Bronchoalveolar lavage in normal cats
Manon Lecuyer, Pierre-Gregoire Dube, Rocky DiFruscia, Michel Desnoyers, Andre Lagace
In several species (3-5,7), including man, broncho-
scopic bronchoalveolar lavage (BAL) is a frequently
used, low-risk technique, that evaluates cellular com-
ponents of the lower airways, and determines humoral
elements (5-7). The procedure also provides visual
assessment of the lower airways (5-7).
The cytological reference values for BAL in cats are
quite variable, and much debate exists, especially con-
cerning the proportion of eosinophils (2,5-7). In certain
species, like man, the horse, and the dog, the percentage
of eosinophils retrieved from bronchoalveolar lavage
should be less than 5% (3,4), but in the normal cat,
several studies have confirmed that the number of
eosinophils can exceed 5% (1,5,7). However, in many of
these studies, complete preliminary physical evalua-
tion or histological examination of the lungs was not rou-
tinely performed (1,7).
Since it is difficult to obtain reliable ranges of normal
values for bronchoalveolar cellular distribution, com-
plementary evaluations are required to improve the
accuracy of the diagnosis of pathology with BAL. Since
lactate dehydrogenase (LDH) is an intracytoplasmic
epithelial enzyme, measurement of LDH activity could
be indicative of epithelial cell injury associated with dis-
ease of the respiratory tract (5,8). In humans and dogs,
but not in cats, the isoenzyme LDH3, has been identified
and measured (8). Also, quantification of various immuno-
globulins and proteins may have a diagnostic value in
supporting the presence of inflammation (9,10). High
levels of immunoglobulins are retrieved from the BAL
of inflammed respiratory tracts in man, with plasmatic
transudation or local production of immunoglobulins
being the suggested mechanism (9). Only a few veteri-
nary studies have involved the measurement of
immunoglobulins A, G, and albumin (5).
The purpose of this study was three-fold: i) to deter-
mine the cellular population of the lower respiratory tract
of the normal cat; ii) to quantify immunoglobulin G
in the BAL; and iii) to measure LDH activity and to
establish a range of values for the normal cat.
Ten adult cats, 8 males and 2 females, were obtained
from a closed colony. All cats had been properly vac-
cinated and treated for intestinal parasites. They were
conditioned for 30 d prior to a complete clinical evalu-
ation that included: physical examination; hematology;
biochemical profile; testing for feline leukemia virus
(FeLV ELISA, Langford, Guelph, Ontario), feline
immunodeficiency virus (FIV Antibodies, Langford), and
Can Vet J 1995; 36: 771-773
Department of Clinical Studies, Small Animal Medicine
(LUcuyer, Dube, DiFruscia), Department of Clinical Pathology
(Desnoyers) and Department of Pathology (Lagace), Faculte
de medecine veterinaire, Universite de Montreal, C.P. 5000,
St-Hyacinthe, Quebec J2S 7C6.
This project was financially supported by the Animal Health
Trust of Canada, Toronto, Ontario.
Can Vet J Volume 36, December 1995
heartworm disease (Unitec CHW, Synbiotics Corp.,
San Diego, California); fecal flotation; and pulmonary
radiography (left lateral and ventrodorsal views). Based
on the results of the above evaluations, all of the cats
were judged to be normal and were included in the
study.
The following anesthetic protocol was utilized for each
subject: 15 to 20 min prior to induction, the cats received
glycopyrrolate (Robinul, Wyeth. Ayerst, Montreal,
Quebec), 0.01 mg/kg/body weight (BW), SC, followed
by anesthetic induction with a combination of diazepam
(Valium, Hoffman-LaRoche, Mississauga, Ontario)
(0.1 mg/kg/BW) and ketamine hydrochloride (Rogarsetic,
rogar/STB, Pointe-Claire, Quebec) (from 5.0 to 10.0 mg/kg/
BW) given IV. The animals were intubated with sterile
endotracheal tubes. Anesthesia was maintained with
halothane at a concentration of 1.5% until an adequate
level of anesthesia was obtained for the procedure. The
animals were extubated to allow the introduction of
the 4 mm diameter bronchoscope (Olympus, RF type
P20D, Lake Success, New York). Care was taken to
avoid excessive pharyngeal and laryngeal contamination
of the bronchoscope, which was subsequently wedged
snuggly against the smallest possible airway of the left
lung (secondary bronchus of the caudal lobe). Pure
oxygen was administered through a sterile tube (Feeding
tube type, 5 french, Seamless, Ocala, Florida), inserted
alongside the bronchoscope. Arterial blood gas analyses
were determined at the beginning and at the end of
each bronchoscopy. If the anesthetic level became inad-
equate to allow bronchoscopy, ketamine hydrochloride
was administered as a 10 mg bolus, IV.
Two 5 mL aliquots were injected through the col-
lecting port of the bronchoscope and retrieved. The
same process was then repeated at the same level in the
right lung. Four sequential 5 mL aliquots of sterile,
nonbacteriostatic, 0.9% saline were injected. The col-
lecting aliquots were mixed together and preserved in
sterile tubes containing EDTA and submitted for cyto-
logical examination within 15 min. For biochemical
analyses, samples were collected in sterile tubes without
anticoagulant.
All cats were humanely euthanized immediately after
recovery from anesthesia.
Quantitative determination of LDH activity was done
using an enzymatic assay (Synchron CX Systems,
Beckman, Brea, California). Immunoglobulins G (IgG)
were measured by radial immunodiffusion (Vet Rid,
Bethyl Laboratories, Montgomery, Texas).
Absolute cell counts were performed by hemocy-
tometer (Unopette, Becton Dickinson, Rutherford,
New Jersey). Aliquots were cytocentrifuged at 1000 RPM
for 5 min. The samples were not filtered. Smears were
prepared with Wright's stain. Epithelial cells were
excluded from the count. All cytologic interpretations
were done by the same clinical pathologist.
The lungs of each cat were preserved in 10% forma-
lin until sectioned for histology. Sections of the right and
771
 Table 1. Total cellular count and differential, and values obtained for lactate dehydrogenase and
immunoglobulins G from bronchoalveolar lavages of 8 cats
Retrieval Percentage of cells
volume TCCa LDHf IgGg
Cat (mL) X 109/L MACb NEUTC EOSINd LYMPHe (u/L) (g/L)
1 12.6 nd 0.66 0.04 0.26 0.04 23 0
2 10.6 0.27 0.56 0.23 0.09 0.12 27 0
3 11.0 0.21 0.65 0.04 0.22 0.09 43 0
4 13.0 0.31 0.75 0.02 0.23 0 95 1.16
5 6.4 nd 0.78 0.16 0.05 0.01 3 0.74
6 11.2 0.45 0.86 0.10 0.04 0 65 0.52
7 6.0 0.91 0.32 0.65 0 0.03 1 0
8 10.4 0.16 0.25 0.65 0 0.10 90 0

Mean ± s 0.28 ± 0.27 0.60 ± 0.21 0.24 ± 0.25 0.11 ± 0.09 0.05 ± 0.04 43.0 ± 35.0 0.30 ± 0.42
aTCC = total cellular count
bMAC = macrophages
CNEUT = neutrophils
dEOSIN = eosinophils
eLYMPH = lymphocytes
(LDH = lactate dehydrogenase
gIgG = immunoglobulins G

left cranial lobes, the right and left caudal lobes, and the
right middle lobe were made and stained with hema-
toxylin, phloxin, and saffranin (HPS). Interpretation of
the tissue was done by the same histopathologist.
Data are expressed in absolute values (range of obser-
vation), percentage, mean, and standard deviation.
Airways visualized at bronchoscopy appeared normal
in all cats. No adverse reactions were noted during and
after bronchoscopy. Results of arterial blood gases
were quite variable (data not shown), but none of them
showed major hypoxia associated with the procedures.
In 2 cats, microscopic examination of the pulmonary
tissue revealed an important infiltration of inflammatory
cells, predominantly macrophages and neutrophils, in dif-
ferent regions of the pulmonary parenchyma. Although
analyses of the BAL were comparable with those of
the other cats, these 2 cats were excluded from the
study.
Minimal peribronchial lymphoid foci were observed
in cats 2 and 7. These foci were present in more than
1 lobe. Their BAL values were comparable with those of
the other cats with respect to lymphocyte count, and LDH
and IgG content. These 2 cats were kept in the study. The
remaining 6 cats had normal histological findings in
the lungs.
Only 50% of the fluid injected for BAL was retrieved
in most cats. Mean specific gravity of the fluid was
1.006 0.001 and mean total solids were 0.37 0.48 g/L.
± ±
Complete results are shown in Table 1.
Bronchoscopic bronchoalveolar lavage is a safe diag-
nostic procedure to evaluate conditions of the lower
respiratory tract in the cat. It is also a simple and reliable
method of collecting cellular and humoral elements
from the respiratory epithelium. No major complications
were noted during the procedure, but it is important to
note that they were done on clinically normal cats with-
out any prior pulmonary compromise of significance.
The low retrieval rate, compared with others studies
(1,5), could be explained by small volume instillation,
inexperience, technical problems, or difficulties in
properly wedging the bronchoscope in the smallest
possible airway.
The exact significance of the peculiar histopatho-
logic finding in cats 2 and 7 is unknown. Possible
explanations include normal variations of bronchial
associated lymphoid tissue, or an active or chronic
immunologic response to infectious or allergenic agents
(12). This finding also suggests that minor histopatho-
logic abnormalities may not be detected with cytology
alone. Histological abnormalities, such as, bronchial
gland and goblet cell hyperplasia, mucus accumula-
tion and purulent exudate, inflammatory infiltration or
smooth muscle hypertrophy, were specifically searched
for but not identified in all other cats included in the
study.
Alveolar macrophages represented the predominant
population of cells and confirmed that fluid did reach the
alveoli. This also agrees with previous reports (1,5-7,1 1).
Mean neutrophil percentages were higher in our study
compared with values reported in the literature (7).
Cats 7 and 8 had a BAL neutrophil percentage of 65%,
although no evidence of neutrophilic inflammation was
seen on histological examination. Reference values
obtained in this study for eosinophils were variable
(range from 0% to 26%). According to different authors
(5,7,11), eosinophils can represent up to 28% of the
total cell count in the BAL of normal cats. Our results
agree with these previous reports.
Higher activity of LDH is an indication of cellular lysis
or damage from any cause (trauma, irritation, infection,
inflammation) (8). Values obtained in this study are
comparable with those published for rodents (8). The
significance of this determination in cats has yet to be
evaluated in the context of pulmonary disease. Other
diagnostic procedures, such as, determination of
eosinophils density and the phagocytic function of
macrophages and neutrophils, would also require study.
The determinations obtained from samples collected
by BAL could have 2 important diagnostic functions: the
1 st would be establishing as accurately as possible the

772 Can Vet J Volume 36, December 1995

link between definite pathological processes and the
type of cellular or humoral response obtained, and the
2nd would be evaluating progression of the disease or
response to therapy from serial collections of BAL.
Acknowledgment
The authors thank Mr. Louis Legendre for technical
assistance. cvi
References
1. Hawkins EC, DeNicola DB. Collection of bronchoalveolar lavage
fluid in cats, using an endotracheal tube. Am J Vet Res 1989; 50:
855-859.
2. Padrid PA, Koblik PD. The techniques used to diagnose feline res-
piratory disorders. Vet Med 1990: 956-985.
3. Rebar AH, DeNicola BA. Bronchopulmonary lavage cytology in
the dog: normal findings. Vet Pathol 1980; 17: 294-304.
4. Derksen FJ, Brown CM, Sonea I, Darien BJ, Robinson NE.
Comparison of transtracheal aspirate and bronchoalveolar lavage
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5. Padrid PA, Feldman BF, Funk K, Samitz EM, Reil D, Cross CE.
Cytologic, microbiologic, and biochemical analysis of broncho-
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1991;52: 1300-1307.
6. Moise NS, Blue JT. Bronchial washings in the cat: Procedure
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7. McCarthy GM, Quinn PJ. Bronchoalveolar lavage in the cat:
Cytological findings. Can J V-et Res 1989; 53: 259-263.
8. Henderson RF, Damon EG, Henderson TR. Early damage indi-
cators in the lung I. Lactate dehydrogenase activity in the airways.
Toxicol Appl Pharmacol 1978; 44: 291-297.
9. Bell DY, Haseman JA, Spock A, McLennan G, Hook GER.
Plasma proteins of the bronchoalveolar surface of the lungs
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72-79.
10. Falk GA, Okinaka AJ, Siskind GW. Immunoglobulins in the
bronchial washings of patients with chronic obstructive pulmonary
disease. Am Rev Respir Dis 1972; 105: 14-21.
11. McCarthy G. Quinn PJ. The development of lavage procedures
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12. Reynolds HY. Bronchoalveolar lavage. Am Rev Respir Dis 1987;
135: 250-263.

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