LETTER
Quantifying Lymphocytes in Bronchoalveolar Lavage Fluid
Ware G. Kuschner and
James K. Brown
15 November 1993 | Volume 119 Issue 10 | Pages 1050-1051
TO THE EDITOR:
In their recent article, Roberts and colleagues [1] reported cell counts and differentials in specimens obtained by bronchoalveolar lavage before and after radiotherapy in 17 women with breast cancer. The authors observed increases in the total number and percentage of lymphocytes after irradiation, especially in those who developed clinical pneumonitis. They concluded that a generalized lymphocyte-mediated hypersensitivity reaction may play a role in the development of radiation pneumonitis.
The authors did not, however, provide an explanation for the striking elevation in the mean percentage of lymphocytes in bronchoalveolar lavage specimens obtained before irradiation. In normal bronchoalveolar lavage fluid, lymphocytes typically account for fewer than 15% of the total cells. Measurements using the millipore filter method may be slightly higher (about 35% more than in cytocentrifuge preparations) [2]. This differential is not sufficient to explain the findings of a mean bronchoalveolar lavage lymphocyte percentage of 34.5% in patients before irradiation.
We need to know the range of normal values for bronchoalveolar lavage cell count and differential in the laboratory that did the cell counts to determine whether an alveolar lymphocytosis was present before irradiation or if what appear to be elevated values are within that laboratory's normal range. Otherwise, the significance of the increase in bronchoalveolar lavage lymphocytes after irradiation and their role in radiation pneumonitis are less clear.
1. Roberts CM, Foulcher E, Zaunders JJ, Bryant DH, Freund J, Cairns D, et al. Radiation pneumonits: a possible lymphocyte-mediated hypersensitivity reaction. Ann Intern Med. 1993; 118:696-700.
2. Saltini C, Hance AJ, Ferrans VJ, Basset F, Bitterman PB, Crystal RG. Accurate quantification of cells recovered by bronchoalveolar lavage. Am Rev Respir Dis. 1984; 130:650-8.
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