BAL Cell Count

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Amylacea

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I am interested in improving our BAL cell counts. How does your lab perform these? For certain lung ILD, the cell counts can be helpful, and the pulmonologists would like some better information rather than "suboptimal for evaluation". I think our methods need some tweaking (the lab is not thrilled with that idea). Do you use any preservatives? Limit time interval to processing? Filter to remove mucus? Currently, the lab puts the BAL in a purple top and makes a cytospin. That's pretty much it. I am new to this department, but seems like there is room for improvement. Any references to point me to? Thanks.

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How does your lab perform these?
We use a cytospin machine and then calculate the cell count using a formula based on number of cells visualized in a set field:
(Average #cells counted x 10) / (# large squares counted in hemogram field) x dilution factor = cells/mm3

Do you use any preservatives?

For the cytospin, we use 1 drop of albumin + 5 drops of the pt's sample.
If the sample is to bloody/cloudy, you can dilute with saline (this happens more often with pleural fluids than BAL's). Remember to multiply your dilution factor!

Limit time interval to processing?

Within 4h of being received. Beyond that, cell integrity can be compromised and the risk of a signing out a "suboptimal for evaluation" increases.

Filter to remove mucus?
No filter. If it's too viscous, add hyaluronidase which helps break it up.
 
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