Published ahead of print on September 11, 2003, doi:10.1164/rccm.200302-174OC Am. J. Respir. Crit. Care Med., Volume 168, Number 11, December 2003, 1373-1377 A more recent version of this article appeared on December 1, 2003
Submitted on February 28, 2003 Induced Sputum vs Bronchoalveolar Lavage during Acute Chest Syndrome in Sickle Cell DiseaseEmmanuelle Lechapt1,1 Department of Pathology, Hopital Henri Mondor, AP-HP, Universite Paris XII, Creteil, France, 2 Sickle Cell Disease Center, Hopital Henri Mondor, AP-HP, Universite Paris XII, Creteil, France, 3 Department of Critical Care Medicine, Hopital Henri Mondor, AP-HP, Universite Paris XII, Creteil, France, 4 Department of Pulmonary, Hopital Henri Mondor, AP-HP, Universite Paris XII, Creteil, France * To whom correspondence should be addressed. E-mail: antenne.pneumo{at}hmn.ap-hop-paris.fr.
Previous reports showed that in more than 40 % of adults with acute chest syndrome, fat droplets suggestive of pulmonary fat embolism were present in alveolar macrophages. To determine whether induced sputum is a reliable test for detecting this embolism, we compared fluid from bronchoalveolar lavage and induced sputum in 20 acute chest syndrome patients. 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
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= 0.657, p < 0.018). Sputum cytology was then studied in another 60 sickle cell disease patients with acute chest syndrome. 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 9 patients with sickle cell disease but no clinical symptoms. Acute chest syndrome patients with Oil red O-stained macrophages had more extrathoracic concomitant pain than those without (76 vs 50 %, p<10-8), 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 induced sputum analysis is a safe, non invasive and useful test for fat embolism detection in acute chest syndrome.
