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Quantifying Lymphocytes in Bronchoalveolar Lavage Fluid
- Ware G. Kuschner, MD; and
- James K. Brown, MD
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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.
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
Include no more than 300 words of text, three authors, and five references
Type with double-spacing
Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright 2004 by the American College of Physicians
