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Hemosiderin-laden macrophages in bronchoalveolar lavage fluid.
Perez-Arellano JL, Losa Garcia JE, Garcia Macias MC, Gomez Gomez F, Jimenez Lopez A, de Castro S.
Department of Medicine, University of Salamanca, Spain.
Diffuse pulmonary hemorrhage syndromes occasionally present diagnostic problems if the clinical picture is not very typical. The presence of hemosiderin-laden alveolar macrophages in bronchoalveolar lavage (BAL) fluid is a useful diagnostic criterion for this entity. However, in many diffuse interstitial pulmonary diseases (DIPD) there is a lesion at the alveolocapillary barrier, and an exit of red blood cells could occur from the blood vessels, leading to the appearance of siderophages. The aim of this work was dual: to evaluate the presence and number of siderophages in different types of interstitial pulmonary disease and to compare the diagnostic yield of two ways of quantifying hemosiderin-laden macrophages. Three groups of patients--controls (n = 5), DIPD (n = 32) and diffuse pulmonary hemorrhage (n = 3)--were subjected to BAL, and a differential count was made on cytocentrifuged Diff-Quik- and Perl-stained preparations. On the latter, two different measurements were made: the number of macrophages laden with hemosiderin and a quantitative "score." The results of a conventional count (percent of Perl-positive macrophages) showed significant differences between the three groups considered overall. Applying a cutoff value of 20%, the sensitivity of this method was 100% and the specificity, 91.6%. The results of the hemosiderin score showed significant differences between the three groups. Applying a value of 50 as a cutoff, the sensitivity and specificity of the method were 100%. In control patients and carriers of DIPD, the percentage of alveolar macrophages was higher than in healthy subjects. Quantification of the hemosiderin content of alveolar macrophages improved the specificity of the diagnosis of diffuse pulmonary hemorrhage by BAL.
PMID: 1546509 [PubMed - indexed for MEDLINE]
Comment in:
Diagnostic value of hemosiderin-containing macrophages in bronchoalveolar lavage.
Grebski E, Hess T, Hold G, Speich R, Russi E.
Department of Internal Medicine, University Hospital, Zurich, Switzerland.
STUDY OBJECTIVE: Our objective was to determine if the hemosiderin content of BAL macrophages allows us to draw any differential diagnostic conclusions in a variety of lung diseases. PATIENTS AND STUDY DESIGN: One hundred one patients who underwent BAL for different diagnostic reasons were studied prospectively. MAIN RESULTS: The highest values for the hemosiderin score (HS) were found in patients with active alveolar hemorrhage and patients who had undergone heart transplantation for congestive heart failure. Compared to a control population, patients with Pneumocystis carinii pneumonia or invasive aspergillosis had a higher HS than patients with bacterial pneumonia or mycobacterial lung infection. High or intermediate values for HS were more often found in patients with a low than in those with a normal platelet count. CONCLUSIONS: The differential diagnostic conclusions which can be based on an HS are limited.
PMID: 1446490 [PubMed - indexed for MEDLINE]
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[Morphologic diagnosis of pulmonary hemorrhage]
[Article in French]
Gosselin B, Janin A, Sault MC, Servais B, Auffret N.
The gross and histologic morphologic features of early and advanced pulmonary hemorrhages are easy to recognize. Although there is no close correlation between the hemorrhagic appearance of the bronchoalveolar lavage fluid, the histologic features of hemorrhage, and the score of hemosiderin in alveolar macrophages, studies of bronchoalveolar lavage fluid samples are valuable for diagnosing and monitoring pulmonary hemorrhages.
PMID: 2817997 [PubMed - indexed for MEDLINE]
Time course of hemosiderin production by alveolar macrophages in a murine model.
Epstein CE, Elidemir O, Colasurdo GN, Fan LL.
Department of Pediatrics, Division of Pulmonary Medicine, Baylor College of Medicine, Houston, TX 77030-2399, USA.
STUDY OBJECTIVES: The diagnosis of alveolar hemorrhage is assisted by the presence of hemosiderin-laden macrophages (HLMs) in the BAL fluid or lung tissue. Despite the importance of this diagnostic method in clinical settings, limited information is available on the formation and clearance of HLMs as a function of time. The objectives of this study are to determine the time course of HLMs within the BAL and lung tissue, and to evaluate the effect of a single blood aspiration on the recruitment of inflammatory cells within the BAL. DESIGN: Under light anesthesia, Balb/c mice received a single intranasal instillation of species-specific blood (50 microL). Control animals received heparinized sterile saline solution in a similar manner. At several time points after blood aspiration, BAL was recovered for cell differentials and determination of HLMs. The time course for HLMs was also established in the lung tissue. RESULTS: Hemosiderin staining within alveolar macrophages was first detected in the BAL and lung tissue at day 3, peaked at day 7, and persisted through 2 months. The analysis of the BAL revealed an increased number of total cells, with an acute inflammatory reaction that resolved within 2 weeks. CONCLUSIONS: Our findings demonstrate the validity of this model for the study of HLM production after blood aspiration. Additional work using animal models of lung hemorrhage is needed to further characterize the cellular events leading to clearance of erythrocytes within the lung.
PMID: 11742936 [PubMed - indexed for MEDLINE]
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Prognostic factors in bronchoalveolar lavage in 77 patients with bone marrow transplants.
Abu-Farsakh HA, Katz RL, Atkinson N, Champlin RE.
Department of Pathology, University of Texas M. D. Anderson Cancer Center, Houston 77030, USA.
OBJECTIVE: To study the prognostic implications of the following factors in bronchoalveolar lavage (BAL) specimens in bone marrow transplant (BMT) patients: number of lymphocytes per high-power field (HPF), presence of hemosiderin-laden macrophages (HLMs), presence of infections and presence of reactive epithelial cellular changes in bronchial and alveolar cells. STUDY DESIGN: A retrospective study of 77 bone marrow transplant patients who required BAL. Each specimen was studied for the number of lymphocytes per HPF, presence of HLMs, presence of infection and presence of reactive epithelial cells. RESULTS: Patients who had < or = 5 lymphocytes per HPF had a much higher death rate than did patients who had > 5 lymphocytes per HPF (P < .001). Eighty-nine percent of patients who had < or = 5 lymphocytes per HPF died within 30 days of undergoing BAL (P < .001). Patients without HLMs had a better prognosis than did patients with HLMs (P < .005). Thirty-six documented viral or fungal infections occurred in 33 patients. Patients with infections had a greater chance of dying than did those who were infection free (P < .05). Multiple logistic regression analysis showed that the previous three factors are statistically significant. Reactive epithelial cellular changes were seen primarily in patients with autologous BMT (11 of 14 cases) and in those with hematologic malignancies, but they had no statistical significance prognostically. CONCLUSION: The following factors in BAL have a good prognostic value: number of lymphocytes > 5 per HPF, absence of HLMs and absence of infections. Reactive epithelial cellular changes have no prognostic value.
PMID: 7483980 [PubMed - indexed for MEDLINE]
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Items 1-5 of 5 |
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One page. |
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