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Lab Manual for Moffitt-Long and Mount Zion

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Lung Biopsy and Bronchoalveolar Lavage

Item Value
Approval req'd? No
Available Stat? No
Test code
Performed by Microbiology
In House Availability Set up daily, day and evening shifts
Collection Instructions Hand carry these specimens to the laboratory, L 515, to promote rapid processing and to ensure communication of priorities if only a limited amount of sample is available. At hours when Microbiology is closed, bring specimens to Specimen Receiving at the main laboratory in Moffitt.

Provide all of the clinical information requested when submitting the Microbiology requisition, and specifically indicate whether the patient has recently undergone organ transplantation or is otherwise immunocompromised.

See Notes for additional information
Container type Clean container
Amount to Collect See preferred volume
Sample type BAL, Tissue
Preferred volume Sample Requirements:

Bronchial lavage fluid: 30 mL of fluid in a sputum (Lukens) trap

Transbronchial lung biopsy tissue (particularly suitable for possible infection with fungi, mycobacteria or Legionella): Submit in a sterile black top tube or a Red top sterile vacutainer in non-bacteriostatic saline or-if Legionella is suspected-in phosphate buffer or sterile water (saline is toxic to Legionella species).

Open lung biopsy: In a sterile container, submit at least 3 cm3 or a 1/2-1 inch cube of tissue. The specimen should be wrapped in gauze moistened with non-bacteriostatic saline to prevent dessication. Saline is toxic to Legionella, and if these species are a diagnostic concern phosphate buffer should be employed.

Phosphate buffer is available in refrigerator #10 at Specimen Receiving in the main laboratory.
Processing notes Maintain sample at room temperature
Normal range
Stability BAL: Refrigerated 24 hours
Biopsy: Room temperature 24 hours
Additional information Bronchial lavage fluid from immunocompromised patients is routinely processed as noted below; for all other specimens you must indicate which of the following tests are desired. If there is any doubt regarding the adequacy of the volume of sample submitted, specify the priority in which the tests should be performed.


Recommended evaluation of Specimens from Immunocompromised Patients

Culture/Test AIDS Pt. Other Imnmunocompromised Pt.
Bacteria (routine Order routinely Order routinely
Yeast/Aspergillus Candida species often contaminate BAL specimens, making interpretation of their isolation difficult Order if indicated
Other Fungi: Order whenever histoplas- mosis, coccidioidomycosis or other mycelial fungi are suspected; examine histology and culture biopsy specimen in parallel Order if fungi other than yeasts and aspergillus are suspected
Mycobacteria Order when M. tuberculosis, MAI, or other mycobacteria are suspected Order if suspected (uncommon)
Legionella (+ DFA) Order if suspected (rare) Order routinely
Respiratory CMV Not indicated Do histology on biopsy specimen; because of frequent excretion of CMV in asymptomatic carriers, a positive culture for CMV does not necessarily imply disease due to CMV
Others virus including HSV and VZV If suspected, culture other anatomic sites also (consult laboratory staff) If suspected, culture other anatomic sites also (consult laboratory staff)
Parasites Cytology for Pneumocystis carinii (by Anatomic Pathology) Order if suspected


Histologic Examination:

Tissue obtained for histologic examination should be submitted directly to Surgical Pathology, M 580, x31633, open 0730-1800 hours Monday-Friday. At other hours, obtain the telephone number of the resident on call from the page operator.

Cytologic Examination:

Bronchial lavage fluid is examined for Pneumocystis carinii by Cytology. M 545, x31613, open 0800-1500 hours, Monday-Friday. Upon request, specimens received before 1000 hours will be reported out the same day.
Last Updated 4/28/2010 4:00:12 PM
Entry Number 628

If you have additional questions regarding this test, please call: 415-353-1667

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