Bronchial Alveolar Lavage

PRINCIPLE OF EXAMINATION

Bronchial alveolar lavage is used mainly for differential cell counts in interstitial lung disease (ILD) and to diagnose infections (such as Pneumocystis jiroveci ) in immunosuppressed / immuno-compromised patients.

SPECIMEN REQUIREMENTS AND LABELLING

Please note: The laboratory should be notified in advanced of any BAL sample requiring a differential cell count (Telephone: 01392 402991)

• All Trust samples must be requested via Epic
• Send aspirated fluid in a suitable container such as the Sherwood Davis & Geck 40ml mucus specimen trap
• Do not send drainage apparatus as this cannot be processed
• Clearly label sample vial with an Epic label
• Clearly label sample vial with the date and time that the sample was taken
• Send a separate specimen and request to Microbiology if a microbiological investigation is required.

The request should contain:

• Three patient identifiers
• Specimen type i.e. ‘BAL’
• Date and time of sample collection
• Requesting clinician
• Patient location – inpatient/outpatient and ward
• All relevant clinical information – including if there is a history of relevant foreign travel
• If the sample requires differential cell count, this MUST be clearly included  with the request  and the sample MUST be received by the laboratory within one hour of collection

URGENT SPECIMENS: Please label urgent specimens clearly; an explanation as to why the specimen is urgent is helpful.  On receipt, laboratory staff will notify the pathologist who will report the specimen as soon as possible.

HIGH RISK SPECIMENS: Requests must indicate if a specimen is high risk.  Please indicate details of the risk, eg: TB, blood-borne virus, MPOX etc.

SPECIMEN DELIVERY

Please note: The laboratory should be notified in advanced of any BAL sample requiring a differential cell count via phone on 01392 402991

To ensure best results, we request that as much fresh specimen is sent to the laboratory as soon as possible, and within 24hrs of collection.

Any sample taken out of hours must be stored in a fridge overnight (4°C).

TURNAROUND TIME

The Laboratory aims to comply with The Royal College of Pathologists Key Performance Indicator (KPI 6.4) for Cellular Pathology reporting turnaround times with 90% of all cases reported within 10 calendar days.