Abstract
RationalePatients with hematological malignancies are a special challenge to health care providers as they undergo a wide variety of immune-suppressive therapies. Both disease and therapy can cause complications. The lungs may be directly injured through infectious or toxic insults. Early identification of the nature of infiltrates will result in better outcome in the management of these patients. Fiberoptic bronchoscopy (FOB) may be a good tool for indentifying the infiltrate nature by using different diagnostic techniques like transbronchial lung biopsy (TBLB) and bronchoalveolar lavage (BAL).Patients and methodsThis study was performed over 6 months, in Kasr Al-Aini Hospital, Cairo University. It included 30 patients with hematological malignancies presenting with pulmonary infiltrates confirmed by computed tomography of the chest. All patients underwent history taking, clinical examination, and investigations included complete blood count and coagulation profile, BAL for culture and sensitivity, cytology examination, and TBLB.ResultsOverall diagnostic yield of FOB was 73.3% in this study. The diagnostic yield of FOB was higher for infectious (43.3%) than both noninfectious (20%) and mixed (10%) etiologies. The combined diagnostic yield of BAL for bacteriological examination and TBLB was higher than that of BAL for cytology examination. Bacteriological examination revealed a predominance for gram-negative bacteria in 62.5% of total culture and sensitivity.ConclusionThis study supports the role of FOB as the initial procedure of choice for identifying the nature of pulmonary infiltrates in patients with hematological malignancies. Because our results suggest that BAL and TBLB are complementary, we recommend performing TBLB whenever it is deemed safe. On the contrary, cytological examination of BAL fluids was not helpful in reaching a final diagnosis.
Highlights
Hematological malignancies are cancers of the hematopoietic cell lines
The study included all patients with hematological malignancies who presented with pulmonary infiltrates, who were above the age of 18 years, who were of either sex, and who signed a written informed consent
Fiberoptic bronchoscopy (FOB) (Pentax FB-1V, Asahi Optical Co., Tokyo, Japan) was done, and bronchoalveolar lavage (BAL) was performed for examination of aerobic and anaerobic culture and sensitivity, fungal culture, direct smear stained by Ziehl–Neelsen stain for acid-fast bacilli, and silver stain if Pneumocystis jiroveci pneumonia is suspected
Summary
Hematological malignancies are cancers of the hematopoietic cell lines. They include acute and chronic leukemias, Hodgkin’s disease, nonHodgkin’s lymphomas (NHLs), multiple myeloma, and myelodysplastic syndrome [1].Immunosuppressive drugs may have impressive response in terms of disease-free survival [2], yet complications can be substantial [3]. Hematological malignancies are cancers of the hematopoietic cell lines. They include acute and chronic leukemias, Hodgkin’s disease, nonHodgkin’s lymphomas (NHLs), multiple myeloma, and myelodysplastic syndrome [1]. Immunosuppressive drugs may have impressive response in terms of disease-free survival [2], yet complications can be substantial [3]. Pulmonary complications related to the disease process differ for different cancers and therapies [4]. Multidisciplinary approach is required to manage these pulmonary complications [5], which may be of short term, necessitating intensive care treatment [6]. Diagnosis of pulmonary infiltrates can be achieved by chest radiography, serological testing, sputum analysis, and bronchoscopic techniques, including bronchoalveolar lavage (BAL) [7]
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