SPUTUM *Trachael Aspiration- For patients with pneumonia and

those who cannot produce specimen.

*Mixture of Tracheibranchial Secretions
*Sputum Containers
(TBS) Sterile, Disposable, with screw cap or tightly fitting cap.
-Cellular Exfoliations
-Nasal and salivary glands secretions (SPUTUM EXAMINATION)
-Normal bacterial flora of the oral cavity -Examine under biosafety hood.
A. Gross/Macroscopic
(PRINCIPAL SOURCES OF TBS) -Examine on petri dish (against dark background)
1. Surface Epithelium -Spread it using sterile disposable wooden applicator
-Serous Cells stick.
-Club Cells (Clara cells)- protect bronchile lining
-Goblet Cells- numerous in the upper respiratory tract 1. Consistency And Appearance
-Thick mucin type secretion Normal: Clear and Watery; (slightly opaque)
2. Submucous Glands a) Liquid/serous
-serous mixture of gylcoprotein, sialoproteins, b) Mucoid
sulfoprotein. c) Bloody(sanguinous)
d) Purulent
(PROPERTIES OF SPUTUM) e) Mucopurulent
1. Viscoelastic -Consistency of sputum depends on
A. Molecular structure of glycoprotein 2. Volume
B. Degree of hydration Gives idea on the prognosis
Poor Prognosis- Vol. Increases w/ treatment
*Sialic Acid- most important single component of Good Prognosis- Vol. Decreases w/ treatment
sputum viscosity.
3. Color
2. Chemical Composition Normal: Colorless
- 95% water, 5% solids (CHO, protein, lipids & DNA) a) Yellow- pus & epithelial cells
Increased Solids = Increase Inflammation b) Greenish Tint- Pseudomonas, release of
verdoperoxidase.
(SPECIMEN COLLECTION) c) Rust- Pneumococcal pneumonia, Pulmonary
1. Pre-rinsing of the mouth. gangrene.
2. First morning specimen- best specimen. d) Bright Red- Recent Hemorrhage, Acute cardiac
24 Hr Collection- For volume measurement failure, Pulmonary infractions, Far advance Tb,
Neoplasm.
-Rinse the mouth with water before sputum is collected
-Take several deep breaths (CAUSES OF BLOOD SPUTUM)
-Cough hard from inside the chest. APPEARANCE USUAL CAUSE
-Spit the sputum into the container carefully Uniform rusty, with pus Pneumococcal Pneumonia
-Replace the cap tightly Uniform rusty, no pus CHF, Mitral valve disease
Bright streaks in viscid Klebsiella Pneumonia
(PEDIATRIC COLLECTION METHODS) sputum
A. Nasopharyngeal swab Scant but persistent streaks Bronchogenic Carcinoma
B. Cough Plate in mucoid sputum
C. Cough Swab Episodic occurences of Tubercolosis
-Recommended method small hemorrhages
-Gives most representative, non-contaminated samples. Episodes of large Cavitary Tb,
-Epiglottis is touch with a swab to induce cough. hemorrhages Pulmonary Infraction,
Fungal Pneumonia
*Sputum Inductions-For uncooperative patients and Spurious Hemoptysis Bleeding in nose,
those who can’t produce sputum. nasopharynx
*Inductants
1. 10% NaCl 4. Odor
2. Sterile Distilled Water Putrid- Lung Abscess
3. Aerosols Fruity- Pseudomonas
(MISCELLANEOUS FINDINGS) (MICROSCOPIC STRUCTURES IN SPUTUM)
1. Cheesy Masses  Alveolar Macrophage- Specimen is from the
-Fragments of necrotic pulmonary tissue. lower respiratory tract.
-Seen in Pulmonary gangrene or PTb.  Neutrophils- Pyogenic Infection
2. Bronchial Casts  Eosinophils- Bronchial Asthma
-Branching Tree-like casts of the bronchi.  Acellular blue bodies- (PAS+) - Obstructive lung
3. Broncholith disease.
-(Lung stones) calcification of necrotic or infected tissue  Elastin Fiber- Curved refractile bodies w/ split
with a larger bronchus or cavity. ends, necrotizing pneumonia.
-Most Common Cause: Histoplasmosis
-also seen in: PTb, papillary CA, Sarcoidosis (COMMON DISEASES ASSOCIATED IN SPUTUM
4. Dittrich’s Plugs ANALYSIS)
-Yellowish or gray caseous bodies(pinhead to navy bean) 1. Pulmonary Tuberculosis
-composed of: cellular bodies, fatty acid crystals, fat -Mycobacterium Tuberculosis
globules and bacteria. -Mucopurulent
-seen in: Bronchitis and Bronchiectasis -Pulmonary Hemorrhage
5. Foreight Bodies -Presence of cheesy ma.
-Food Particles and buttons Types of specimen:
6. Parasites -Early morning
-Ascaris, E. Granulosus, T. Canis, P. Westermani. -Induced sputum
-Bronchial washings
(MICROSCOPIC EXAMINATION) -Transtracheal aspiration : lower lung field Tb
-Unstained & stained smears -Gastric aspiration
2. Myotic Disease - Fungal Infection
*Stained Smear Preparation: -First morning specimen:preferred
-Air Dry, Flame, Stain -Uses directmount w/ 10% NaOH
Stain: India Ink
*STAIN* -Cryptococcus Neoformans
a) Gram’s Stain- Commoly used. -Histoplasma Capsulatum
b) Wirghts or Giemsa- WBC Differential. -Coccicoides Immitis
c) Buffered Crystal Violet- Bronchial Epithelial Cell. -Apergillus famigatus
d) Ziehl Neelsen- Tuberculi Bacili. 3. Bronchial Asthma
e) Papanicolaou- Malignant Cell. -Periodic, reversible constrictions of the bronchi.
-White mucoid sputum, no blood and pus
*Spuamous EC- Marker in the rejection of a specimen Common Findings:
for culture. 1. Eosinophils
>10 SEC/lpf-reject the specimen 2. Charcot-Leyded Crystals- colorless,pointed
Alveolar Macrophage- Sputum is from lower RT hexagons. Derived from disintegration of
eosinophils.
*CYTOLOGY STAINS* 3. Broncial epithelial Cells
 No Stain a) Creola bodies- bronchial epithelial
-Blastomycosis cells in large clusters, vacuolated
-Cryptococcosis cytoplasm and ciliated borders.
 Gram Stain 4. Curschmann spirals -Wavy thread frequently
-Gram Positive Bacteria coiled into little balls.
-Candida a) Also seen in:
-Tubercolosis (weakly gram positive) -Chronic Bronchitis
-Nocardia (wealky gram positive) -Heavy cigarette smokers
 Direct Fluorescent Antibody Staining 4. Bronchiectasis
-Legionella Irreversible widening of portions of the bronchi
 Wrigth stain or Giemsa stain -Mucopurulent
-Intracellular organisms -Putrid; gray-green
-Ocassional blood streaks
-Microscopic exam: bronchial epithelial cells
-Dittrich plugs, fatty crystals, bacteria
5. Chronic Bronchitis 12. Pneumocystis Jiroveci
Inflammation of bronchioles as well as the bronchi Causes an interstitial pneumonia in the immunologically
-Smokers cough: mildest form impaired hosts.
-Macroscopically: tenacious white, mucoid
-Microscopically: histiocytes & monocytes 13. Viral Infections
70-90% of all respiratory infections
6. Lung Abscess Observe for presence of inclusions bodies
Large amount of bloody, creamy, foul smelling sputum
Presence of elastic fibers cellular debris and leukocytes. (BRONCHOALVEOLAR LAVAGE (BAL))
-Obtaining cellular and microbiological information
7. Pneumonia from the lower RT.
Inflammation of the lungs caused by bacteria, viruses or -Saline infused by a bronchoscope mixes with the
chemical irritants. bronchial content and is aspirated for cellular exam and
-Grams stain: important examination gram+pneumonia culture.
1. Streptococcus pneumonia- principal pathogen
-Ealy stage: scanty, transparent;occasional blood. BAL- important diagnostic test for Pneumocystis
a) Klebsiella Jiroveci(Carinii)
b) Haemophilus
c) Branhamella
d) Enterobacteria
e) Pseudomonas
f) Escherichia Coli

8. Pneumoconiosis
Fibrosis of the lung secondary to inhalation of organic
and inorganic dust.
1. Anthracosis- Accumulation of carbon in the
lungs from inhaled smoke or coal dust.
a) Blacklung disease
b) Coal workers pneumoconiosis
c) Miners pneumoconiosis
2. Silicosis- Silica dust, elongated and fragmented
crystals under polarized light.
3. Anthracosilicosis- carbon and silica; angular
black granules.
4. Asbestosis- Dumbbell shaped.
5. Byssinosis- Cotton Dust, rectangular, prism
shaped crystals that shine brightly under polarized
light.

9. Pulmonary Embolism
Sudden blocking of an artery of the lung by an embolus.
Brighten red, very tenacious, mucoid.

10. Heart Disease

Congestive Hearth Failure (Hemosiderin- laden
macrophages)
-Frothy and rust colored.
-Presence of heart failure cells (round, colorless bodies
filled w/ yellow to brown hemosiderin pigment.

11. Pulmonary Alveolar Proteinosis

Alveoli become plugged with a prtein rich fluid
Many macrophages with periodic acid-schiff PAS(+)
materials.