• Damien Contou, Armand Mekontso Dessap, Guillaume Carteaux, Christian Brun-Buisson, Bernard Maitre, and Nicolas de Prost.
• Service de Réanimation Médicale, Cardiovascular and Respiratory Manifestations of Acute Lung Injury and Sepsis (CARMAS) Research Group, Groupe Henri Mondor-Albert Chenevier, Assistance Publique Hôpitaux de Paris and Université Paris-Est Créteil Val de Marne, Créteil, France. Institut National de la Santé et de la Recherche Médicale, Unité U955, Créteil, France.
• Respir Care. 2015 Apr 1;60(4):e73-5.

AbstractAcute chest syndrome (ACS) is the leading cause of ICU admission in patients with sickle cell disease and is characterized by golden sputum, which is commonly attributed to the presence of bilirubin. Three young consecutive patients with homozygous sickle cell disease were admitted for severe acute respiratory syndrome due to ACS. In all 3 patients, tracheal secretions and bronchoalveolar lavage fluid (BALF) showed a yellowish plasma-like stain. After normalization for the plasma-to-BAL urea ratio, BALF protein and lactate dehydrogenase levels were consistent with an exudative process. BALF bilirubin concentrations were very low, implying that the yellowish stain was not related to bilirubin content. The yellowish coloration of tracheal secretions and BALF observed during ACS appears to be related to an intense exudative process rather than to the presence of bilirubin.Copyright © 2015 by Daedalus Enterprises.

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