Bronchial alveolar lavage

Question 1

How to perform BAL

Answer 1

1) Wedge the scope
2) Ideal position in diffuse disease: RML, L lingula
3) Flush with 20-60mls aliquot, to total of 100-240mls (lesser than this may cause contamination by bronchial spaces)
4) After each flush, fluid to be immediately recovered by hand gentle suction into the syringe or gentle wall suction into fluid trap
5) Return must be >30% of instilled volume (usu 40-70%)
6) Bx to be done after BAL to avoid contamination with blood
7) The aliquot should be send to lab asap (<1h at room temp), coz cells are not well preserved in saline.
8) High epithelial cells (>5%) = contamination by bronchial cells

Question 2

Risk factors for developing side-effects following BAL are:

Answer 2

• PaO2 <60 mmHg, oxygen saturation below 90%,
• FEV1 below 1.0 L,
• prothrombin time <50 s, platelet count <20000 mL–1,
• significant comorbidity, and
• bronchial hyperreactivity.

Question 3

Normal ranges of differential cell counts in healthy subjects

Answer 3

• macrophages>80%
• lymphocytes≤15%
• neutrophils≤3%
• eosinophils≤0.5%
• mast cells ≤0.5%
• plasma cells 0%

Question 4

Diagnostic BAL findings

Answer 4

Question 5

BAL cellular pattern

Answer 5

Question 6

In lymphocytic BAL, CD4/CD8 may help to differentiate causes such as?

Answer 6

Question 7

BAL yield in ILD

Answer 7

Question 8

BAL cellular pattern

Answer 8