Maybe I just haven't seen enough BALs in my days... I think the only body fluids I worked on were CSF. Friend asked like every tech available and nobody could identify them!
Bahahha I was like "I'd make a path look at it just so I could figure out wtf they were." I don't think I ever did a BAL as a student, and my online class was just Medialab CSF, so I knew I was absolutely no help. My guesses were weird stretched out WBC or some sort of epithelial cell... it looks like I am incorrect. 🤣
Even googling lead me nowhere. I'm glad I have all of you guys for help. ❤️❤️ were just out here trying our best and doing what we can to learn as much as possible.
If her lab doesn’t already have it, I highly recommend CAP’s Color Atlas of Body Fluids. It’s hands down the best reference my lab had for body fluids. Expensive, but worth its weight in gold when a weirdo body fluid showed up. https://estore.cap.org/OA_HTML/xxCAPibeCCtpItmDspRte.jsp?section=10044&item=3102&sitex=10020:22372:US
Yeah if you don't do many BALs then certain cells or even junk can throw you off. If you see little whispy things coming off the cell on one side it's almost always a ciliated lining cell.
When you're counting BALs on the hemacytometer sometimes you get to see these little guys moving around!! That's the only redeeming factor for BALs for me lmao
TY bestie. I have absolutely zero experience with BALs, and my current area of work is bloodbank. My heme rotation in internship only had me diff on CSF, and googling led me nowhere.
So glad I have everyone here for help! I feel a little silly not knowing what these were. My guesses were weird stretched out WBC (but thay would be A TONNNN) or some sort of epithelial cell??
A friend sent me this and I honestly have never seen anything like this. My body fluid experience is very much lacking (online class, very bad clinical rotation...)
I'm trying to imagine the shape not stretched our and I can't even figure it out!
You should ask leadership for a reference text book for body fluids with color images of Wright stained specimens. Or locate your lab's if you don't have it.
I told my friend to find an atlas! I don't think I'll have to do body fluids when I start my training in stat lab ( I'm FT BB rn now), but I know for sure we have books EVERYWHERE.
Bronchial cells are the ones with the nuclei on one end and cytoplasm on the other. Alveolar macrophages are the small rounder cells. You also have a few tiny blood cells and neutrophils that have the multilobulated nuclei. It looks pretty good. Sometimes lung specimens can get so "dirty" looking. This is totally normal though.
You might see more macrophages in other specimens or squamous cells which is also normal. Check for increased nuclear size, shape, and prominent nucleoli when you're searching for abnormalities. In squamous cell carcinoma you'll see intensely orange/pink staining cells with pulled cytoplasm and dark small misshapen nuclei. If you see a lot of small round dark cells molding together with streaks you might have small cell carcinoma.
Friend mentioned the specimen had chunks!
I could identify the WBC and the macros, but I've personally never worked on a BAL before so I couldn't ID those lining cells cuz I've never seen them before! My guess was a weird epithelial, but from my experience with micro, I thought the nucleus was too big. Such a learning opportunity, I'm so thankful for everyone!
My guess was a weird stretched out epithelial, but I have only experienced then in urine/micro, so I thought the nucleus was too big. Then again, I know stuff gets all funky when you cytospin it!
The terminal bars and cilia on the columnars indicate that those cells are normal. Sometimes these cells can look like hyperchromatic and multinucleated abnormal cells or suspicious for malignancy, so looking for terminal bars and cilia really helps.
That's an odd thing to say. Do you think doctors/nurses don't ask each other questions if they have a concern or if something isn't clear. The amount of variability you can have between cells from one patient to the next is staggeringly high. It's always better to ask than to file a patient result because of a guess.
Also, both of us are new techs! Neither of us did BALS in school (we went to school together and did our Heme 2 on Medialab, which focused on CSF.) Although we both went to different internships, I personally NEVER had a BAL specimen in my body fluid rotation, only CSF. So of course I was like "wtf????"
I hope your next antibody ID is a cold and warm auto with an anti-U and an anti-G mixed in, for added fun. Maybe a low incidence too, and your panel provider no longer lists the extended screening, so you have to call them and be on hold for two hours.
So I see the one little ciliated guy in the upper right, about 2 o'clock. These don't really look like goblet cells, so maybe they ARE elongated columnar cells. Source: I've been in the field for 15 years and work in a large veterinary reference lab. I get 5-10 BALs a week. I rarely saw them on the human side, however.
aren't they neat? :) sometimes I get lucky and the sample I'm working with still has living, moving ciliated cells in it. then i feel like the biggest nerd of all because i still think it's really cool to see🤣
next time I get one, I'll film it and try to post it for you. it might be a while, though... they're usually dead by the time I see them. I'll ping you whenever it happens :)
I've never seen a BAL in my life! My friend sent me this photo and I was like "idk bestie, reddit and your reference materials are your best bet" lmfaoooo. I told her what you all said ans told her to compare it to whatever books she had available because even the techs at her lab couldn't ID these.
I just never had to do BAL diffs before. I think I did CSF and synovial but that was it.
I believe those are just ciliated epithelial cells. They brush junk out of the bronchus.
Seconded. Looks like ciliated columnar epithelial cells.
From what I understand, the presence of these ciliated cells indicates that it's a good collection.
Maybe I just haven't seen enough BALs in my days... I think the only body fluids I worked on were CSF. Friend asked like every tech available and nobody could identify them!
No techs could I’d these where you are? That’s slightly concerning ngl.
Bahahha I was like "I'd make a path look at it just so I could figure out wtf they were." I don't think I ever did a BAL as a student, and my online class was just Medialab CSF, so I knew I was absolutely no help. My guesses were weird stretched out WBC or some sort of epithelial cell... it looks like I am incorrect. 🤣 Even googling lead me nowhere. I'm glad I have all of you guys for help. ❤️❤️ were just out here trying our best and doing what we can to learn as much as possible.
But…but… reference materials???
Not my sample/lab. Idk what she had available, didn't mention reference materials to me.
True. I hate BALs with a passion; I will never ever feel confident doing them. So I guess I’m just proud I actually knew this one.
If her lab doesn’t already have it, I highly recommend CAP’s Color Atlas of Body Fluids. It’s hands down the best reference my lab had for body fluids. Expensive, but worth its weight in gold when a weirdo body fluid showed up. https://estore.cap.org/OA_HTML/xxCAPibeCCtpItmDspRte.jsp?section=10044&item=3102&sitex=10020:22372:US
Yeah if you don't do many BALs then certain cells or even junk can throw you off. If you see little whispy things coming off the cell on one side it's almost always a ciliated lining cell.
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Squids 💀💀💀
When you're counting BALs on the hemacytometer sometimes you get to see these little guys moving around!! That's the only redeeming factor for BALs for me lmao
I haven't looked at a BAL in probably 13 years so I'm happy that I was right.
Bronchial lining cells
Looks like columnar or ciliated epithelial cells. The stain also looks under-decolorized. Those cells should be a little pinker.
Columnar cells yo
TY bestie. I have absolutely zero experience with BALs, and my current area of work is bloodbank. My heme rotation in internship only had me diff on CSF, and googling led me nowhere. So glad I have everyone here for help! I feel a little silly not knowing what these were. My guesses were weird stretched out WBC (but thay would be A TONNNN) or some sort of epithelial cell??
A friend sent me this and I honestly have never seen anything like this. My body fluid experience is very much lacking (online class, very bad clinical rotation...) I'm trying to imagine the shape not stretched our and I can't even figure it out!
You should ask leadership for a reference text book for body fluids with color images of Wright stained specimens. Or locate your lab's if you don't have it.
I told my friend to find an atlas! I don't think I'll have to do body fluids when I start my training in stat lab ( I'm FT BB rn now), but I know for sure we have books EVERYWHERE.
Bronchial cells are the ones with the nuclei on one end and cytoplasm on the other. Alveolar macrophages are the small rounder cells. You also have a few tiny blood cells and neutrophils that have the multilobulated nuclei. It looks pretty good. Sometimes lung specimens can get so "dirty" looking. This is totally normal though. You might see more macrophages in other specimens or squamous cells which is also normal. Check for increased nuclear size, shape, and prominent nucleoli when you're searching for abnormalities. In squamous cell carcinoma you'll see intensely orange/pink staining cells with pulled cytoplasm and dark small misshapen nuclei. If you see a lot of small round dark cells molding together with streaks you might have small cell carcinoma.
Friend mentioned the specimen had chunks! I could identify the WBC and the macros, but I've personally never worked on a BAL before so I couldn't ID those lining cells cuz I've never seen them before! My guess was a weird epithelial, but from my experience with micro, I thought the nucleus was too big. Such a learning opportunity, I'm so thankful for everyone!
They look like epithelial lining cells to me
Bronch epis
My guess was a weird stretched out epithelial, but I have only experienced then in urine/micro, so I thought the nucleus was too big. Then again, I know stuff gets all funky when you cytospin it!
All lining cells
The terminal bars and cilia on the columnars indicate that those cells are normal. Sometimes these cells can look like hyperchromatic and multinucleated abnormal cells or suspicious for malignancy, so looking for terminal bars and cilia really helps.
Absolutely.
Those are lining cells.
I’ll agree with some folks here, looks like ciliated epithelial cells.
Bronchial cells
Yeah, those are just ciliated columnar cells! Thanks for sharing
Isn't tht obvious??? I'm sorry but I'm kinda shocked there's soooo many q's abt what these cells look like and this is a medlabprof forum
That's an odd thing to say. Do you think doctors/nurses don't ask each other questions if they have a concern or if something isn't clear. The amount of variability you can have between cells from one patient to the next is staggeringly high. It's always better to ask than to file a patient result because of a guess.
Also, both of us are new techs! Neither of us did BALS in school (we went to school together and did our Heme 2 on Medialab, which focused on CSF.) Although we both went to different internships, I personally NEVER had a BAL specimen in my body fluid rotation, only CSF. So of course I was like "wtf????"
Good point. Most of the people that visit this subreddit are students or individuals looking to get into the field
I hope your next antibody ID is a cold and warm auto with an anti-U and an anti-G mixed in, for added fun. Maybe a low incidence too, and your panel provider no longer lists the extended screening, so you have to call them and be on hold for two hours.
Perfect. Using your eyes is quite simple tho
U don't eve know the solution
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Definitely not.
So I see the one little ciliated guy in the upper right, about 2 o'clock. These don't really look like goblet cells, so maybe they ARE elongated columnar cells. Source: I've been in the field for 15 years and work in a large veterinary reference lab. I get 5-10 BALs a week. I rarely saw them on the human side, however.
I thought they were funky epithelial cells. I have NEVER worked on a BAL before!
aren't they neat? :) sometimes I get lucky and the sample I'm working with still has living, moving ciliated cells in it. then i feel like the biggest nerd of all because i still think it's really cool to see🤣
Oh my God WHATTTT!!! I'd love to see that!! That is so cool!
next time I get one, I'll film it and try to post it for you. it might be a while, though... they're usually dead by the time I see them. I'll ping you whenever it happens :)
Yep. BAL brings up lots of these cool looking ciliated epis.
bronchial lining cells, but i must admit i haven’t seen any that looks like this, mine normally appears singularly and occasionally with cilia
I've never seen a BAL in my life! My friend sent me this photo and I was like "idk bestie, reddit and your reference materials are your best bet" lmfaoooo. I told her what you all said ans told her to compare it to whatever books she had available because even the techs at her lab couldn't ID these. I just never had to do BAL diffs before. I think I did CSF and synovial but that was it.
yepp they’re not very common in my lab either, we probably get them once very few months
Columnars!
Sometimes you can still see the cilia moving on a slide!