Oil Red O Staining of Pulmonary Macrophages in Bronchoalveolar Lavage Specimens Is Not Specific for Vaping-Associated Lung Injury: A Study of 50 Non–Vaping-Related Cases

Objectives Oil Red O (ORO) positivity in bronchoalveolar lavage (BAL) fluid macrophages in the setting of e-cigarette, or vaping, product use–associated acute lung injury (EVALI) has been frequently requested by clinicians based on rare reports and subsequent US Centers for Disease Control and Preve...

Full description

Saved in:
Bibliographic Details
Published in:American journal of clinical pathology 2022-12, Vol.158 (6), p.723-729
Main Authors: Thangaiah, Judith Jebastin, Booth, Christine N, Brainard, Jennifer A, Elsheikh, Tarik M, Reynolds, Jordan P, Ondrejka, Sarah L, Thilagar, Bright P, Mukhopadhyay, Sanjay, Doxtader, Erika E
Format: Article
Language:English
Subjects:
Alveoli
Asthma
Bronchoscopy
Bronchus
Fibrosis
Hemoptysis
Lavage
Leukocytes (eosinophilic)
Lung diseases
Lung transplantation
Macrophages
Sarcoidosis
Vaping
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Objectives Oil Red O (ORO) positivity in bronchoalveolar lavage (BAL) fluid macrophages in the setting of e-cigarette, or vaping, product use–associated acute lung injury (EVALI) has been frequently requested by clinicians based on rare reports and subsequent US Centers for Disease Control and Prevention guidelines. The aim of this study was to determine the specificity of ORO staining in BAL specimens with disease states other than EVALI. Methods Consecutive BAL specimens (October-December 2019) were stained with ORO. The lipid-laden macrophage index (LLMI) was calculated for each case. Results We studied BAL samples from 50 patients. Indications for BAL were surveillance bronchoscopy for lung transplantation (27/50), suspected infection (12/50), sarcoidosis/suspected sarcoidosis (3/50), nodules or ground-glass opacities (3/50), hemoptysis (2/50), asthma or eosinophilic pneumonia (2/50), and idiopathic pulmonary fibrosis (1/50). ORO staining was seen in BAL fluid macrophages in 45 of 50 cases (focal in 18, moderate in 23, diffuse in 4); LLMI ranged from 0 to 218. Using a threshold of LLMI of 85 or higher as positive, ORO was positive in 7 of 50 (14%) cases (range, 85-218). Conclusions ORO staining in BAL fluid macrophages is not specific for EVALI. Even when an LLMI of 85 or higher is used as a threshold for positivity, ORO positivity occurs in a significant subset of non–vaping-related cases.
ISSN:0002-9173
1943-7722
DOI:10.1093/ajcp/aqac118