Role of Bronchoalveolar Lavage in the Evaluation of Interstitial Pneumonitis in Recipients of Bone Marrow Transplants

Overview

Journal Thorax

Date 1987 Oct 1

PMID 2827335

Citations 7

Authors

H J Milburn

H G Prentice

R M du Bois

Affiliations

Soon will be listed here.

Abstract

Forty episodes of pneumonitis in 30 recipients of allogeneic bone marrow transplants were investigated by fibreoptic bronchoscopy and bronchoalveolar lavage. A positive diagnosis was made in 32 episodes of pneumonitis (24 patients), giving a diagnostic yield of 80%. In 31 of these the diagnosis was made within 24 hours of bronchoscopy and this enabled the appropriate treatment to be instituted early. Eighteen patients recovered from their primary infection, although two died subsequently of respiratory failure due to postpneumonic lung destruction. Ten patients later developed a second episode of pneumonitis and a diagnosis was made in nine of these. Only three survived a second episode. Bronchoalveolar lavage was well tolerated by all patients and there was no morbidity or mortality that could be directly attributed to the procedure. Bronchoalveolar lavage is a safe and valuable early diagnostic procedure for the investigation of pulmonary complications in patients who have received bone marrow transplants.

Citing Articles

Microbiologic yield of bronchoalveolar lavage specimens from stem cell transplant recipients.

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Investigation and management of pulmonary infiltrates following bone marrow transplantation: an eight year review.

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The many uses of bronchoalveolar lavage.

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Humoral immune responses within the lung of bone marrow transplant recipients studied by bronchoalveolar lavage.

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References

Kalinske R, Parker R, Brandt D, Hoeprich P . Diagnostic usefulness and safety of transtracheal aspiration. N Engl J Med. 1967; 276(11):604-8. DOI: 10.1056/NEJM196703162761103. View

Shepp D, Dandliker P, de Miranda P, Burnette T, Cederberg D, Kirk L . Activity of 9-[2-hydroxy-1-(hydroxymethyl)ethoxymethyl]guanine in the treatment of cytomegalovirus pneumonia. Ann Intern Med. 1985; 103(3):368-73. DOI: 10.7326/0003-4819-103-3-368. View

ANDERSEN H, FONTANA R . Transbronchoscopic lung biopsy for diffuse pulmonary diseases: technique and results in 450 cases. Chest. 1972; 62(2):125-8. DOI: 10.1378/chest.62.2.125. View

Flick M, Wasson K, Dunn L, Block A . Fatal pulmonary hemorrhage after transbronchial lung biopsy through the fiberoptic bronchoscope. Am Rev Respir Dis. 1975; 111(6):853-6. DOI: 10.1164/arrd.1975.111.6.853. View

Davidson M, Tempest B, PALMER D . Bacteriologic diagnosis of acute pneumonia. Comparison of sputum, transtracheal aspirates, and lung aspirates. JAMA. 1976; 235(2):158-63. View

ZAVALA D . Pulmonary hemorrhage in fiberoptic transbronchial biopsy. Chest. 1976; 70(5):584-8. DOI: 10.1378/chest.70.5.584. View

Cunningham J, ZAVALA D, Corry R, Keim L . Trephine air drill, bronchial brush, and fiberoptic transbronchial lung biopsies in immunosuppressed patients. Am Rev Respir Dis. 1977; 115(2):213-20. DOI: 10.1164/arrd.1977.115.2.213. View

Neiman P, Reeves W, Ray G, Flournoy N, Lerner K, Sale G . A prospective analysis interstitial pneumonia and opportunistic viral infection among recipients of allogeneic bone marrow grafts. J Infect Dis. 1977; 136(6):754-67. DOI: 10.1093/infdis/136.6.754. View

Leight Jr G, Michaelis L . Open lung biopsy for the diagnosis of acute, diffuse pulmonary infiltrates in the immunosuppressed patient. Chest. 1978; 73(4):477-82. DOI: 10.1378/chest.73.4.477. View

10.

Kelley J, Landis J, Davis G, Trainer T, Jakab G, Green G . Diagnosis of pneumonia due to Pneumocystis by subsegmental pulmonary lavage via the fiberoptic bronchoscope. Chest. 1978; 74(1):24-8. DOI: 10.1378/chest.74.1.24. View

11.

Winston D, Gale R, Meyer D, Young L . Infectious complications of human bone marrow transplantation. Medicine (Baltimore). 1979; 58(1):1-31. DOI: 10.1097/00005792-197901000-00001. View

12.

Davis G, Kelley J . Invasive techniques for the diagnosis of respiratory infections. Clin Lab Med. 1982; 2(2):269-83. View

13.

Meyers J, Flournoy N, Thomas E . Nonbacterial pneumonia after allogeneic marrow transplantation: a review of ten years' experience. Rev Infect Dis. 1982; 4(6):1119-32. DOI: 10.1093/clinids/4.6.1119. View

14.

Sloane J, Depledge M, Powles R, Morgenstern G, Trickey B, Dady P . Histopathology of the lung after bone marrow transplantation. J Clin Pathol. 1983; 36(5):546-54. PMC: 498284. DOI: 10.1136/jcp.36.5.546. View

15.

Puksa S, Hutcheon M, Hyland R . Usefulness of transbronchial biopsy in immunosuppressed patients with pulmonary infiltrates. Thorax. 1983; 38(2):146-50. PMC: 459505. DOI: 10.1136/thx.38.2.146. View

16.

Hopkin J, Turney J, Young J, Adu D, Michael J . Rapid diagnosis of obscure pneumonia in immunosuppressed renal patients by cytology of alveolar lavage fluid. Lancet. 1983; 2(8345):299-301. DOI: 10.1016/s0140-6736(83)90287-8. View

17.

Coleman D, Dodek P, Luce J, Golden J, Gold W, Murray J . Diagnostic utility of fiberoptic bronchoscopy in patients with Pneumocystis carinii pneumonia and the acquired immune deficiency syndrome. Am Rev Respir Dis. 1983; 128(5):795-9. DOI: 10.1164/arrd.1983.128.5.795. View

18.

Prentice H, Blacklock H, Janossy G, Gilmore M, Tidman N, Trejdosiewicz L . Depletion of T lymphocytes in donor marrow prevents significant graft-versus-host disease in matched allogeneic leukaemic marrow transplant recipients. Lancet. 1984; 1(8375):472-6. DOI: 10.1016/s0140-6736(84)92848-4. View

19.

Stover D, Zaman M, HAJDU S, Lange M, Gold J, Armstrong D . Bronchoalveolar lavage in the diagnosis of diffuse pulmonary infiltrates in the immunosuppressed host. Ann Intern Med. 1984; 101(1):1-7. DOI: 10.7326/0003-4819-101-1-1. View

20.

Stover D, White D, Romano P, Gellene R . Diagnosis of pulmonary disease in acquired immune deficiency syndrome (AIDS). Role of bronchoscopy and bronchoalveolar lavage. Am Rev Respir Dis. 1984; 130(4):659-62. DOI: 10.1164/arrd.1984.130.4.659. View