Bronchoalveolar Lavage (BAL)

This is a method for obtaining cellular, immunologic, and microbiologic information from the lower respiratory tract

This is a method for obtaining cellular, immunologic, and microbiologic information from the lower respiratory tract

Bronchoalveolar Lavage

During bronchoscopy, a fiber-optic bronchoscope is guided into a selected bronchopulmonary segment, usually the?

Right middle or lingular lobe

Sterile saline volume should be?

Between 100 and 300 mL

Aliquots volume should be?

20 to 50 mL

Which part of the aliquot should be discarded?

First aliquot

Which part of the aliquot should be sent individually for analysis/pooled for further analysis

Remaining aliquots

The desired fluid volume for analysis is?

10 to 20 mL

Minimal fluid volume for analysis should be?

5 mL

Specimens should be kept at a __ during transport to the laboratory and process them __

Room temperature; immediately

When should you put your specimens on ice during transportation?

Delayed for longer than 30 minutes

Specimens that will not be analyzed immediately should be?

Centrifuged

Specimens are unacceptable for testing after?

24 hours

Cell counts should be performed within?

1 hour or are stable for up to 3 hours

Samples can be filtered with the use of?

Loose gauze

Loose gauze is used to filter out what?

Mucus, phlegm, and dust

A macroscopic observation is recorded describing the __ and __ of the specimen

Color and clarity

BAL fluid color can be?

Clear, milky white, light brown-beige, and red

____ is the result of an older hemorrhagic syndrome and would be evaluated for intracellular iron content

Orange-red BAL fluid

This indicates an accumulation of phospholipid-protein complexes derived from pulmonary surfactant in the lung alveoli and strongly suggests pulmonary alveolar proteinosis

Milky or light brown-beige

The BAL fluid should be centrifuged if it looks?

Milky

In what degrees should the specimen be put when delayed

4 degrees celsius

Which are performed on BAL and is also diluted to facilitate counting?

WBC and RBC

WBC and RBC is diluted using a?

Hemocytometer

Cell viability can be determined by adding?

Trypan blue

If a hemocytometer is used, WBC counts may be diluted using the ____ to facilitate counting

BMP LeukoChek system

A BMP LeukoChek system is available with a 1 to 100 dilution of __ to lyse the RBCs

Ammonium oxalate

RBC count is diluted with _____ using an ______

Isotonic saline; MLA pipette

For leukocytes, differential slides are prepared by?

Cytocentrifugation

This is the cell that is most frequently seen

Macrophages

Macrophages contains a variety of?

Phagocytized materials

Macrophage ranges from?

56% to 80%

Lymphocytes ranges from?

1% to 15%

Increased lymphocytes suggests?

Interstitial lung disease, drug reactions, pulmonary lymphoma, and non bacterial infection

Lymphocyte with a differential count equal or greater than 25% suggests

Granulomatous lung disease

Lymphocyte with a differential count greater than 50% suggests

Hypersensitivity pneumonitis or non specific interstitial pneumonia

This leukocyte further defines the disease process

Ratio of CD4 to CD8 lymphocytes

Elevated CD4/CD8 indicates?

Sarcoidosis or connective tissue disorders

Normal CD4/CD8 indicates?

Tuberculosis or malignancies

Low CD4/CD8 indicates?

Hypersensitivity pneumonitis, silicosis, drug induced disease, or HIV infection

Immunologic analysis is performed by?

Flow cytometry

What is the primary granulocyte that is seen in BAL

Neutrophils

Normal value of neutrophils

Less than 3%

Neutrophils count equal to or greater than 50% strongly suggests

Acute lung injury, aspiration pneumonia, or suppurative infection

Eosinophil with a differential count greater than or equal to 25%

Eosinophilic lung disease

CASE STUDY. When you get the result of a mast cell differentiation greater than 1%, a lymphocyte counts greater than 50% as well as a neutrophil count greater than 3% strongly suggests that this patient has?

Hypersensitivity pneumonitis

Presence of erythrocytes indicates?

Acute Alveolar hemorrhage

Alveolar hemorrhage has occured within the past 48 hours indicates a presence of?

Phagocytosed erythrocytes

Presence of Hemosiderin-laden macrophages indicates?

Alveolar hemorrhage older than 48 hours

In lavage specimen, epithelial cells normally range from?

4% to 17%