Bronchoalveolar Lavage in the Normal Volunteer Subject* - Chest

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OBSERVATIONS
FIGURE 3. Scattergrams of the percentage of A, alveolar macrophages;
B, lymphocytes; C, neutrophils; and D, eosinophils (as
determined by analysis of cytocentrifuge preparation of BAL cells
from 78 consecutive normal volunteer subjects).
extremely rare and were similarly not included in the
differential analysis.
Viability of BAL Cells
The viability (mean +±SD) of BAL cells was
91.4 8.6 percent with a range from 66 to 100 percent.
Viability of cells from seven subjects (9 percent) was
less than 80 percent, but there was no evident
explanation for the lower than normal cell viability
Safety and ComplicationslAdverse Reaction
There were no complications of any consequence
related to the performance of BAL in any subject.
Virtually all subjects noted mild transient light headedness
of 15 to 20 minute duration immediately
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following termination of the BAL. Approximately 50
percent of the subjects reported being more tired than
usual for up to 24 hours following the BAL. Subjects
were specifically requested to monitor for fever, but
only seven reported any temperature elevation and in
only one subject was the elevation >37.7°C. This
isolated subject noted onset offever (39.1C) and chills
approximately four hours after the procedure which
subsided over the next 24 hours without morbid
sequelae. No cardiac arrhythmias were noted.
DISCUSSION
There is considerable variation in the manner in
which BAL is performed and the specimen processed
in both clinical and research applications of BAL.
There is little evidence to support the use of one
technique over the other, and in all likelihood, if BAL
specimens are processed similarly in an individual
laboratory, results may be compared to the locally
established norms. However, there may be some
danger in comparing results obtained and published
by other investigators who may have used a different
size bronchoscope or processing techniques. More-
may also limit comparison of results of in vitro
functional assays in which BAL cells are used. The
purpose of the current study was not to promote or
espouse a particular method, but rather to report on
the subject-to-subject variability in BAL results found
in a relatively large population of normal subjects
when using rigidly controlled conditions.
All bronchoscopies and processing of the BAL
specimens were performed by or under the direct
supervision of one experienced individual, and all
BAL was performed using the same diameter bronchoscope,
the same type of fluid, the same relative
location (lingula), at the same time of day. The subject
pool was also controlled by several criteria. Despite
the uniformity of the BAL protocol, there was considerable
variability in both the percentage of return and
cell number obtained (Table 1) and with the exception
of BALs with low percentage return, there was no
correlation between cell number and percentage of
return. There was also no correlation of either value
with any lung volume. Similarly, there was no correlation
ofnumbers of lavage cells per milliliter lavageate
with any lung volume. Not surprisingly then, even
though female subjects had significantly smaller lung
volumes than males, there was no correlation between
cell numbers or percentage of return and the gender
of the lavage subject and no significant gender-related
differences in any lavage parameter. A possible explanation
of this observation may be that similar surface
area of lung was lavaged in all subjects irrespective of
lung size. Since the same diameter bronchoscope was
used for all subjects, it is likely that bronchi of nearly
BAL in Normal Volunteer Subjects. 1. Technical Aspects (Ettensohn et al)