Bronchoalveolar Lavage Chapter 14 PDF

6/26/2024 B R O N C H OA LVE O L AR L AVAG E CHAPTER 14 A method for examining cellular, immunologic, and microbiological information from...

6/26/2024 B R O N C H OA LVE O L AR L AVAG E CHAPTER 14 A method for examining cellular, immunologic, and microbiological information from the lower respiratory tract Helpful for B R O N C H O A L V E O L A R L A V A G E ( B A L ) immunocompromised patients, patient with airway/ breathing problems 1  6/26/2024 SPECIMEN COLLECTION Procedure = Bronchoscopy – performed by Pulmonologist and the respiratory therapist Fiber optic into middle of lobe (upper or lower) Documentation of what area examined Sterile saline is slowly administered into the scope and mixed and then aspirated the contents for examination and culture The amount of saline instilled is 100 – 300 ml in 20 to 50 ml aliquots First sample in discarded An optimum sample is >30% of recovery (50-70%) 15 cells RBC difference should not be > 30 The cells should agree within 10% on each side Clumps present should be note “cell count may be inaccurate due to clumps of cells or clot” 3  6/26/2024 CELLS PRESENT IN BAL Evaluate the inflammatory process in the respiratory tract Cell that will be seen Macrophage Lymphocytes (CD4/CD8 ratio) Neutrophils Eosinophils Ciliated columnar bronchial epithelial cells Squamous epithelial cells CELLS PRESENT IN BAL Macrophage Lymphocyte Phagocytize Normal range is 1-5% Hemosiderin (golden, brown, black ↑ in lung disease, drug reactions, pigment within cell) pulmonary lymphoma & nonbacterial Foamy cells infection Normal range 56- 80% >25% lymphocytes - granulomatous lung disease >50% lymphocytes – hypersensitivity pneumonitis Ratio of CD4/CD8 will help define the process See Table 14-1 4  6/26/2024 CELLS PRESENT IN BAL Neutrophils Eosinophil Primary cell seen Usually, < 1-2% of total cells Normal is 25% eosinophilic lung disease ≥ 50% - acute lung injury, aspiration pneumonia or infection 5  6/26/2024 CELLS PRESENT IN BAL Erythrocytes (RBCs) Epithelial Cells Indicates acute alveolar hemorrhage or Ciliated columnar cells are prominent from procedure in bronch specimens Phagocytized RBC – suggest a alveolar Normal range in 4 – 17% hemorrhage in last 48 hours Hemosiderin macrophage indicates older than 48 hours M I C R O B I O LO GY TEST Box 14-1 list many different pathogens in the Bronchoalveolar Lavage Fungal, bacterial, and viral Quantification is helpful May be due to extended use of ventilator causing a pneumonia In the case with COVID PCR is useful in identification quickly 6  6/26/2024 CY TO LO GY Look for observation of : Sulfur granules (actinomyces) Hemosiderin-laden macrophage Langerhans cell Cytomegalic cells Fat droplets (Red O) Periodic-acid Schiff (PAS) for fungus Dust particles in pneumoconiosis or asbestos exposure PREAMBLE PowerPoints are a general overview and are provided to help students take notes over the video lecture ONLY. PowerPoints DO NOT cover the details needed for the Unit exam Each student is responsible for READING the TEXTBOOK for details to answer the UNIT OBJECTIVES Unit Objectives are your study guide (not this PowerPoint) Test questions cover the details of UNIT OBJECTIVES found only in your Textbook! 7  6/26/2024 P O STA M B L E READ the TEXTBOOK for the details to answer the UNIT OBJECTIVES. USE THE UNIT OBJECTIVES AS A STUDY GUIDE All test questions come from detailed material found in the TEXTBOOK (Not this PowerPoint) and relate back to the Unit Objectives 8