Bronchiectasis laboratory findings: Difference between revisions
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{{Bronchiectasis}} | {{Bronchiectasis}} | ||
==Overview== | ==Overview== | ||
There are both routine investigations and investigations done for special cases. Routine investigations include sputum analysis, full blood count, and quantitative immunoglobulin | There are both routine investigations and investigations done for special cases. Routine investigations include sputum analysis, full blood count, and quantitative [[immunoglobulin]] evels. Other tests such as tests for [[cystic fibrosis]] and autoimmune testing are done if the patient is suspected to have an underlying condition. | ||
==Bronchiectasis Laboratory Findings== | ==Bronchiectasis Laboratory Findings== | ||
===Sputum Analysis=== | ===Sputum Analysis=== | ||
*Observe for Dittrich plugs (foul smelling masses of bacteria), white, or yellow concretions. | *Observe for Dittrich plugs (foul smelling masses of [[bacteria]]), white, or yellow concretions. | ||
*A gram stain and culture should be performed. Evidence of Psuedomonas species, Escherichia coli, or Staphylococcus. aureus may suggest cystic fibrosis or bronchopulmonary aspergillosis. | *A gram stain and culture should be performed. Evidence of Psuedomonas species, [[Escherichia coli]], or Staphylococcus. aureus may suggest cystic [[fibrosis]] or bronchopulmonary aspergillosis (ABPA). | ||
*A smear and culture should be performed for mycobacteria and fungi. | *A smear and culture should be performed for [[mycobacteria]] and [[fungi]]. | ||
*Sputum acid fast bacilli for | *Sputum acid fast bacilli for [[tuberculosis]] | ||
===Full Blood Count=== | ===Full Blood Count=== | ||
*Nonspecific findings | *Nonspecific findings | ||
*Anemia | *[[Anemia]] | ||
*Elevated white blood cell count | *Elevated white blood cell count | ||
*Increased percentage of neutrophils | *Increased percentage of [[neutrophils]] | ||
*Eosinophils suggests bronchopulmonary aspergillosis. | *Eosinophils suggests bronchopulmonary aspergillosis (ABPA). | ||
*Polycythemia (secondary to hypoxia) in severe cases | *[[Polycythemia]] (secondary to hypoxia) in severe cases | ||
===Quantitative Immunoglobulin Levels=== | ===Quantitative [[Immunoglobulin]] Levels=== | ||
*Measure IgG, IgA, IgM, and serum electrophoresis to exclude hypogammaglobulinemia | *Measure IgG, IgA, IgM, and serum electrophoresis to exclude [[hypogammaglobulinemia]] | ||
*Serum IgE or skin prick testing or IgE radioallergosorbent test for ABPA | *Serum IgE or skin prick testing or IgE radioallergosorbent test for ABPA | ||
:*Diagnostic criteria include a total serum IgE level greater than 1000 IU/mL or a greater than 2-fold rise from baseline. | :*Diagnostic criteria include a total serum IgE level greater than 1000 IU/mL or a greater than 2-fold rise from baseline. | ||
*Antibodies to Haemophilus influenza type B or Streptococcus pneumonia | *Antibodies to Haemophilus influenza type B or Streptococcus pneumonia | ||
===Quantitative Serum Alpha 1-antitrypsin (AAT) Levels=== | ===Quantitative Serum [[Alpha 1-antitrypsin]] (AAT) Levels=== | ||
* This is used to rule out AAT deficiency. | * This is used to rule out AAT deficiency. | ||
===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 ciliary beat frequency | ||
*Screening should be done if there is childhood chronic otitis media, infertility, dextrocardia, or middle lobe bronchiectasis | *Screening should be done if there is childhood chronic [[otitis media]], [[infertility]], [[dextrocardia]], or middle lobe bronchiectasis | ||
===Testing for Cystic Fibrosis=== | ===Testing for Cystic Fibrosis=== | ||
*The testing is two measurements of sweat chloride and cystic fibrosis transmembrane regulator (CFTR) genetic mutation analysis should be done for all children and adults up to 40 years. | *The testing is two measurements of sweat chloride and cystic fibrosis transmembrane regulator (CFTR) genetic mutation analysis should be done for all children and adults up to 40 years. | ||
*If the the patient is more than 40 years, he should do cystic fibrosis testing if he has persistent isolation of S. aureus in the sputum, features of malabsorption, male primary infertility | *If the the patient is more than 40 years, he should do [[cystic fibrosis]] testing if he has persistent isolation of S. aureus in the sputum, features of [[malabsorption]], male primary [[infertility]] upper lobe bronchiectasis, or a history of childhood [[steatorrhoea]]. | ||
===24-hour pH Monitoring=== | ===24-hour pH Monitoring=== | ||
*This testing is for those who are suspected of having bronchiectasis secondary to gastrointestinal reflux or aspiration. | *This testing is for those who are suspected of having bronchiectasis secondary to gastrointestinal [[reflux]] or [[aspiration]]. | ||
===Autoimmune Screening Tests=== | ===Autoimmune Screening Tests=== | ||
*These test should be done if the patient is suspected of having an autoimmune disorder such as Rheumatoid Arthritis. | *These test should be done if the patient is suspected of having an autoimmune disorder such as [[Rheumatoid Arthritis]]. | ||
==References== | ==References== | ||
Revision as of 13:07, 25 June 2015
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Overview
There are both routine investigations and investigations done for special cases. Routine investigations include sputum analysis, full blood count, and quantitative immunoglobulin evels. Other tests such as tests for cystic fibrosis and autoimmune testing are done if the patient is suspected to have an underlying condition.
Bronchiectasis Laboratory Findings
Sputum Analysis
- Observe for Dittrich plugs (foul smelling masses of bacteria), white, or yellow concretions.
- A gram stain and culture should be performed. Evidence of Psuedomonas species, Escherichia coli, or Staphylococcus. aureus may suggest cystic fibrosis or bronchopulmonary aspergillosis (ABPA).
- A smear and culture should be performed for mycobacteria and fungi.
- Sputum acid fast bacilli for tuberculosis
Full Blood Count
- Nonspecific findings
- Anemia
- Elevated white blood cell count
- Increased percentage of neutrophils
- Eosinophils suggests bronchopulmonary aspergillosis (ABPA).
- Polycythemia (secondary to hypoxia) in severe cases
Quantitative Immunoglobulin Levels
- Measure IgG, IgA, IgM, and serum electrophoresis to exclude hypogammaglobulinemia
- Serum IgE or skin prick testing or IgE radioallergosorbent test for ABPA
- Diagnostic criteria include a total serum IgE level greater than 1000 IU/mL or a greater than 2-fold rise from baseline.
- Antibodies to Haemophilus influenza type B or Streptococcus pneumonia
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 done if there is childhood chronic otitis media, infertility, dextrocardia, or middle lobe bronchiectasis
Testing for Cystic Fibrosis
- The testing is two measurements of sweat chloride and cystic fibrosis transmembrane regulator (CFTR) genetic mutation analysis should be done for all children and adults up to 40 years.
- If the the patient is more than 40 years, he should do cystic fibrosis testing if he has persistent isolation of S. aureus in the sputum, features of malabsorption, male primary infertility upper lobe bronchiectasis, or a history of childhood steatorrhoea.
24-hour pH Monitoring
- This testing is for those who are suspected of having bronchiectasis secondary to gastrointestinal reflux or aspiration.
Autoimmune Screening Tests
- These test should be done if the patient is suspected of having an autoimmune disorder such as Rheumatoid Arthritis.