title: Golden tracheal secretions and bronchoalveolar fluid during acute chest syndrome in sickle cell disease.
abstract: Acute chest syndrome (ACS) is the leading cause of ICU admission in patients with sickle cell disease and is characterized by golden sputum, which is commonly attributed to the presence of bilirubin. Three young consecutive patients with homozygous sickle cell disease were admitted for severe acute respiratory syndrome due to ACS. In all 3 patients, tracheal secretions and bronchoalveolar lavage fluid (BALF) showed a yellowish plasma-like stain. After normalization for the plasma-to-BAL urea ratio, BALF protein and lactate dehydrogenase levels were consistent with an exudative process. BALF bilirubin concentrations were very low, implying that the yellowish stain was not related to bilirubin content. The yellowish coloration of tracheal secretions and BALF observed during ACS appears to be related to an intense exudative process rather than to the presence of bilirubin.
authors.affiliation: Service de Réanimation Médicale, Cardiovascular and Respiratory Manifestations of Acute Lung Injury and Sepsis (CARMAS) Research Group, Groupe Henri Mondor-Albert Chenevier, Assistance Publique Hôpitaux de Paris and Université Paris-Est Créteil Val de Marne, Créteil, France. Institut National de la Santé et de la Recherche Médicale, Unité U955, Créteil, France.
authors.forename: Damien
authors.initials: D
authors.lastname: Contou
authors.affiliation: Service de Réanimation Médicale, Cardiovascular and Respiratory Manifestations of Acute Lung Injury and Sepsis (CARMAS) Research Group, Groupe Henri Mondor-Albert Chenevier, Assistance Publique Hôpitaux de Paris and Université Paris-Est Créteil Val de Marne, Créteil, France. Institut National de la Santé et de la Recherche Médicale, Unité U955, Créteil, France.
authors.forename: Armand
authors.initials: A
authors.lastname: Mekontso Dessap
authors.affiliation: Service de Réanimation Médicale, Cardiovascular and Respiratory Manifestations of Acute Lung Injury and Sepsis (CARMAS) Research Group, Groupe Henri Mondor-Albert Chenevier, Assistance Publique Hôpitaux de Paris and Université Paris-Est Créteil Val de Marne, Créteil, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Carteaux
authors.affiliation: Service de Réanimation Médicale, Cardiovascular and Respiratory Manifestations of Acute Lung Injury and Sepsis (CARMAS) Research Group, Groupe Henri Mondor-Albert Chenevier, Assistance Publique Hôpitaux de Paris and Université Paris-Est Créteil Val de Marne, Créteil, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Brun-Buisson
authors.affiliation: Service de Réanimation Médicale, Cardiovascular and Respiratory Manifestations of Acute Lung Injury and Sepsis (CARMAS) Research Group, Groupe Henri Mondor-Albert Chenevier, Assistance Publique Hôpitaux de Paris and Université Paris-Est Créteil Val de Marne, Créteil, France. Antenne de Pneumologie, Service de Réanimation Médicale, Groupe Henri Mondor-Albert Chenevier, Assistance Publique Hôpitaux de Paris, Créteil, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Maitre
authors.affiliation: Service de Réanimation Médicale, Cardiovascular and Respiratory Manifestations of Acute Lung Injury and Sepsis (CARMAS) Research Group, Groupe Henri Mondor-Albert Chenevier, Assistance Publique Hôpitaux de Paris and Université Paris-Est Créteil Val de Marne, Créteil, France. Institut National de la Santé et de la Recherche Médicale, Unité U955, Créteil, France. nicolas.de-prost@hmn.aphp.fr.
authors.forename: Nicolas
authors.initials: N
authors.lastname: de Prost
mesh_terms: D056586:Acute Chest Syndrome / Q000209:etiology / Q000473:pathology*; D000328:Adult; D000755:Anemia, Sickle Cell / Q000150:complications*; D001663:Bilirubin / Q000032:analysis; D001992:Bronchoalveolar Lavage Fluid / Q000737:chemistry; D005260:Female; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000032:analysis; D013183:Sputum / Q000737:chemistry; D014132:Trachea / Q000378:metabolism*; D055815:Young Adult
chemical_list: D007770:L-Lactate Dehydrogenase; D001663:Bilirubin
keywords: acute chest syndrome; acute respiratory distress syndrome; intensive care; pulmonary fat embolism; sickle cell disease; yellow sputum