BRONCHOALVEOLAR LAVAGE (BAL)

 Provide a method for obtaining and microbiological information from the lower - Esosinophilic pneumonia
respiratory tract Ciliated columnar bronchial 4 to 17 %
 Useful in evaluating immunocompromised patients, interstitial lung disease, and epithelial cells
airway diseases
 Detection of any infectious agents present in the lower respiratory tract, obstructions,
pneumonia, carcinoma, hemoptysis, foreign bodies, or abcesses
 BAL - detection of Pneumocystis jiroveci or Aspergillus spp in immunocompromised
patients

METHOD OF COLLECTION:
 Specimens are obtained in surgery using a bronchoscope equipped with suction
catheters, brushes or biopsy attachments
 Bronchial washings - more proximal areas of the bronchoalveolar tree
 BAL - more distal sites to obtain more cellular alveolar material

EXAMINATIONS:
1. CELL COUNT
- Done manually on undiluted specimens by counting cells in one large
square of the neubauer
- No. of cells per mL = No of cells counted X 10, 000
- Total cell count = No. of cells per mL X fluid volume in mL

2. DIFFERENTIAL COUNT
- Prepared by cytocentrifugation using routine procedures
- 300 cells are included in the count

DIFFERENTIAL COUNT IN BAL AND THEIR CLINICAL SIGNIFICANCE

CELLS NORMAL CLINICAL SIGNIFICANCE
Macrophages 56 to 79 % Most frequently seen
Lymphocytes 1 to 10 % Increased in:
- Interstitial lung disease
- Drug reactions
- Pulmonary lymphoma
- Bacterial infections
Neutrophils 3 to 21 % Elevated in:
- Cigarette smokers
- Bronchopneumonia
- Toxin exposure
- Diffuse alveolar damage
Eosinophils <1% Elevated in:
- Bronchial asthma
- Pneumonitis

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