Analysis of asbestos bodies in BAL from subjects with particular exposures

Our plain-English summary of Analysis of asbestos bodies in BAL from subjects with particular exposures, by P. De Vuyst, P. Dumortier, P.A. Gevenois (American Journal of Industrial Medicine, 1997).

The study

• Authors: P. De Vuyst, P. Dumortier, P.A. Gevenois
• Journal: American Journal of Industrial Medicine
• Published: 1997;31(6):699-704
• Type of article: Case report
• Cited by: 12 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Four patients with asbestos-related diseases and with unusual exposures underwent bronchoalveolar lavage (BAL) for mineralogical analysis. Asbestos bodies (AB) were counted by light microscopy and analyzed by transmission electron microscopy and X-ray energy spectrometry. AB's were found in all cases, after a mean delay from the end of exposure of 27.7 years. Analysis of the core fibers indicated the type of alveolar asbestos burden and was compared with the previous exposures: Pleural plaques due to household exposure to amosite and crocidolite. Pleural plaques due to occult occupational exposure to crocidolite in a coal miner. Asbestosis due to environmental exposure to tremolite in Turkey. Asbestosis, pleural plaques, and peritoneal mesothelioma due to a short, intense exposure to crocidolite. AB counting in BAL and identification of the central fibers by analytical electron microscopy is a useful, non-invasive and reliable method to evaluate the alveolar retention of bio-persistent fibers and to relate them to specific exposures.

In plain English

This was a case series of four patients seen in Belgium with suspected asbestos-related disease and unusual exposures. Asbestos bodies (coated fibers) in their bronchoalveolar lavage (BAL, lung washing) fluid were counted by light microscopy, and their core fibers were identified by electron microscopy. A woman who had washed the work clothes of her husband, an asbestos spray insulator, had pleural plaques and 1.2 asbestos bodies per ml, mostly on amosite and the rest on crocidolite. Her husband had 2,350 per ml, with similar fiber types. A former coal miner with calcified pleural plaques had bodies mainly on crocidolite, and coal-mine mask filters contained crocidolite. A man from Turkey with asbestosis had 1,530 per ml, all on tremolite. A man exposed to crocidolite for two months at age 15 in a battery factory had 36 per ml, all on crocidolite, and died of peritoneal mesothelioma in 1994. The authors concluded that BAL counting is an easy, valuable way to indicate past exposure. They noted that it does not reflect fibers in the parietal pleura.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case series (four patient case reports, plus BAL from one patient's husband for comparison)
• Who was studied: Four patients examined at Erasme University Hospital, Brussels, Belgium: a woman born in 1942 (a dressmaker, then a school cleaner); a man born in Italy in 1917 who worked in Belgian coal mines from 1948 to 1967; a man born in Malatiya, Turkey, in 1930 who migrated to Belgium in 1974; and a man born in 1928. The first woman's husband was also tested for comparison.
• Exposure: Four different exposures: (1) household exposure from washing the work clothes of a husband who was an asbestos spray insulator from 1963 to 1970 (amosite and crocidolite); (2) crocidolite in particle filters of protective masks worn in coal mines; (3) environmental tremolite exposure in Turkey; (4) two months, at age 15 during World War II, insulating batteries with crocidolite in a very dusty factory.
• Main results:
  • Case 1 (woman, household exposure): bilateral pleural and diaphragmatic plaques with calcifications and no lung fibrosis. Her BAL contained 1.2 asbestos bodies/ml. Of 14 asbestos bodies analyzed, 11 (79%) were formed on amosite and 3 (21%) on crocidolite.
  • Her husband (the spray insulator) had 2,350 asbestos bodies/ml. Of 36 analyzed, 25 (70%) were on amosite and 11 (30%) on crocidolite. He also had bilateral pleural plaques. The authors noted that the extent and type of lesions were identical in husband and wife despite roughly 3 orders of magnitude difference in concentration.
  • Case 2 (coal miner): BAL showed 22 typical asbestos bodies/ml and 15/ml ferruginous bodies formed on coal particles. Of 13 asbestos bodies analyzed, the core was crocidolite in 12 and unclassified in one.
  • Particle filters from protective masks used in coal mines contained crocidolite fibers mixed with organic fibers.
  • Case 3 (man from Turkey, interstitial lung fibrosis with extensive calcified pleural thickening): BAL in 1991 showed 1,530 asbestos bodies/ml, all formed on tremolite. No erionite or talc particles were detected.
  • Case 4 (two months of crocidolite exposure at age 15): BAL in 1990 showed 36 asbestos bodies/ml, all formed on crocidolite.
  • Case 4 lung tissue taken at surgery contained 166,500 asbestos bodies per gram of dry tissue and 7.74 million asbestos fibers per gram of dry tissue. The fibers were mainly crocidolite (98.8%), with small amounts of chrysotile (1.2%).
  • Case 4 had no malignancy detected at surgery in 1990, but the patient died from a peritoneal mesothelioma in 1994.
  • In the four patients, BAL analysis was done 22, 25, 17 and 47 years, respectively, after the end of the suspected exposure.
• The authors' conclusion: The authors concluded that counting asbestos bodies in BAL is an easy and valuable method of indicating past exposure in patients with ill-defined exposures. They also concluded that environmental and very short exposures are not the same as low-dose exposures.
• Limitations the authors state:
  • BAL analysis reflects fibers retained in the alveoli. It does not show fibers that moved to other sites, such as the parietal pleura where plaques develop.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Pleural plaques and thickening.

Medical terms in this study, explained in our Lexicon: Asbestos Bodies, Bronchoalveolar Lavage (BAL), Transmission Electron Microscopy (TEM), Pleural Plaques, Amosite, Crocidolite, Occupational Exposure, Environmental Exposure.

Related studies

• Erionite bodies and fibres in bronchoalveolar lavage fluid (BALF) of residents from Tuzköy, Cappadocia, Turkey — P. Dumortier, L. Coplü, et al. (2001)
• Diagnostic value of asbestos bodies in bronchoalveolar lavage fluid — P. De Vuyst, P. Dumortier, et al. (1987)
• Asbestos bodies in bronchoalveolar lavage fluids of brake lining and asbestos cement workers — P. Dumortier, P. De Vuyst, et al. (1990)
• Alveolar fiber load in asbestos workers and in subjects with no occupational asbestos exposure: an electron microscopy study — G. Chiappino, K.H. Friedrichs, et al. (1988)
• Fibres and asbestos bodies in bronchoalveolar lavage fluids of asbestos sprayers — T. Tuomi, P. Oksa, et al. (1992)
• Asbestos bodies in bronchoalveolar lavage in relation to asbestos bodies and asbestos fibres in lung parenchyma — A. Karjalainen, R. Piipari, et al. (1996)

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