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The TNC count of BAL fluid is useful, even if used purely as an adjunct to results of other tests. Protocols for preparing the sample and counting cells, whether manually or by flow cytometry, enhance patient care.

1. Radhakrishna N, Farmer M, Steinfort DP, King P. A comparison of techniques for optimal performance of bronchoalveolar lavage. J Bronchology Interv Pulmonol. 2015;22(4):300–305.
2. Meyer KC, Raghu G, Baughman RP, et al. An official American Thoracic Society clinical practice guideline: the clinical utility of bronchoalveolar lavage cellular analysis in interstitial lung disease. Am J Respir Crit Care Med. 2012;185(9):1004–1014.
3. Haslam PL, Baughman RP. Report of ERS Task Force: guidelines for measurement of acellular components and standardization of BAL. Eur Respir J. 1999;14(2):245–248.
4. Clinical and Laboratory Standards Institute. H56-A: Body Fluid Analysis for Cellular Composition; Approved Guideline; 2006.
5. Domagała-Kulawik J, Skirecki T, Maskey-Warzechowska M, Grubek-Jaworska H, Chazan R. Bronchoalveolar lavage total cell count in interstitial lung diseases—does it matter? Inflammation. 2012;35(3):803–809.
6. Choi SH, Hong SB, Hong HL, et al. Usefulness of cellular analysis of bronchoalveolar lavage fluid for predicting the etiology of pneumonia in critically ill patients. PLoS One. 2014;9(5):e97346.
7. Martinu T, Koutsokera A, Benden C, et al. International Society for Heart and Lung Transplantation consensus statement for the standardization of bronchoalveolar lavage in lung transplantation. J Heart Lung Transplant. 2020;39(11):1171–1190.

Julie A. Rosser, DO
Associate Pathologist
Department of Pathology and Laboratory Medicine
Presbyterian/St. Luke’s Medical Center
Denver, Colo.
Member, CAP Hematology/Clinical Microscopy Committee

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