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Value of bronchoalveolar lavage before haematopoietic stem cell transplantation for primary immunodeficiency or autoimmune diseases.
- Source :
-
Bone marrow transplantation [Bone Marrow Transplant] 2007 Sep; Vol. 40 (6), pp. 529-33. Date of Electronic Publication: 2007 Jul 16. - Publication Year :
- 2007
-
Abstract
- Pulmonary infection, often insidious, is frequent in primary immunodeficiency (PID) and acquired immunodeficiency. Pulmonary complications are serious obstacles to success of haematopoietic SCT (HSCT) for these conditions. Bronchoalveolar lavage (BAL) permits identification of lower respiratory tract pathogens that may direct specific treatment and influence prognosis. There are no reports about the utility of pre-HSCT BAL for immunodeficient patients. We prospectively studied the value of 'routine' BAL before commencing transplantation in patients undergoing HSCT for severe immunological disease. Routine non-bronchoscopic BAL was performed under general anaesthetic, a few days before commencing pre-HSCT cytoreductive chemotherapy. Patients were categorized as symptomatic or asymptomatic with respect to pulmonary disease or infection. Samples were sent for microbiological processing. Complications arising from the procedure, pathogens isolated and treatments instituted were recorded. Results were available from 69/75 patients transplanted during the study period; 26 (38%) had pathogens identified (six asymptomatic patients), 10 (14.5%) developed complications post-procedure (two asymptomatic patients)-all recovered, 21 had management changes. There was no statistically significant difference in the number of positive isolates from severe combined or other immunodeficient patients, or of symptomatic or asymptomatic patients. Routine non-bronchoscopic BAL is safe in immunodeficient patients about to undergo HSCT, and leads to management changes.
- Subjects :
- Adolescent
Anesthesia, General
Autoimmune Diseases complications
Bronchoalveolar Lavage Fluid microbiology
Child
Child, Preschool
Humans
Infant
Infant, Newborn
Pneumonia, Bacterial complications
Pneumonia, Bacterial diagnosis
Pneumonia, Bacterial immunology
Pneumonia, Pneumocystis complications
Pneumonia, Pneumocystis immunology
Prognosis
Prospective Studies
Severe Combined Immunodeficiency complications
Autoimmune Diseases therapy
Bronchoalveolar Lavage
Hematopoietic Stem Cell Transplantation
Pneumocystis carinii isolation & purification
Pneumonia, Pneumocystis diagnosis
Severe Combined Immunodeficiency therapy
Subjects
Details
- Language :
- English
- ISSN :
- 0268-3369
- Volume :
- 40
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- Bone marrow transplantation
- Publication Type :
- Academic Journal
- Accession number :
- 17637688
- Full Text :
- https://doi.org/10.1038/sj.bmt.1705776