Browsing by Author "Marshall, Michelle Anthea"

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    The investigation of bronchoalveolar lavage fluid in paediatric chronic wheezers
    (Stellenbosch : Stellenbosch University., 2020-03) Marshall, Michelle Anthea; Schubert, Pawel T.; Goussard, Pierre; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Pathology. Anatomical Pathology.
    ENGLISH ABSTRACT: Background: Paediatric broncho-alveolar lavage (BAL) is a minimally invasive procedure, performed during flexible bronchoscopy using isotonic saline to obtain a sample of bronchial and alveolar fluid from the distal lung. The BAL sample provides a determination of the different cell types that are present in the alveolar space as well as establishing the presence of lipid or haemosiderin in alveolar macrophages. In paediatric clinical practice, the patients that undergo BAL most frequently are children with chronic wheezing and recurrent chest infections as part of their workup to determine the possible cause. However, the interpretation of these results, in the clinical context is relatively uncertain. We therefore conducted this study in collaboration with the paediatric pulmonology unit at Tygerberg hospital in an attempt to determine if the BAL specimens can be used to categorize children with wheezing into either a gastro-eosophageal reflux or primary respiratory pathology group. We wanted to guage whether laboratory tests such as the differential cells counts; lipid-laden macrophage index, haemosiderin-laden macrophages index and number of carbon-laden macrophages can be used as a marker for pulmonary pathology. To determine if BAL can assist with sub-classification of the primary respiratory pathology group and determine if the amount of carbon-laden macrophages corresponds to the risk of increased lung disease Aim: Henceforth, we undertook this study to determine if the BAL specimens could be used to categorize these children as belonging to either the gastro-esophageal reflux or primary respiratory pathology group by grading the amounts of Oil red O lipid-laden macrophages (LLM) which is a marker for gastro-oesophageal reflux aspiration , Perl’s Prussian blue positive haemosiderin-laden macrophages(HLM) which serves to indicate the presence of pulmonary haemorrage and carbonladen macrophage (CLM) which may contribute to chronic lung disease, however has not yet been assessed in our setting. We also wanted to determine if the amount of phagocytosed carbon by alveolar macrophages had any correlation with chronic wheezing. Methods: Between march 2017 and march 2018, 68 paediatric patients presenting with a chronic wheeze underwent clinical investigations which included routine chemical pathology, microbiology and virology testing and the cytological evaluation of their BAL specimens. Once processed, the slides were stained with the Papanicolaou, Giemsa, Oil red O and Perl’s Prussian blue to quantitate the differential cell count as well as lipid-laden macrophage index, haemosiderin-laden macrophage index and number of carbon-laden macrophages present. After a full clinical work-up, these patients were placed into a broad category of recurrent wheeze and recurrent infection, and sub-category groups of gastro-eosaphageal reflux disease (GORD), alveolar proteinosis, idiopathic pulmonary haemosiderosis (IPH), recurrent wheeze, infection/inflammation and structural abnormalities. Results: There was no statistical significance when comparing the cellular differential counts; carbon; lipid and haemosiderin-macrophages; tuberculosis investigations; cystic fibrosis investigations; virology investigations; microbiology investigations and c-reactive protein in the broad categories of recurrent wheezer vs. recurrent infection as well as subcategories of infection/inflammation, GORD, structural abnormality, idiopathic wheezer, IPF and alveolar proteinosis. Conclusion: The cytological investigation of paediatric BAL specimens continues to play a role in the clinical work up of children with chronic wheezing. This study did not manage to yield statistically significant data to identify a specific underlying cause and further research is needed in this field.