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Quantifying Lymphocytes in Bronchoalveolar Lavage Fluid
- Gregory C. Kane, MD
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TO THE EDITOR:
I read with great interest the recent article by Roberts and colleagues [1]. Of concern was the marked lymphocytosis present in lavage fluid before irradiation, as well as the slightly elevated cell count. The patients had an increased total cell count (22.4 106 cells with 61% macrophages, 34.5% lymphocytes, and 4% neutrophils). Such an increase in cellularity and prominent lymphocytosis represents a markedly abnormal baseline. In studies reviewed by the Bronchoalveolar Lavage Cooperative Group Steering Committee, total cell counts were generally less than 16 106 cells in nonsmoking patients when the lavage volume was 150 mL. The percentage of lymphocytes in bronchoalveolar lavage fluid in normal persons is universally less than 20% (10% on average). In normal smokers, the total cell count is generally increased on the order of 30 to 50 106 cells, with lymphocytes not expected to exceed 8% [2].
This finding suggests a baseline lymphocytic alveolitis before any radiotherapy that was apparently exacerbated by a course of unilateral thoracic irradiation.
Determining the cause of this baseline abnormality in these patients is essential before concluding anything about the true effect of unilateral thoracic radiation. These findings could be associated with methotrexate pneumonitis [3] or toxicity from another chemotherapeutic agent, or they could be secondary to extrinsic allergic alveolitis [4] related to a humidifier system or related to another antigen in the local environment. Studying bronchoalveolar lavage fluid obtained before chemotherapy, as well as screening the patients for hypersensitivity pneumonitis, would be helpful to clarify the underlying disorder.
Gregory C. Kane
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
