An Approach to the Bone Marrow Workup and Diagnosis of Eosinophilia and Mast Cell Disorders.

Abstract

The approach to eosinophilia and mast cell disorders in the bone marrow is diverse and depends on multiple factors including access to ancillary testing, resources to support testing, type of practice setting (eg, community, remote, tertiary care center or specialized referral center for these disorders) and whether there are options for clinical trial enrollment. That said, while there are some basic principles to the workup that we can all likely agree upon, individual practice habits will need to be tailored to suit an individual setting. As such, the approach presented in this manuscript is meant to serve as a practical guide and not as dogma per se. Importantly, an in-depth discussion of individual diseases and International Consensus Classification diagnostic criteria will not be covered, as the main focus of this article is the approach to these disorders. The reader is referred to a comprehensive discussion of these diseases and diagnostic criteria in several excellent articles. While there are clear areas of overlap between eosinophilia and mast cell conditions (eg, systemic mastocytosis associated with eosinophilia, myeloid neoplasm with eosinophilia, and tyrosine kinase rearrangements), it is the authors' opinion that it is perhaps easier to navigate these entities separately (eg, eosinophilia as one broad topic and mast cell conditions as another) and to recognize the settings in which overlap may exist and what testing might be considered. Eosinophilia and mast cell conditions will be discussed separately supplemented by generous use of figures and tables to highlight key points.