Cellular Analysis Of Bronchoalveolar Lavage Fluid Research Articles

Cellular analysis of bronchoalveolar lavage fluid in various lung lesions

Introduction: Bronchoalveolar lavage (BAL) is a standard tool in the diagnosis of lung diseases. Cellular analysis of BAL fluid when deviates from normal are indicative of an inflammatory/infiltrative process. This study involves an analysis of BAL fluid performed manually and also using an automated analyzer which offers a rapid and reliable method for analysis of unprocessed BAL fluid. Aims and Objectives: To utilize the cellular analysis of bronchoalveolar lavage (BAL) fluid in the diagnosis of various lung diseases. Materials and Methods: 37 patients with pulmonary diseases of varying etiologies were included in this study. Fiberoptic bronchoscopy with BAL was performed. BAL fluid was run in SYSMEX XNL/350 six-part analyzer which gave total and differential cell count (mononuclear and polymorphonuclear cells). The sample was also centrifuged, sediment smears prepared and differential cell counts were determined. Results: Total WBC count ranged from 31 cells/µl to 94 cells/µl with the maximum increase seen in asthma. Mononuclear cells were increased in the majority of cases, being 84% in pneumoconiosis with the predominance of macrophages. An increase in lymphocytes was seen in Non-Specific Interstitial Pneumonia (45.3%) and Bronchiolitis Obliterans Organising Pneumonia (35.3%), neutrophils in Usual Interstitial Pneumonia (26.2%) and eosinophils in Chronic Eosinophilic Pneumonia (55.5%) and asthma (8.4%). There were 58% mononuclear cells and 42% polymorphonuclear cells in tuberculosis. There were two cases of adenocarcinoma and one case of squamous cell carcinoma in the present study. Conclusion: BAL cell differentials when combined with additional clinical and radiographic information help secure a confident diagnosis in lung diseases and help clinicians to make therapeutic decisions.

Phenotypes of lymphocytic alveolitis in our group of bronchoalveolar lavage fluids

Background Bronchoalveolar lavage (BAL) has a stable place in the diagnostics of various forms of the diffuse parenchymal lung disease. The analysis of cellular components of the bronchoalveolar lavage fluid (BALF) informs us about inflammatory and immune processes in the alveolar space. This can be very helpful in the diagnostics of many interstitial lung diseases (ILDs), but also in the diagnostics of pulmonary haemorrhage and bronchoalveolar carcinoma or lymphomas. The aim of study is to present our experience in cellular analysis of BALF.

Usefulness of cellular analysis of bronchoalveolar lavage fluid for predicting the etiology of pneumonia in critically ill patients.

BackgroundThe usefulness of bronchoalveolar lavage (BAL) fluid cellular analysis in pneumonia has not been adequately evaluated. This study investigated the ability of cellular analysis of BAL fluid to differentially diagnose bacterial pneumonia from viral pneumonia in adult patients who are admitted to intensive care unit.MethodsBAL fluid cellular analysis was evaluated in 47 adult patients who underwent bronchoscopic BAL following less than 24 hours of antimicrobial agent exposure. The abilities of BAL fluid total white blood cell (WBC) counts and differential cell counts to differentiate between bacterial and viral pneumonia were evaluated using receiver operating characteristic (ROC) curve analysis.ResultsBacterial pneumonia (n = 24) and viral pneumonia (n = 23) were frequently associated with neutrophilic pleocytosis in BAL fluid. BAL fluid median total WBC count (2,815/µL vs. 300/µL, P<0.001) and percentage of neutrophils (80.5% vs. 54.0%, P = 0.02) were significantly higher in the bacterial pneumonia group than in the viral pneumonia group. In ROC curve analysis, BAL fluid total WBC count showed the best discrimination, with an area under the curve of 0.855 (95% CI, 0.750–0.960). BAL fluid total WBC count ≥510/µL had a sensitivity of 83.3%, specificity of 78.3%, positive likelihood ratio (PLR) of 3.83, and negative likelihood ratio (NLR) of 0.21. When analyzed in combination with serum procalcitonin or C-reactive protein, sensitivity was 95.8%, specificity was 95.7%, PLR was 8.63, and NLR was 0.07. BAL fluid total WBC count ≥510/µL was an independent predictor of bacterial pneumonia with an adjusted odds ratio of 13.5 in multiple logistic regression analysis.ConclusionsCellular analysis of BAL fluid can aid early differential diagnosis of bacterial pneumonia from viral pneumonia in critically ill patients.

Role of Cytology and Polymerase Chain Reaction Based Detection of Pneumocystis jirovecii Infection in Bronchoalveolar Lavage Fluid

To study the role of cytology and polymerase chain reaction (PCR) for the detection of Pneumocystis carinii pneumonia (PCP) in bronchoalveolar lavage fluid (BALF).In a prospective observational study, a BALF pellet from 55 patients (35 immunosuppressed patients clinically suspicious for PCP and 20 immunocompetent individuals not suspicious for PCP) were subjected to cytology examination as well as PCR for PCP using the major surface glycoprotein gene. Additionally, DNA was extracted from destained cytology slide scrapings from 5 cases each positive for PCR and negative for PCP on BALF, respectively, and was further subjected to PCR.Of 35 immunosuppressed patients, 2 were positive on microscopy for PCP, while 5 (including 2 microscopy positive) were positive by PCR from BALF. Four of the 5 positive cases showed predominantly alveolar macrophages, while one showed 40% alveolar macrophages, 30% lymphocytes and 20% neutrophils upon cellular analysis of BALF. One case had coinfection with Cryptococcus. Destained smear scrapings of PCR-positive slides (n = 5) were all successfully amplified for PCP major surface glycoprotein PCR after DNA extraction, while control slides (n = 5) did not show amplification.BALF is considered the sample of choice for the diagnosis of PCP. In our study, cases with PCP showed mainly alveolar macrophages on BALF examination by cytology and no or mild inflammatory cells. Thus, inflammatory cell population found on cytology may provide direction for PCR. Two-step screening of BALF using cytology followed by PCR from slides is possible and may overcome the limitations of BALF cytology alone for the diagnosis of PCP.

Fibroblast growth-stimulationg activity in bronchoalveolar lavage fluid of patients with pulmonary sarcoidosis.

Increased fibroblast growth-stimulating activity (FGA) was found in bronchoalveolar lavage fluid (BALF) from sarcoidosis patients. For evaluation of the significance of FGA in disease activity and the pathophysiology of sarcoidosis, the FGA levels were compared with data on cellular analysis of BALF, serum angiotensin-converting enzyme (S-ACE) activity and chest radiograms. The FGA level was significantly higher in sarcoidosis patients with parenchymal involvement (radiological stages II and III) than in those without parenchymal involvement (radiological stage I). The FGA was positively correlated with albumin and fibronectin concentrations in BALF. However, it was not significantly correlated with the ratio of CD-4 + to CD-8 + T-lymphocytes in BALF or the S-ACE level, which are known to be useful in evaluating the disease activity of sarcoidosis. These results indicate that the diagnostic value of FGA is different from that of the lymphocyte subpopulations in BALF and S-ACE, and is useful in estimating the extent of parenchymal involvement in sarcoidosis.

Hyaluronan Reflects the Pre-fibrotic Inflammation in Irradiated Rat Lung: Concomitant Analysis of Parenchymal Tissues and Bronchoalveolar Lavage

The pathogenesis of pulmonary fibrosis is a complicated chain of interactions between cells and molecules. During recent years bronchoalveolar lavage (BAL) in patients with various interstitial lung disorders has increased our knowledge of the fibrosis process and focused on new interesting interactions. Here we present an animal model which makes it possible to apply both morphological and immunohistochemical tissue staining to perform bronchoalveolar lavage in the same animal. Irradiation is an established method for experimentally evoking lung fibrosis in animals. Rats received irradiation (30 Gy) to the lower parts of both lungs. Bronchoalveolar lavage was performed in the right lung. The biochemical determination of lavage concentration of hyaluronan (HA) and cellular differential counts were compared with interstitial morphology. Animals were sacrificed and analysed 2, 4, 6, 8 and 10 weeks after irradiation. After 6 weeks a massive increase in connective tissue mast cells was seen in the peribronchial and alveolar-interstitial tissue. This mastocytosis was closely related to a marked increase in HA. It became obvious that, in this model, cellular analysis of BAL fluid did not correctly reflect the cellular changes in the lung interstitium. While BAL revealed a pronounced increase of neutrophils with no--or only very few--mast cells, a concomitant increase in mononuclear cells and mast cells was seen in the lung interstitium. In contrast an increase in HA in BAL correlated well with an increase in HA-deposition in the lung interstitium, indicating that measurement of a non-cellular component, such as HA, may better reflect the tissue inflammation.