Also available as PDF (figures and tables appear in the PDF).
A 77-year-old healthy woman was referred to our hospital with sudden hemoptysis. Chest X-ray showed moderate consolidation in the right upper lung fields. On hospital day 3, urgent bronchoscopy was performed and sequential Bronchoalveolar lavage (BAL) fluid obtained from segment 2 of the right lung was progressively more hemorrhagic.
Keywords: Hemosiderin-laden macrophages; Alveolar hemorrhage; Rapid diagnosis; Diff-quick stain; Hemosiderin
PULMONARY RESEARCH AND RESPIRATORY MEDICINE ISSN 2377-1658 http://dx.doi.org/10.17140/PRRMOJ-2-122 Open Journal Illustration Rapid Diagnosis of Hemosiderin-Laden * *Corresponding author Macrophages With Diff-Quick Stain Takeshi Saraya, MD, PhD Assistant Professor Department of Respiratory Medicine Kyorin University School of Medicine * Takeshi Saraya, MD, PhD ; Manabu Ishida, MD; Shoko Wada, MD; Masachika Fujiwara, 6-20-2 Shinkawa, Mitaka City MD, PhD; Hajime Takizawa, MD, PhD Tokyo 181-8611, Japan Tel. +81 (0)422 44 0671 Fax: +81 (0)422 44 0671 Department of Respiratory Medicine, Kyorin University School of Medicine, 6-20-2 Shinkawa, E-mail: sara@yd5.so-net.ne.jp Mitaka City, Tokyo 181-8611, Japan Volume 2 : Issue 4 Article Ref. #: 1000PRRMOJ2122 KEYWORDS: Hemosiderin-laden macrophages; Alveolar hemorrhage; Rapid diagnosis; Diff- quick stain; Hemosiderin.
Article History th A 77-year-old healthy woman was referred to our hospital with sudden hemoptysis. Received: February 4 , 2016 th Chest X-ray showed moderate consolidation in the right upper lung fields. On hospital day Accepted: February 15 , 2016 th 3, urgent bronchoscopy was performed and sequential Bronchoalveolar lavage (BAL) fluid Published: February 16 , 2016 obtained from segment 2 of the right lung was progressively more hemorrhagic. Of note, cytological evaluation with rapid Diff-quick stain demonstrated the presence of numerous Citation large Alveolar Macrophages (AMs) engulfing yellow-colored material (Figures 1A and 1B; Saraya T, Ishida M, Wada S, Fuji- arrows), so-called Hemosiderin-laden macrophages together with abundant red blood cells in wara M, Takizawa H. Rapid diag- the background. On Papanicolaou staining, intracytoplasmic hemosiderin accumulation in the nosis of hemosiderin-laden macro- AMs was seen as faint, brown-colored, dense deposits (Figure 1C). She was thus tentatively phages with diff-quick stain. Pulm Res Respir Med Open J. 2016; 2(4): 128. diagnosed with idiopathic alveolar hemorrhage. Hemosiderin-laden macrophages are a 1,2 doi: 10.17140/PRRMOJ-2-122 hallmark of alveolar hemorrhage, which usually takes a few days to diagnose,1,2 but this case clearly demonstrated that these cells can be seen even in a rapid diagnostic test with Diff-quick stain.
Figure 1:A and B. Cytological evaluation with rapid Diff-quick stain demonstrated the presence of numerous large Alveolar Macrophages (AMs) engulfing yellow-colored material. C. On Papanicolaou staining, intracytoplasmic hemosiderin accumulation in the AMs was seen as faint, brown-colored, dense deposits. CONFLICTS OF INTEREST The authors declare no conflict of interest associated with this manuscript.