Published ahead of print on September 11, 2003, doi:10.1164/rccm.200302-174OC
© 2003 American Thoracic Society Induced Sputum versus Bronchoalveolar Lavage during Acute Chest Syndrome in Sickle Cell DiseaseDepartments of Pathology, Pulmonary Disease, and Critical Care Medicine, Sickle Cell Disease Center, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Inserm U492, Université Paris XII, Créteil, France Correspondence and requests for reprints should be addressed to Bernard Maitre, M.D., Ph.D., Unité de Pneumologie, Hôpital H. Mondor, Assistance Publique-Hôpitaux de Paris & Université Paris XII 151, Avenue du Mal de Lattre de Tassigny, 94010 Créteil Cedex, France. E-mail: bernard.maitre{at}hmn.ap-hop-paris.fr
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:
Key Words: fat embolism • fiberoptic bronchoscopy • acute lung injury This article has been cited by other articles:
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= 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. 
