Bronchoalveolar llavage dduring nneutropenic eepisodes: diagnostic yyield aand ccellular ppattern

Few data are available concerning the relationship between alveolar and blood cell populations during neutropenia. We wanted to compare the value of pulmonary endoscopic procedures with lavage in neutropenic (polymorphonu- clear (PMN) count ≤1,000·mm-3) and non-neutropenic settings. We therefore, retrospectively, reviewed the results of 118 investigations for pneu- monia in patients with malignant haematological diseases. All had bronchoalveolar lavage (BAL), and some had additional studies with protected bacteriological sam- ples. Each BAL specimen was studied after cytocentrifugation by cytological exam- ination for opportunistic infections, haemorrhage, virus, legionellae, and bacteriological cultures. The diagnostic yield of all endoscopic procedures (BAL, telescoping plugged catheter and protected specimen brush) was 53% in neutropenic (Group 1) and 61% in non- neutropenic (Group 2) patients. The aetiological pattern of pneumonia was nearly the same in the two groups, except for more alveolar proteinosis in Group 1 and more cytomegalovirus (CMV) in Group 2. The absolute number of alveolar cells recovered through BAL (total number, macrophages, lymphocytes and PMNs) was significantly lower in neutropenic patients. We conclude that: 1) neutropenic patients with pneumonia require the same inves- tigative approach as non-neutropenic patients; 2) profound neutropenia may be con- comitant with a decreased cellularity of alveoli, which may reflect the consequences of marrow aplasia on the pulmonary cell population and/or direct effect of chemother- apy on the lung.

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