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Lisa, MSN, FNP-BC, CCRN
Lisa, MSN, FNP-BC, CCRN, Nurse Practitioner
Category: Health
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Experience:  Board Certified Family Nurse Practitioner
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A high eosinophil count (17), Low hemoglobin(12.8),Mcv(79),RDW

Resolved Question:

A high eosinophil count (17), Low hemoglobin(12.8),Mcv(79),RDW (18.1), Neutrophil(47) and lymphocytes(24).I have an ulcer at the moment. An allergist thinks its eosinophilic esophagitis thats the cause of the high eosinophil count. I dont think so because i believe the esophagitis is relativley new and ive had a high eosinophil count for quite a while.(not as high as 17). What could i have?
Submitted: 7 years ago.
Category: Health
Expert:  Lisa, MSN, FNP-BC, CCRN replied 7 years ago.
Hello;

Thank you for writing in today. I want to provide you with the best possible information, so I do have a few questions. I hope you understand.

Age?
Any other medical conditions?
What medications and supplements do you take?
How long have you had the elevated eosinophils? What are your usual eosinophil counts?
Any abnormal respiratory, liver, or kidney functioning?
Does your allergist know why you have elevated eosinophils?
Have you had any genetic testing done by an immunologist?

Please let me know.

Lisa
Expert:  Lisa, MSN, FNP-BC, CCRN replied 7 years ago.
I now find your additional information, so please disregard any repeat questions.

Customer: replied 7 years ago.
48 years old.I have no other medical conditions that im aware of.other than whats been perscribed i take a vitamin supplement. ive had the high eosinophils for a while im not sure how long(years) My usual eosinophil count is at least double what it should be .I think it averages around 12 or 13.No abnormal respiratory, liver or kidney functioning. No my allergist does not know why i have elevated eosinophils. No on genetic testing(Sounds interesting).
Expert:  Lisa, MSN, FNP-BC, CCRN replied 7 years ago.
<p>I am going to locate some information I want you to have, and I am going to type up my answer. It may take me a few minutes, but know I am working on it.</p><p> </p><p>Lisa</p>
Expert:  Lisa, MSN, FNP-BC, CCRN replied 7 years ago.
Hello;

First of all, it is quite possible, and very likely, that your esophagitis is caused by eosinophilia. When eosinophils are high, there is a potential for inflammation, as the eosinophils infiltrate tissues. This can cause a great deal of inflammation in the stomach. Therefore, that is a likely diagnosis. Now, with this being said, I do want to offer more information with regard to your eosinophilia.

Obviously, when a person has a spike in their eosinophils, allergies are the most obvious concern. Most cases of eosinophilia are caused by some type of allergic reaction. This explains why you are working with an allergist. However, since your allergist is unable to identify a cause for your eosinophilia, and you are also demonstrating an anemia, I would recommend discussing with your provider the possible need for additional testing. In particular, I would discuss the possible need for a hematology referral. I will explain.

Since there is not an obvious allergy cause, additional causes for eosinophilia should be considered. These causes can range from blood marrow disorders to genetic mutations. You actually fit the profile for possible disorder other than allergy related eosinophilia. With your current eosinophilia and an anemia, bone marrow should be evaluated. In addition, with regard to genetic mutation disorder, such as Hypereosinophilic Syndrome, this disorder peaks in the 40s and is primarily a male disorder; therefore, it could be a potential concern. A hematologist will be able to determine if there is a possible bone marrow disorder. In addition, a hematologist would be able to order the necessary genetic testing to rule out HES, if indicated.

I am going to provide you with an article regarding HES. The language of the article can be a bit confusing; however, you may gain some insight regarding disorders of eosinophils. The article addresses HES, but also provides a list of Differential Diagnosis for eosinophilia. I am not saying that you have HES; however, I think this article will demonstrate the importance of further evaluation and broader consideration regarding the origin of your eosinophilia.Feel free to read over the article and share any opinions or questions you may have.

http://bonehome.com/article/202030-overview

At this point, please feel free to discuss this information and share this article with your provider. He/she will be able to shed more light on the situation, since he/she will have access to your labs and trends.

It is important to identify the cause of eosinophilia early if possible, because eosinophilia can have the potential to cause organ damage in some patients.

I hope this helps. If you have additional questions, concerns, or need clarification, please let me know.

Lisa
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