Bronchiectasis laboratory findings: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Bronchiectasis}} | {{Bronchiectasis}} | ||
{{CMG}} {{AE}} Saarah T. Alkhairy, M.D. | {{CMG}}; {{AE}} {{HQ}}, Saarah T. Alkhairy, M.D. | ||
==Overview== | ==Overview== | ||
There are both routine investigations and special case investigations. Routine investigations include sputum analysis, full blood count, and quantitative [[immunoglobulin]] levels. [[Cystic fibrosis]] and [[autoimmune]] testing are done if the patient is suspected of having an underlying condition. | There are both routine investigations and special case investigations. Routine investigations include [[Sputum culture|sputum analysis]], [[Complete blood count|full blood count]], and quantitative [[immunoglobulin]] levels. [[Cystic fibrosis]] and [[autoimmune]] testing are done if the patient is suspected of having an underlying condition. | ||
==Bronchiectasis Laboratory Findings== | ==Bronchiectasis Laboratory Findings== | ||
The laboratory findings of bronchiectasis are as follows:<ref name="O'Donnell2008">{{cite journal|last1=O'Donnell|first1=Anne E.|title=Bronchiectasis|journal=Chest|volume=134|issue=4|year=2008|pages=815–823|issn=00123692|doi=10.1378/chest.08-0776}}</ref> | |||
===Sputum Analysis=== | ===Sputum Analysis=== | ||
* | *Dittrich plugs (foul smelling masses of [[bacteria]]), white or yellow concretions | ||
*A gram stain and culture should be performed | *A [[Gram staining|gram stain]] and [[Culture collection|culture]] should be performed | ||
**Evidence of ''[[Pseudomonas aeruginosa]]'', ''[[Escherichia coli]]'', or ''[[Staphylococcus aureus]]'' may suggest [[cystic fibrosis]] (CF) or [[allergic bronchopulmonary aspergillosis]] (ABPA) | |||
*A smear and culture should be performed for ''[[Mycobacterium]]'' and [[fungi]] | *A smear and culture should be performed for ''[[Mycobacterium]]'' and [[fungi]] | ||
*Sputum acid fast bacilli for [[tuberculosis]] | *[[Sputum]] [[Acid-fast|acid fast]] [[bacilli]] for [[tuberculosis]] | ||
===Full Blood Count=== | ===Full Blood Count=== | ||
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*[[Leukocytosis]] | *[[Leukocytosis]] | ||
*[[Neutrophilia]] | *[[Neutrophilia]] | ||
*[[Eosinophilia]] suggests bronchopulmonary aspergillosis (ABPA) | *[[Eosinophilia]] suggests bronchopulmonary aspergillosis (ABPA) | ||
===Quantitative Immunoglobulin Levels=== | ===Quantitative Immunoglobulin Levels=== | ||
*Measure IgG, IgA, IgM, and serum electrophoresis to exclude [[hypogammaglobulinemia]] | *Measure [[Immunoglobulin G|IgG]], [[Immunoglobulin A|IgA]], [[Immunoglobulin M|IgM]], and serum [[electrophoresis]] to exclude [[hypogammaglobulinemia]]. | ||
*Serum IgE, skin prick testing, | *Serum [[Immunoglobulin E|IgE]], [[skin]] prick testing, or [[Immunoglobulin E|IgE]] [[RAST test|radioallergosorbent test]] ([[RAST test|RAST]]) for [[ABPA]]. | ||
**Diagnostic criteria include a total serum [[Immunoglobulin E|IgE]] concentration greater than 1000 IU/mL or a greater than 2-fold rise from baseline | |||
*Antibodies to ''Haemophilius influenzae'' type B or ''Streptococcus pneumoniae'' | |||
*Antibodies to ''Haemophilius influenzae'' type B or ''[[Streptococcus pneumoniae]]'' | |||
===Quantitative Serum Alpha 1-antitrypsin (AAT) Levels=== | ===Quantitative Serum Alpha 1-antitrypsin (AAT) Levels=== | ||
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===Tests for Ciliary Function=== | ===Tests for Ciliary Function=== | ||
*Screening for PCD-nasal [[nitric oxide]] measurements, nasal [[biopsy]] and ciliary beat frequency | *Screening for PCD-nasal [[nitric oxide]] measurements, nasal [[biopsy]] and [[Primary ciliary dyskinesia|ciliary]] beat frequency. | ||
*Screening should be | *Screening should be performed if there is childhood chronic [[otitis media]], [[ infertility]], [[dextrocardia]], or middle lobe bronchiectasis. | ||
===Testing for Cystic Fibrosis=== | ===Testing for Cystic Fibrosis=== | ||
*Two measurements of sweat chloride and cystic fibrosis transmembrane regulator ([[CFTR]]) genetic mutation analysis should be | *Two measurements of sweat chloride and [[Cystic fibrosis transmembrane conductance regulator|cystic fibrosis transmembrane regulator]] ([[CFTR]]) [[Mutation|genetic mutation]] analysis should be performed for all children and adults up to 40 years | ||
* | *The patient should perform [[cystic fibrosis]] testing if he is more than 40 years plus | ||
**Persistent isolation of '''''[[Staphylococcus aureus]]''''' in the sputum | |||
**Features of [[malabsorption]] | |||
**Male primary [[infertility]] | |||
**Upper lobe bronchiectasis | |||
**History of childhood [[steatorrhoea|steatorrhoea.]] | |||
===24-hour pH Monitoring=== | ===24-hour pH Monitoring=== | ||
* | *If suspected of bronchiectasis secondary to [[Gastroesophageal reflux disease|gastrointestinal reflux]] or [[aspiration]]. | ||
===Autoimmune Screening Tests=== | ===Autoimmune Screening Tests=== | ||
* | *If suspected of an autoimmune disorder such as [[rheumatoid arthritis]]. | ||
==References== | ==References== | ||
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{{Reflist|2}} | {{Reflist|2}} | ||
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{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
[[Category:Pulmonology]] | |||
[[Category:Medicine]] | |||
[[Category:Radiology]] | |||
[[Category:Up-To-Date]] | |||
Latest revision as of 20:43, 29 July 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hamid Qazi, MD, BSc [2], Saarah T. Alkhairy, M.D.
Overview
There are both routine investigations and special case investigations. Routine investigations include sputum analysis, full blood count, and quantitative immunoglobulin levels. Cystic fibrosis and autoimmune testing are done if the patient is suspected of having an underlying condition.
Bronchiectasis Laboratory Findings
The laboratory findings of bronchiectasis are as follows:[1]
Sputum Analysis
- Dittrich plugs (foul smelling masses of bacteria), white or yellow concretions
- A gram stain and culture should be performed
- Evidence of Pseudomonas aeruginosa, Escherichia coli, or Staphylococcus aureus may suggest cystic fibrosis (CF) or allergic bronchopulmonary aspergillosis (ABPA)
- A smear and culture should be performed for Mycobacterium and fungi
- Sputum acid fast bacilli for tuberculosis
Full Blood Count
- Anemia
- Polycythemia (secondary to hypoxia) in severe cases
- Leukocytosis
- Neutrophilia
- Eosinophilia suggests bronchopulmonary aspergillosis (ABPA)
Quantitative Immunoglobulin Levels
- Measure IgG, IgA, IgM, and serum electrophoresis to exclude hypogammaglobulinemia.
- Serum IgE, skin prick testing, or IgE radioallergosorbent test (RAST) for ABPA.
- Diagnostic criteria include a total serum IgE concentration greater than 1000 IU/mL or a greater than 2-fold rise from baseline
- Antibodies to Haemophilius influenzae type B or Streptococcus pneumoniae
Quantitative Serum Alpha 1-antitrypsin (AAT) Levels
- This is used to rule out AAT deficiency
Tests for Ciliary Function
- Screening for PCD-nasal nitric oxide measurements, nasal biopsy and ciliary beat frequency.
- Screening should be performed if there is childhood chronic otitis media, infertility, dextrocardia, or middle lobe bronchiectasis.
Testing for Cystic Fibrosis
- Two measurements of sweat chloride and cystic fibrosis transmembrane regulator (CFTR) genetic mutation analysis should be performed for all children and adults up to 40 years
- The patient should perform cystic fibrosis testing if he is more than 40 years plus
- Persistent isolation of Staphylococcus aureus in the sputum
- Features of malabsorption
- Male primary infertility
- Upper lobe bronchiectasis
- History of childhood steatorrhoea.
24-hour pH Monitoring
- If suspected of bronchiectasis secondary to gastrointestinal reflux or aspiration.
Autoimmune Screening Tests
- If suspected of an autoimmune disorder such as rheumatoid arthritis.
References
- ↑ O'Donnell, Anne E. (2008). "Bronchiectasis". Chest. 134 (4): 815–823. doi:10.1378/chest.08-0776. ISSN 0012-3692.
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