Diagnostic Algorithm for Patients with Eosinophil Disorders - Flowchart

Diagnostic Algorithm for Patients with Eosinophil Disorders - Flowchart

Diagnostic Algorithm for Patients with Eosinophil Disorders - Flowchart Eosinophil CountHypereosinophilia and Hypereosinophilic Syndrome Eosinophil Count Hypereosinophilia and Hypereosinophilic Syndrome

«Flowchart»

Hypereosinophilia = HE

Hypereosinophilia = HE

Hypereosinophilia = HE

Hypereosinophilia = HE

End

End

End

End

+ Organ damage

+ Organ damage

+ Organ damage

+ Organ damage

Familial HES = HES_F

Familial HES = HES_F

Familial HES = HES_F

Familial HES = HES_F

_F

Reactive HE = HE_R

Reactive HE = HE_R

Reactive HE = HE_R

Reactive HE = HE_R

_R

Positive

Positive

Positive

Positive

Negative

Negative

Negative

Negative

+ Organ damage

+ Organ damage

+ Organ damage

+ Organ damage

Reactive HES = HES_R

Reactive HES = HES_R

Reactive HES = HES_R

Reactive HES = HES_R

_R

Explore underlying cause
Establish the final diagnosis

Explore underlying cause
Establish the final diagnosis

Explore underlying cause
Establish the final diagnosis

Explore underlying cause
Establish the final diagnosis

WHO-based myeloid or lymphoid neoplasm with HE and abnormalities of PDGFRA, PDGFRB or FGFR1

WHO-based myeloid or lymphoid neoplasm with HE and abnormalities of PDGFRA, PDGFRB or FGFR1

WHO-based myeloid or lymphoid neoplasm with HE and abnormalities of PDGFRA, PDGFRB or FGFR1

WHO-based myeloid or lymphoid neoplasm with HE and abnormalities of PDGFRA, PDGFRB or FGFR1

PDGFRA, PDGFRB FGFR1

Screen for FIP1L1-PDGFRA by FISH or RT-PCR, and perform cytogenetic analysis for translocations involving 4q12 (PDGFRA), 5q31-q33 (PDGFRB), or 8p11-12 (FGFR1)

Screen for FIP1L1-PDGFRA by FISH or RT-PCR, and perform cytogenetic analysis for translocations involving 4q12 (PDGFRA), 5q31-q33 (PDGFRB), or 8p11-12 (FGFR1)

Screen for FIP1L1-PDGFRA by FISH or RT-PCR, and perform cytogenetic analysis for translocations involving 4q12 (PDGFRA), 5q31-q33 (PDGFRB), or 8p11-12 (FGFR1)

Screen for FIP1L1-PDGFRA by FISH or RT-PCR, and perform cytogenetic analysis for translocations involving 4q12 (PDGFRA), 5q31-q33 (PDGFRB), or 8p11-12 (FGFR1)

FIP1L1-PDGFRA PDGFRA PDGFRB FGFR1

Positive

Positive

Positive

Positive

Negative

Negative

Negative

Negative

Define the histopathological and clinical nature of the underlying neoplasm
Establish the final diagnosis

Define the histopathological and clinical nature of the underlying neoplasm
Establish the final diagnosis

Define the histopathological and clinical nature of the underlying neoplasm
Establish the final diagnosis

Define the histopathological and clinical nature of the underlying neoplasm
Establish the final diagnosis

+ Organ damage

+ Organ damage

+ Organ damage

+ Organ damage

Neoplastic HES = HES_N

Neoplastic HES = HES_N

Neoplastic HES = HES_N

Neoplastic HES = HES_N

_N

Screen for other molecular markers and hematologic diseases

Screen for other molecular markers and hematologic diseases

Screen for other molecular markers and hematologic diseases

Screen for other molecular markers and hematologic diseases

WHO-defined myeloid neoplasm associated with eosinophilia

WHO-defined myeloid neoplasm associated with eosinophilia

WHO-defined myeloid neoplasm associated with eosinophilia

WHO-defined myeloid neoplasm associated with eosinophilia

Other molecular abnormality, clonal eosinophils, and/or increased marrow blasts (≥5-19%) ?

Other molecular abnormality, clonal eosinophils, and/or increased marrow blasts (≥5-19%) ?

Other molecular abnormality, clonal eosinophils, and/or increased marrow blasts (≥5-19%) ?

≥ Other molecular abnormality

Abnormal T-cell phenotype ± Th2 cytokine production ?

Abnormal T-cell phenotype ± Th2 cytokine production ?

Abnormal T-cell phenotype ± Th2 cytokine production ?

Abnormal T-cell phenotype ± Th2 cytokine production ?

Chronic eosinophilic leukemia, NOS

Chronic eosinophilic leukemia, NOS

Chronic eosinophilic leukemia, NOS

Chronic eosinophilic leukemia, NOS

HE of unknown significance = HE_US

HE of unknown significance = HE_US

HE of unknown significance = HE_US

HE of unknown significance = HE_US

_US

Yes

Yes

Yes

Yes

No

No

No

No

+ Organ damage

+ Organ damage

+ Organ damage

+ Organ damage

Idiopathic HES = HES_I

Idiopathic HES = HES_I

Idiopathic HES = HES_I

Idiopathic HES = HES_I

_I

Lymphocyte-variant hypereosinophilia

Lymphocyte-variant hypereosinophilia

Lymphocyte-variant hypereosinophilia

Lymphocyte-variant hypereosinophilia

Yes

Yes

Yes

Yes

No

No

No

No

+ Organ damage

+ Organ damage

+ Organ damage

+ Organ damage

HES_L

HES_L

HES_L

HES_L

_L

Screen for secondary causes

Screen for secondary causes

Screen for secondary causes

Screen for secondary causes

Rare syndromes

Hereditary
Nonhereditary
Mono-organ

Rare syndromes

Hereditary
Nonhereditary
Mono-organ

Rare syndromes

Hereditary
Nonhereditary
Mono-organ

Hereditary
Nonhereditary
Mono-organ Rare syndromes

Familial HE = HE_F

Familial HE = HE_F

Familial HE = HE_F

_F Familial HE = HE(F)