BRONCHOALVEOLAR LAVAGE DURING NEUTROPENIC EPISODES - DIAGNOSTIC YIELDAND CELLULAR-PATTERN

Few data are available concerning the relationship between alveolar an d blood cell populations during neutropenia. We wanted to compare the value of pulmonary endoscopic procedures with lavage in neutropenic (p olymorphonuclear (PMN) count less than or equal to 1,000.mm(-3)) and n on-neutropenic settings. We therefore, retrospectively, reviewed the r esults of 118 investigations for pneumonia in patients with malignant haematological diseases. All had bronchoalveolar lavage (BAL), and som e had additional studies with protected bacteriological samples. Each BAL specimen was studied after cytocentrifugation by cytological exami nation for opportunistic infections, haemorrhage, virus, legionellae, and bacteriological cultures. The diagnostic yield of all endoscopic p rocedures (BAL, telescoping plugged catheter and protected specimen br ash) was 53% in neutropemic (Group 1) and 61% in non-neutropenic (Grou p 2) patients. The aetiological pattern of pneumonia was nearly the sa me in the two groups, except for more alveolar proteinosis in Group 1 and more cytomegalovirus (CMV) in Group 2. The absolute number of alve olar cells recovered through BAL (total number, macrophages, lymphocyt es and PMNs) was significantly lower in neutropenic patients. We concl ude that: 1) neutropenic patients with pneumonia require the same inve stigative approach as non-neutropenic patients; 2) profound neutropeni a may be concomitant with a decreased cellularity of alveoli, which ma y reflect the consequences of marrow aplasia on the pulmonary cell pop ulation and/or direct effect of chemotherapy on the lung.