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Updated: Aug 9, 2026
Bronchoalveolar Lavage (BAL) for Research; Obtaining Adequate Sample Yield
Published on: March 25, 2014
Differential cytology of bronchoalveolar lavage fluid in normal children
F Ratjen1, M Bredendiek, M Brendel
1Dept of Paediatrics, University of Essen, Germany.
Insights
This study establishes crucial reference values for bronchoalveolar lavage (BAL) fluid cytology in children. These findings provide essential baseline data for diagnosing pediatric lung diseases.
Area of Science:
- Pediatric Pulmonology
- Clinical Cytology
Background:
- Bronchoalveolar lavage (BAL) is vital for assessing pediatric lung conditions.
- A significant gap exists in reference values for BAL fluid cellular components in children.
Purpose of the Study:
- To establish reference data for BAL fluid differential cytology in healthy children.
- To provide a baseline for future studies on pediatric pulmonary diseases.
Main Methods:
- Analyzed BAL fluid from 48 children (3-16 years) undergoing non-pulmonary surgery.
- Used a flexible bronchoscope and standardized saline lavage technique.
- Compared differential cell counts between initial and pooled samples.
Main Results:
- Macrophages were the predominant cell type (mean 81.2%).
- Lymphocyte proportions were higher than in adults (mean 16.1%).
- Granulocyte counts were higher in children under 8 years.
Conclusions:
- This study presents the first reference data for BAL differential cytology in children.
- These values are critical for interpreting BAL findings in pediatric lung diseases.
Abstract:
Bronchoalveolar lavage (BAL) is increasingly used in the assessment of pulmonary diseases in children. However, reference values for cellular and non-cellular constituents of BAL fluid in children are lacking. We have studied the differential cytology of BAL fluid in 48 children aged 3-16 years (mean age +/- SD 7.9 +/- 3.5 yrs) undergoing elective surgery for nonpulmonary illnesses. A flexible bronchoscope (Pentax 3.5 or 4.9 mm) was wedged in the middle lobe or one of its segments. BAL was performed with 3x1 ml-kg-1 body weight of normal saline warmed to body temperature. The first sample was studied separately; subsequent samples were pooled for analysis. The mean recovery was 58 +/- 15%. Significantly more granulocytes and less lymphocytes were found in the first, as compared to the pooled, sample. Total cell counts were highly variable and ranged from 0.5-57.1 x 10(4) ml-1. Macrophages were the predominant cell type, with a mean percentage of 81.2 +/- 12.7%. The relative proportion of lymphocytes was higher than that reported in most studies of adult volunteers (16.1 +/- 2.4%). No age dependency was observed for either cell type. The mean percentage of granulocytes was 2.5 +/- 3.3%. Absolute granulocyte counts were significantly higher in children under 8 yrs of age. This study provides the first reference data on BAL differential cytology in children without pulmonary disease and will be the basis for future investigations of BAL in paediatric lung diseases.
