Cellular analysis of bronchoalveolar lavage fluid in various lung lesions

Introduction: Bronchoalveolar lavage (BAL) is a standard tool in the diagnosis of lung diseases. Cellular analysis of BAL fluid when deviates from normal are indicative of an inflammatory/infiltrative process. This study involves an analysis of BAL fluid performed manually and also using an automated analyzer which offers a rapid and reliable method for analysis of unprocessed BAL fluid. Aims and Objectives: To utilize the cellular analysis of bronchoalveolar lavage (BAL) fluid in the diagnosis of various lung diseases. Materials and Methods: 37 patients with pulmonary diseases of varying etiologies were included in this study. Fiberoptic bronchoscopy with BAL was performed. BAL fluid was run in SYSMEX XNL/350 six-part analyzer which gave total and differential cell count (mononuclear and polymorphonuclear cells). The sample was also centrifuged, sediment smears prepared and differential cell counts were determined. Results: Total WBC count ranged from 31 cells/µl to 94 cells/µl with the maximum increase seen in asthma. Mononuclear cells were increased in the majority of cases, being 84% in pneumoconiosis with the predominance of macrophages. An increase in lymphocytes was seen in Non-Specific Interstitial Pneumonia (45.3%) and Bronchiolitis Obliterans Organising Pneumonia (35.3%), neutrophils in Usual Interstitial Pneumonia (26.2%) and eosinophils in Chronic Eosinophilic Pneumonia (55.5%) and asthma (8.4%). There were 58% mononuclear cells and 42% polymorphonuclear cells in tuberculosis. There were two cases of adenocarcinoma and one case of squamous cell carcinoma in the present study. Conclusion: BAL cell differentials when combined with additional clinical and radiographic information help secure a confident diagnosis in lung diseases and help clinicians to make therapeutic decisions.