Bronchoalveolar Lavage

Test indications: For the detection and characterization of microbiologic pathogens (primarily Pneumocystis, viral, fungal, and bacterial) in immunocompromised patients; for detection and characterization of malignancy, interstitial lung disease, transplant rejection, pulmonary hemorrhage, acute inflammatory diseases and disorders in which lymphocytes are predominant.

Methodology: Routine cytopathologic evaluation.
Performed: Monday-Friday. *STAT Performed on weekends, holidays or after hours for rapid evaluation of opportunistic pulmonary infection.
TAT: 1 day (24 hours).

Specimen requirement: Lavage obtained by bronchoscopy (preferably at least 20 mL) of the distal airways and alveoli. Note: BAL specimens sent for culture MUST be split from the main cytologic specimen prior to transport. The Cytopathology Laboratory does not have the proper facilities for the sterile handling of BAL specimens necessary for culture procedures.

Supplies: Standard bronchoscopy equipment.120 mL clean plastic specimen containers, test requisition and biohazard bag.

Collection procedure: Using standard bronchoscopy BAL technique, lavage the lung distribution in question with sterile, normal saline (or other physiologic solution). Collect the lavage specimen in a clean specimen container. Label the container with the patient’s first and last name and specimen type. Submit the specimen, along with the completed Cytology test request form, to the Cytopathology Laboratory. If transport will be delayed, refrigerate the specimen.

Fixation: Do not add fixative to the specimen. BAL specimens are submitted fresh because microbiologic studies, immunologic studies or chemical analyses may be requested.

Transport: Each specimen should be placed in a clearly labeled container that is leak proof. Place specimen in a biohazard transport bag. The paper requisition(s) that accompanies the specimen should be placed in the outside pocket of the biohazard bag to avoid exposure to any leakage.

Causes for rejection: Incomplete patient requisitions, unlabeled/incorrectly labeled specimen, frozen specimen, incorrect test ordered for specimen, specimen in incorrect or expired fixative, specimen from unauthorized person.

Specimen stability: Varies; if some delay is unavoidable (12-24 hours) body fluids may be refrigerated.

Reference interval: By report.

CPT code(s): 88108 Concentration and interpretation, or 88112 Selective cellular enhancement with interpretation and/88312 x3 Special stains. Additional CPT codes may apply if special studies are required.

Note: BAL specimens sent for culture MUST be split from the main specimen prior to transport. The Cytopathology Laboratory does not have facilities for the sterile handling of BAL specimens necessary for culture procedures.

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