Rapid Diagnosis of Hemosiderin-Laden Macrophages With Diff-Quick Stain

Takeshi Saraya, MD, PhD

Assistant Professor, Department of Respiratory Medicine, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka City, Tokyo 181-8611, Japan; Tel. +81 (0)422 44 0671; Fax: +81 (0)422 44 0671; E-mail: sara@yd5.so-net.ne.jp

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. Of note, cytological evaluation with rapid Diff-quick stain demonstrated the presence of numerous large Alveolar Macrophages (AMs) engulfing yellow-colored material (Figures 1A and 1B; arrows), so-called Hemosiderin-laden macrophages together with abundant red blood cells in the background. On Papanicolaou staining, intracytoplasmic hemosiderin accumulation in the AMs was seen as faint, brown-colored, dense deposits (Figure 1C). She was thus tentatively diagnosed with idiopathic alveolar hemorrhage. Hemosiderin-laden macrophages are a 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.

1. Sherman JM, Winnie G, Thomassen MJ, Abdul-Karim FW, Boat TF. Time course of hemosiderin production and clearance by human pulmonary macrophages. Chest. 1984; 86(3): 409-411. doi: 10.1378/chest.86.3.409

2. Epstein CE, Elidemir O, Colasurdo GN, Fan LL. Time course of hemosiderin production by alveolar macrophages in a murine model. Chest. 2001; 120(6): 2013-2020. doi: 10.1378/chest.120.6.2013