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Module UBF-13 · Version 1.0

Bronchoalveolar Lavage Cell Morphology

A working guide to reading bronchoalveolar lavage (BAL) cytospin differentials: how the specimen is collected and prepared, what a normal cell distribution looks like, how to judge whether a specimen is adequate to trust, how to read macrophage pigment and hemosiderin, and where the bench-level call stops and cytopathology or microbiology review begins.

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Who this module is for

Clinical laboratory scientists and cytology-trained technologists who perform manual body fluid cell differentials on bronchoalveolar lavage specimens.

Learning objectives

  • Identify alveolar macrophages, lymphocytes, neutrophils, eosinophils, epithelial cells, hemosiderin-laden macrophages, and common contaminants on a BAL cytospin using size, border, and cytoplasmic detail rather than color alone.
  • Evaluate BAL specimen quality, including recovered volume, squamous or bronchial contamination, mucus, cellularity, and preparation degeneration, before interpreting the differential.
  • Use BAL differential patterns as supportive, nonspecific evidence and recognize atypical, organism-suspicious, or malignant-appearing findings that require referral rather than a bench-level final call.

How completion works

Mark every required section done and answer every knowledge check in those sections correctly. The final save completes the module automatically.

Sources

14 sources

  1. 1. 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.

    Source note · professional society guidance

  2. 2. American Thoracic Society. Online Data Supplement to: The Clinical Utility of Bronchoalveolar Lavage Cellular Analysis in Interstitial Lung Disease. 2012.

    Source note · professional society guidance

  3. 3. Clinical and Laboratory Standards Institute. Body Fluid Analysis for Cellular Composition; Approved Guideline. CLSI document H56-A. Wayne, PA: CLSI; 2006 (retained for laboratory value; content reviewed via CAP-cited excerpts and CLSI sample material).

    Source note · consensus standard

  4. 4. Bronchoalveolar Lavage. In: StatPearls. Treasure Island, FL: StatPearls Publishing; updated 2024.

    Source note · peer-reviewed literature

  5. 5. Lipid-Laden Macrophage Index as a Diagnostic Tool for Pediatric Aspiration: A Systematic Review. PMC10046735.

    Source note · peer-reviewed literature

  6. 6. College of American Pathologists. All Common Checklist, COM.40620 Body Fluid Analysis (Phase II). CAP Accreditation Program, 12.09.2025 edition.

    Source note · accreditation standard

  7. 7. College of American Pathologists. Hematology, Coagulation, and Clinical Microscopy Checklist, HEM.35357 Body Fluid Analysis Procedure (Phase II). CAP Accreditation Program, 12.09.2025 edition.

    Source note · accreditation standard

  8. 8. College of American Pathologists. Hematology, Coagulation, and Clinical Microscopy Checklist, HEM.35528 Body Fluid Cell Differentials (Phase I). CAP Accreditation Program, 12.09.2025 edition.

    Source note · accreditation standard

  9. 9. College of American Pathologists. Hematology, Coagulation, and Clinical Microscopy Checklist, HEM.35547 Body Fluid Smear Quality (Phase I). CAP Accreditation Program, 12.09.2025 edition.

    Source note · accreditation standard

  10. 10. College of American Pathologists. Hematology, Coagulation, and Clinical Microscopy Checklist, HEM.35566 Morphologic Observation Evaluation - Body Fluid (Phase II). CAP Accreditation Program, 12.09.2025 edition.

    Source note · accreditation standard

  11. 11. College of American Pathologists. Hematology, Coagulation, and Clinical Microscopy Checklist, HEM.35623 Cytomorphology Reference Library (Phase I). CAP Accreditation Program, 12.09.2025 edition.

    Source note · accreditation standard

  12. 12. College of American Pathologists. Hematology, Coagulation, and Clinical Microscopy Checklist, HEM.35642 Slide Retention - Body Fluid Differential (Phase I). CAP Accreditation Program, 12.09.2025 edition.

    Source note · accreditation standard

  13. 13. College of American Pathologists. Hematology, Coagulation, and Clinical Microscopy Checklist, HEM.35650 Body Fluid Result Reporting of Nucleated Cells (Phase I). CAP Accreditation Program, 12.09.2025 edition.

    Source note · accreditation standard

  14. 14. College of American Pathologists. Laboratory General Checklist, GEN.55500 Competency Assessment Elements - Nonwaived Testing (Phase II). CAP Accreditation Program, 12.09.2025 edition.

    Source note · accreditation standard