title: Induced sputum versus bronchoalveolar lavage during acute chest syndrome in sickle cell disease.
abstract: Previous reports have shown that in more than 40% of adults with acute chest syndrome (ACS), fat droplets suggestive of pulmonary fat embolism were present in alveolar macrophages. To determine whether induced sputum (IS) is a reliable test for detecting this embolism, we compared bronchoalveolar lavage and IS results in 20 patients with ACS. We found a correlation between the number of Oil Red O-stained macrophages in sputum and lavage fluid (Spearman's coefficient: rho = 0.657, p < 0.018). Sputum cytology was then studied in another 60 patients who had sickle cell disease with ACS. An elevated percentage of Oil Red O-stained macrophages was found in the sputum of 37/47 patients, but they did not include any of the patients with sickle cell disease but no clinical symptoms. Patients suffering from ACS with Oil Red O-stained macrophages had more extrathoracic concomitant pain than those without (76 vs. 50%, p < 10-8), had more neurologic symptoms (7 vs. 0%, p < 10-8), a lower differential platelet count (-49 +/- 121 vs. +85 +/- 229, p < 0.04), and higher abnormal transaminase values (28 vs. 17%, p < 0.01). We conclude that IS analysis is a safe, noninvasive, and useful test for fat embolism detection in ACS.
authors.affiliation: Department of Pathology, Sickle Cell Disease Center, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Inserm U492, Université Paris XII, Créteil, France.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Lechapt
authors.forename: Anoosha
authors.initials: A
authors.lastname: Habibi
authors.forename: Dora
authors.initials: D
authors.lastname: Bachir
authors.forename: Frederic
authors.initials: F
authors.lastname: Galacteros
authors.forename: Annette
authors.initials: A
authors.lastname: Schaeffer
authors.forename: Dominique
authors.initials: D
authors.lastname: Desvaux
authors.forename: Laurent
authors.initials: L
authors.lastname: Brochard
authors.forename: Bruno
authors.initials: B
authors.lastname: Housset
authors.forename: Bertrand
authors.initials: B
authors.lastname: Godeau
authors.forename: Bernard
authors.initials: B
authors.lastname: Maitre
mesh_terms: D000208:Acute Disease; D000328:Adult; D000755:Anemia, Sickle Cell / Q000150:complications* / Q000473:pathology; D001992:Bronchoalveolar Lavage Fluid / Q000166:cytology*; D001999:Bronchoscopy; D004620:Embolism, Fat / Q000209:etiology / Q000473:pathology*; D005260:Female; D006801:Humans; D016676:Macrophages, Alveolar / Q000473:pathology*; D008297:Male; D011655:Pulmonary Embolism / Q000209:etiology / Q000473:pathology*; D015203:Reproducibility of Results; D013183:Sputum / Q000166:cytology*; D013577:Syndrome