{"id":26235,"date":"2024-03-18T15:56:52","date_gmt":"2024-03-18T14:56:52","guid":{"rendered":"https:\/\/www.mylav.net\/?p=26235"},"modified":"2024-09-11T11:42:48","modified_gmt":"2024-09-11T09:42:48","slug":"indications-pour-la-preparation-correcte-du-lavage-bronchoalveolaire","status":"publish","type":"post","link":"https:\/\/www.mylav.net\/fr\/cytologie\/indications-pour-la-preparation-correcte-du-lavage-bronchoalveolaire\/","title":{"rendered":"INDICATIONS POUR LA PREPARATION CORRECTE DU LAVAGE BRONCHOALVEOLAIRE"},"content":{"rendered":"

Nous avons demand\u00e9 \u00e0 nos consultants en maladies respiratoires et en endoscopie de nous donner quelques conseils essentiels pour la pr\u00e9paration correcte des \u00e9chantillons cytologiques du lavage broncho-alv\u00e9olaire (LBA). Comme pour les autres cytologies la qualit\u00e9 de l’\u00e9chantillon est essentielle pour obtenir des informations diagnostiques utiles. Malheureusement, les \u00e9chantillons cytologiques du LBA sont de mauvaise qualit\u00e9 si certaines r\u00e8gles fondamentales ne sont pas strictement respect\u00e9es.
\nLes voici r\u00e9sum\u00e9es:<\/p>\n

1) Comme pour tous les \u00e9chantillons dans lesquels les cellules sont en suspension dans un liquide, dans la pr\u00e9paration de la cytologie \u00e0 partir du LBA, la pr\u00e9paration de l’\u00e9chantillon doit \u00eatre aussi rapide que possible, et il est pr\u00e9f\u00e9rable de ne pas retarder la pr\u00e9paration de plus d’une heure apr\u00e8s le pr\u00e9l\u00e8vement. Pour cette raison, il est \u00e9vident que les frottis cytologiques doivent \u00eatre pr\u00e9par\u00e9s par le clinicien et non au laboratoire, si l’on ne veut pas risquer d’obtenir des r\u00e9sultats insatisfaisants.<\/p>\n

2) Si l’on veut effectuer un examen de culture \u00e0 partir du mat\u00e9riel pr\u00e9lev\u00e9, la premi\u00e8re chose \u00e0 faire est de pr\u00e9lever 2 ml de liquide et de mucus dans une seringue st\u00e9rile qui sera conserv\u00e9e au r\u00e9frig\u00e9rateur jusqu’au moment de l’envoi; le mat\u00e9riel pr\u00e9lev\u00e9 doit \u00eatre conserv\u00e9 au r\u00e9frig\u00e9rateur jusqu’au moment de l’envoi, le mat\u00e9riel collect\u00e9 ne doit pas avoir \u00e9t\u00e9 en contact avec de l’EDTA, car l’anticoagulant a des propri\u00e9t\u00e9s bact\u00e9riostatiques et pourrait \u00eatre responsable de faux n\u00e9gatifs. Le mat\u00e9riel destin\u00e9 \u00e0 la culture doit id\u00e9alement parvenir au laboratoire dans les 24 heures suivant le pr\u00e9l\u00e8vement ou \u00eatre mis sur un milieu de culture qui peut prolonger la dur\u00e9e de conservation de l’\u00e9chantillon.<\/p>\n

3) Si le tube dans lequel le liquide de lavage a \u00e9t\u00e9 pr\u00e9lev\u00e9 contient du mat\u00e9riel flocul\u00e9, celui-ci doit \u00eatre pr\u00e9lev\u00e9 \u00e0 l’aide d’une pipette ou d’une aiguille de seringue et plac\u00e9 sur une lame, puis \u00e9cras\u00e9 avec une autre lame de fa\u00e7on \u00e0 obtenir deux \u00e9chantillons cytologiques qui doivent \u00eatre s\u00e9ch\u00e9s rapidement (par exemple \u00e0 l’aide d’un s\u00e8che-cheveux ou d’un radiateur), sous peine d’en alt\u00e9rer la qualit\u00e9 en raison des ph\u00e9nom\u00e8nes de coarctation cellulaire.<\/p>\n

4) A partir du composant liquide, il convient de r\u00e9aliser des frottis directs en recueillant une goutte de liquide \u00e0 l’aide d’une pipette comme on le ferait pour un frottis sanguin. Ces \u00e9chantillons ne sont pas tr\u00e8s utiles pour l’interpr\u00e9tation cytologique car ils ont tendance \u00e0 \u00eatre hypocellulaires, mais ils peuvent donner une id\u00e9e approximative de la cellularit\u00e9 de l’\u00e9chantillon.<\/p>\n

5) Pour l’interpr\u00e9tation cytologique, il est essentiel de concentrer les cellules ; la technique la plus simple consiste \u00e0 centrifuger 5 ml (ou la totalit\u00e9 de la quantit\u00e9 pr\u00e9lev\u00e9e si l’aliquote est plus petite) pendant 10 minutes \u00e0 faible vitesse. Jeter ensuite tout le surnageant, \u00e0 l’exception d’une petite quantit\u00e9 de s\u00e9diment, et proc\u00e9der \u00e0 la remise en suspension du culot cellulaire recueilli au fond du tube en l’agitant pendant quelques secondes.<\/p>\n

6) Pr\u00e9lever une goutte du mat\u00e9riel pr\u00e9par\u00e9 et pr\u00e9parer au moins 2 lames de frottis comme d\u00e9crit au point 4); l\u00e0 encore, il est conseill\u00e9 de s\u00e9cher rapidement les \u00e9chantillons, \u00e9ventuellement \u00e0 l’aide d’une source d’air chaud.<\/p>\n

7) N’oubliez pas de pr\u00e9ciser clairement quels sont les \u00e9chantillons pr\u00e9par\u00e9s par frottis direct et quels sont ceux pr\u00e9par\u00e9s apr\u00e8s centrifugation, en l’indiquant clairement sur la lame de mani\u00e8re ind\u00e9l\u00e9bile.<\/p>\n

A ce stade, les \u00e9chantillons peuvent \u00eatre envoy\u00e9s au laboratoire pour une coloration de routine, sans pr\u00e9cautions particuli\u00e8res. Pensez simplement \u00e0 les prot\u00e9ger de mani\u00e8re appropri\u00e9e pour \u00e9viter qu’ils ne se cassent et, surtout il est important de ne pas les envoyer avec les \u00e9chantillons destin\u00e9s \u00e0 l’histologie (c’est-\u00e0-dire dans la m\u00eame bo\u00eete contenant des bocaux de formol), ce qui rendrait la cytologie presque illisible en raison du d\u00e9p\u00f4t de formol.<\/p>\n

\"\u00e9chantillon
Exemple d’un \u00e9chantillon de bonne qualit\u00e9 : les cellules semblent bien conserv\u00e9es et il est facile d’effectuer m\u00eame une num\u00e9ration diff\u00e9rentielle<\/figcaption><\/figure>\n
\"\u00e9chantillon
Exemple d’un \u00e9chantillon de mauvaise qualit\u00e9, de faible valeur diagnostique : les cellules apparaissent grossi\u00e8res ou endommag\u00e9es et il n’est pas facile d’effectuer un comptage diff\u00e9rentiel.<\/figcaption><\/figure>\n
\nPar Enrico Bottero et Davide De Lorenzi\n<\/div>\n","protected":false},"excerpt":{"rendered":"

Nous avons demand\u00e9 \u00e0 nos consultants en maladies respiratoires et en endoscopie de nous donner […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"inline_featured_image":false,"footnotes":""},"categories":[1118],"tags":[],"class_list":["post-26235","post","type-post","status-publish","format-standard","hentry","category-cytologie"],"acf":[],"yoast_head":"\nINDICATIONS POUR LA PREPARATION CORRECTE DU LAVAGE BRONCHOALVEOLAIRE - MyLav<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.mylav.net\/fr\/cytologie\/indications-pour-la-preparation-correcte-du-lavage-bronchoalveolaire\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"INDICATIONS POUR LA PREPARATION CORRECTE DU LAVAGE BRONCHOALVEOLAIRE - 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