1. ¹Department of Paediatric Immunology, Newcastle upon Tyne Hospitals Foundation Trust, Newcastle upon Tyne, UK
2. ²Newcastle Laboratory, Health Protection Agency North East, Newcastle General Hospital, Newcastle upon Tyne, UK
3. ³Department of Microbiology, Newcastle upon Tyne Hospitals Foundation Trust, Royal Victoria Infirmary, Newcastle upon Tyne, UK

Correspondence: Dr AR Gennery, Department of Paediatric Immunology, Newcastle upon Tyne Hospitals Foundation Trust, Newcastle General Hospital, Ward 23, Westgate Road, Newcastle upon Tyne NE4 6BE, UK. E-mail: a.r.gennery@ncl.ac.uk

Received 12 January 2007; Revised 8 June 2007; Accepted 9 June 2007; Published online 16 July 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.