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BRONCHOALVEOLAR LAVAGE Flashcards

1
Q

TRUE or FALSE:
Analyzing specimens obtained by BAL is a method for obtaining cellular, immunologic, and microbiological information from the lining of fluid of the lower respiratory tract.

A

TRUE

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2
Q

Bronchoalveolar lavage is particularly useful in evaluating all of the following, except:
A. Interstitial lung disease
B. Airway disease
C. Suspected alveolar hemorrhage
D. Pulmonary alveolar proteinosis
E. Langerhans cell histiocytosis
F. Exposure to dust and asbestos
G. None of the above

A

G. None of the above

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3
Q

Often, BAL is used in conjunction with HRCT, medical history, and physical examination to determine the need for a surgical biopsy. HRCT stands for:

A

High-resolution computerized tomography

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4
Q

A procedure where a fiber-optic bronchoscope is guided into a selected bronchopulmonary segment, usually the right middle or lingular lobe of the lung.

A

Bronchoscopy

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5
Q

Aliquots of this reagent is instilled into the alveolar spaces through the bronchoscope to mix with the bronchial contents and are aspirated for cellular examination and culture.

A

Sterile normal saline

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6
Q

During bronchoscopy, the instillation volume of sterile normal saline is ______ to ______ mL in 20- to 50-mL aliquots.

A

100-300 mL

Note:
First aliquot is discarded; the remaining aliquots are sent either individually or pooled for further analysis

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7
Q

Desired BAL volume for analysis

A

10-20 mL

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8
Q

The minimal volume required for BAL analysis

A

5 mL

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9
Q

Optimal sampling retrieves greater than ____% with a typical recovery range of ___% to ____%.

A

30%; 50%-70%

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10
Q

How much (in percentage) is considered a low-volume recovery in BAL collection?

A

<25%

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11
Q

Low-volume recovery caused by fluid retention may be indicative of what disease?

A

Chronic obstructive lung diseases

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12
Q

BAL specimen must be kept at what temperature?

A

Room

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13
Q

When BAL specimen cannot be delivered to the laboratory within 30 minutes, specimens must be transported at what temperature?

A

4°C

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14
Q

If BAL specimen will not be analyzed immediately, it should be centrifuged, cells resuspended in a nutrient-supplemented medium, and refrigerated at what temperature for how many hours?

A

4°C up to 24 hours

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15
Q

When performing cell counts in BAL specimen, it must be done within _____ hour/s.

A

1

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16
Q

If BAL specimen are in a nutrient supplemented medium, cell counts may be performed within _____ hours/s.

A

3

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17
Q

BAL fluids may be filtered through what type of gauze to remove mucus, phlegm, and dust?

A

50- to 70-um nylon filter

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18
Q

Macroscopic examination of bronchoalveolar lavage takes note of which characteristics?

A

Color and clarity

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19
Q

BAL fluid may be in colors of? (Including normal to abnormal)

A

Colorless
Milky white
Light brown-beige
Gray-beige
Red

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20
Q

Clarity of BAL fluid may be described as? (Including normal to abnormal)

A

Clear
Hazy
Cloudy
Turbid

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21
Q

Appearance of BAL fluid indicating acute diffuse alveolar hemorrhage

A

Bloody

(with increasing intensities during sequential aliquots)

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22
Q

Orange-red BAL fluid is indicative of?

A

Older hemorrhagic syndrome

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23
Q

When orange-red BAL fluid is encountered in the laboratory, what specific content is evaluated by cytochemistry?

A

Intracellular iron

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24
Q

Appearance of BAL fluid that suggests pulmonary alveolar proteinosis

A

Milky or light brown-beige

NOTE:
This appearance indicates accumulation of phospholipid -protein complexes derived from pulmonary surfactant in the lung alveoli

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25
If BAL fluid looks milky, what must be done to the specimen?
Centrifuged
26
Upon centrifugation of milky BAL fluid specimen, a creamy layer on top indicates presence of?
Lipid-protein complexes
27
In performing cell counts on BAL fluid, this reagent may be added to determine cell viability
Trypan blue
28
If hemocytometer is used for cell counting in BAL fluids, WBC counts may be diluted using the BMP LeukoCheck system to facilitate counting. This system contains what dilution of what reagent to lyse the red blood cells?
1 to 100 dilution of ammonium oxalate
29
In using hemocytometer in cell counting of BAL fluids, cells must settle for how long prior to counting?
5 minutes
30
Formula for WBC count of BAL fluids
WBC/uL = (average number of cells x dilution factor x 10) / 9 squares
31
This reagent is used to dilute BAL fluids for RBC counting
Isotonic saline
32
Formula for RBC count of BAL fluids
RBC/uL = (number of cells x dilution factor x 10) / number of squares counted
33
In a normal WBC count, there should be no more than ____ cell difference between the highest and lowest total number of cells found among the squares counted.
15
34
In a normal RBC count, there should be no more than ____ cell difference between the highest and lowest total number of cells found among the squares counted.
30
35
For BAL fluids, total cell counted on each side of the counting chamber must agree within ___% of each other.
10
36
TRUE or FALSE: BAL body fluids may not be counted on the Sysmex instrumentation because of the varied types of cells present.
TRUE
37
For leukocyte counting in BAL fluids, differential slides are prepared by cytocentrifugation using routine procedures with what stain?
Wright-Giemsa or May Grunwald-Giemsa
38
For leukocyte counting in BAL fluids using differential slides, what is the minimum number of cells to be counted and classified?
At least 300
39
For leukocyte counting in BAL fluids using differential slides, what is the typical number (range) of cells to be counted and classified?
500-1000
40
These are white blood cells seen most frequently in BAL fluids.
Macrophages (ranges from 56%-80%)
41
Predominance of this type of cell suggests smoking-related interstitial lung disease or pulmonary Langerhans cell histiocytosis
Macrophages
42
Lymphocytes constitute what percentage of the cell population in BAL fluids?
1%-15%
43
Increased number of lymphocytes in BAL fluid is seen in all of the following conditions, except: A. Interstitial lung disease B. Pulmonary lymphoma C. Drug reactions D. Toxin exposure E. Nonbacterial infections
D. Toxin exposure NOTE: In cases of toxin exposure, the predominant cell is neutrophil.
44
A lymphocyte differential count equal to or greater than 25% suggests what disease?
Granulomatous lung disease
45
A lymphocyte differential count greater than 50% suggests what disease/s?
Hypersensitivity pneumonitis or nonspecific interstitial pneumonia.
46
Indicate whether the CD4/CD8 lymphocyte ratio is LOW, NORMAL, or HIGH in the following conditions: Hypersensitivity pneumonitis
Low
47
Indicate whether the CD4/CD8 lymphocyte ratio is LOW, NORMAL, or HIGH in the following conditions: Silicosis
Low
48
Indicate whether the CD4/CD8 lymphocyte ratio is LOW, NORMAL, or HIGH in the following conditions: Drug-induced disease
Low
49
Indicate whether the CD4/CD8 lymphocyte ratio is LOW, NORMAL, or HIGH in the following conditions: HIV infection
Low
50
Indicate whether the CD4/CD8 lymphocyte ratio is LOW, NORMAL, or HIGH in the following conditions: Tuberculosis
Normal
51
Indicate whether the CD4/CD8 lymphocyte ratio is LOW, NORMAL, or HIGH in the following conditions: Malignancies
Normal
52
Indicate whether the CD4/CD8 lymphocyte ratio is LOW, NORMAL, or HIGH in the following conditions: Sarcoidosis
High
53
Indicate whether the CD4/CD8 lymphocyte ratio is LOW, NORMAL, or HIGH in the following conditions: Connective tissue disorder
High
54
This is the primary granulocyte seen in BAL fluids
Neutrophil
55
Normal value of neutrophils (in percentage) seen in BAL fluid
<3%
56
A neutrophil count equal to or greater than 50% strongly suggests what condition/s?
Acute lung injury Aspiration pneumonia Suppurative infection
57
Eosinophils constitute what percentage to cell population in BAL fluids?
B. Diffuse alveolar damage
58
An eosinophil differential count greater than or equal to 25% diagnosis what condition?
Eosinophilic lung disease
59
What disease is suggested by the presence of the following: Mast cell diff count >1% Lymphocyte count >50% Neutrophil count >3%
Hypersensitivity pneumonitis
60
Type of cell present that indicates an alveolar hemorrhage has occurred within the past 48 hours
Phagocytosed erythrocytes
61
Type of cell present that indicates an alveolar hemorrhage older than 48 hours?
Hemosiderin-laden macrophages
62
In a lavage specimen, epithelial cells normally range from __% to __%.
4% to 17%
63
BAL is an important test to identify this organism where characteristic amorphous material is seen microscopically under LPO, and organisms are visible under HPO.
P. jirovecii
64
In cytological studies, what stain is used to observe sulfur granules, hemosiderin-laden macrophages, Langerhans cells, cytomegalic cells, and fat droplets seen in fat embolism?
Oil Red O stain
65
In cytological studies, what stain is used to observe lipid-laden alveolar macrophages?
Sudan III
66
Stains which can be used to diagnose cases of pulmonary alveolar proteinosis or aspiration
Periodic Acid-Schiff, Oil Red O
67
List of viruses which can be isolated from BAL fluid
Cytomegalovirus Herpes simplex virus Varicella-zoster virus Adenoviruses Measles Influenza A and B Respiratory syncytial virus
68
List of fungi which can be isolated from BAL fluid
Aspergillus P. jirovecii Histoplasma capsulatum Blastomyces dermatitidis Coccidioides immitis Cryptococcus neoformans Mucor Candida
69
List of bacteria which can be isolated from BAL fluid
S. aureus (MSSA, MRSA) S. pneumoniae M. pneumoniae Chlamydia L. pneumophila S. stercoralis (parasite) Actinomyces M. tuberculosis K. pneumoniae E. coli
70
Immunological study of cells is typically performed by what method?
Flow cytometry
71
This is an opportunistic pathogen in patients with AIDS that can be recovered in BAL fluid
Cryptococcus neoformans

AUBF (5 decks)

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