Chest
Volume 103, Issue 6, June 1993, Pages 1720-1724
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Clinical Investigations
Differential Diagnostic Value of Plasma Cells in Bronchoalveolar Lavage Fluid

https://doi.org/10.1378/chest.103.6.1720Get rights and content

The aim of this study was to investigate whether the demonstration of plasma cells (PC), which are normally absent in bronchoalveolar lavage (BAL) fluid, facilitates differentiation among pulmonary disorders. Initial BAL fluid samples of 1,260 patients were analyzed. In 83 of these, PC were found. Of these 83, 47 were obtained from individuals suffering from extrinsic allergic alveolitis (EAA). The number of PC in BAL fluid from EAA patients was found related to the time between antigen exposure and BAL. Drug-induced pneumonitis appeared to be another disorder with a high percentage of cases with PC in the BAL fluid (35.7 percent). Therefore, we conclude that determination of PC in BAL fluid has differential diagnostic value in discrminating among interstitial lung diseases of various origins. However, the exact role of BAL fluid and PC and the link to clinical manifestations of these diseases needs further investigation.

(Chest 1993; 103:1720-24)

Section snippets

Patients

Retrospectively, the initial BAL fluid samples of 1,260 patients with a great variety of pulmonary diseases were selected for study out of all BAL fluid analyses (n = 2,008) performed over a ten-year period between 1980 and 1990.

Bronchoalveolar Lavage

Bronchoalveolar lavage was performed as previously reported during fiberoptic bronchoscopy.3 At the same time, blood samples were drawn for differentia] cell counts. In short, the procedure is as follows. After premedication with atropine and sometimes diazepam and

RESULTS

In 6.6 percent (n = 83) of the cases, PC were detected in the BAL fluid (Fig 1, Table 1). Patients with PC in BAL fluid were most frequently found among those with verified EAA (EAA-group A; 36 of 69 [52.1 percent]). Also, patients with mere clinical symptoms of EAA (EAA-group B; 11 of 26 [42.3 percent]) and those with drug-induced pneumonitis (5 of 14 [35.7 percent]) showed PC in BAL fluid (Table 1). Among the remaining interstitial lung diseases, PC were found in 7 of 100 patients with

DISCUSSION

Plasma cells are seldom found in BAL fluid. Morphologically, these cells can be identified in a routine May-Grünwald-Giemsa-stained slide. The incidence of PC in BAL fluid has been reported in a number of pulmonary disorders, especially in EAA.9 In the present study, PC were found in the BAL fluid obtained from 36 of 69 patients with serologically proven EAA and in 11 of 26 patients with clinical manifestations of the disease. Since nearly no BAL fluid PC were found in other interstitial lung

ACKNOWLEDGMENTS

We gratefully acknowledge Dr. Paul H. G. Mulder for his help with the statistical analysis, Dr. H. C. Hoogsteden for his critical comments, and Mrs. Els Tuenter for her excellent technical assistance.

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    This study was supported by a grant from Glaxo BV, the Netherlands.

    Manuscript received June 18; revision accepted September 15.

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