrome Bone Marrow
■ 4q12 (PDGFRA)

■ 5q32 (PDGFRB)

■ 8p11.23 (FGFR1)

■ 9p24.1 (JAK2)

■ 9q34 (ABL1)

Myeloid neoplasm with Consider chronic Consider the following diagnoses:***


■ PDGFRA rearrangement eosinophilic leukemia, ■ Reactive eosinophilia

■ PDGFRB rearrangement not otherwise specified ■ Idiopathic hypereosinophilia

■ FGFR1 rearrangement ■ Idiopathic hypereosinophilia syndrome

■ JAK2 rearrangement

■ FLT3 rearrangement

■ ETV6::ABL1 rearrangement

*Do not routinely order the following: BCR::ABL FISH or PCR, FISH for PDGFRB or FGFR1, mast cell flow cytometry
**Detection of the t(5;14)(q31;q32) [IGH::IL3] mutation is associated with B-lymphoblastic leukemia with reactive eosinophilia.
***If there is significant dysplasia (hypercellularity, odd megakaryocytes, ring sideroblasts, etc.), or if the clinical scenario is
worrisome for a clonal myeloid process, consider adding next-generation sequencing and FISH for PDGFRB, FGFR1,
ABL1, and JAK2, as rarely these may be cryptic.

© Mayo Foundation for Medical Education and Research (MFMER). All rights reserved. 06/2024

You might also like