Bronchiectasis laboratory findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: 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

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 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, orIgE 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 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 done 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 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

• 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 having bronchiectasis secondary to gastrointestinal reflux or aspiration.

Autoimmune Screening Tests

• If suspected of having an autoimmune disorder such as rheumatoid arthritis