Bronchiectasis laboratory findings

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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 levels. 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.
• 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.
• 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.