SPUTUM ANALYSIS (LAB) Red/reddish

Lobar pneumonia (specific area that

affected in the lungs is the individual lobes
Transcribed by: DAPNolasco | December 2022
brown that are infiltrated by fluid or mucus),
myocardial infarction
Upper Respiratory Tract: nasal cavity, pharynx, larynx Rusty red TB, pneumococcal infection (S.pneumoniae)
Lower Respiratory Tract: trachea, primary bronchi, lungs (where Olive-green Diagnostic of chronic cancer
sputum is derived 😁) /grass green
Blood tinged Acute heart failure
SPUTUM
 Goblet cells – secretes sputum; found in the lining of bronchus Odor
 Must be produced from the lower respiratory tract Normal – odorless
 Best differentiated from saliva (coming from upper respiratory Variations Disease association
tract by presence of carbon-layden macrophage/dust cells) Foul and putrid Lung gangrene, necrotizing
o If merong carbon-layden macrophage or dust cells edi tumors/lesions
saliva siya. Sweetish Bronchiectasis, TB
Fecaloid Tissue necrosis. Liver abscess, gram
Importance of Sputum analysis negative bacterial infections
 Detects neoplastic diseases (associated with new growth due Cheesy Necrosis, tumors, emphyema
to tumor or cancer whether benign or malignant) of the lungs
and other respiratory origin Consistency
 Detect occurrence of infections for example, TB and Watery
bronchitis Variations Disease association
 Detect other respiratory diseases like allergic reactions- Mucoid Asthma and bronchitis
asthma, inflammation, pulmonary lesions. Frothy and blood-tinged Pulmonary edema
Mucopurulent Bronchiectasis, TB
Precaution before collection
Tenacious (thick and Asthma and Klebsiella
 Wag magtotooth brush viscous) infection
 Wag iinom ng tubig
 Wag kakain kasi it may interfere with the quality of sx Macroscopic Features/Structures
 Wag magma-mouthwash. Gargle ka nalang ng mouth with
water
Features/structures Description
Cheesy masses Thick purulent fragments of necrotic
Methods of Collection
tissue
 Expectoration (deep cough; early morning expectorated Dittrich’s plugs Gray caseous matter about the size of
sputum) a pinhead that gives a foul odor when
 Bronchoalveolar lavage (invasive) crushed and is associated with
 Heated aerosol technique (for infants and px with pulmonary bronchiectasis and chronic bronchitis
lesions) Curshmann’s Yellow waxy spirally-twisted mucus
 Sputum  centrifugation  layer formation spirals strands frequently coiled into little
o 1st layer: frothy mucus balls; associated with bronchial
o 2nd layer: opaque watery material asthma and consist of EC, WBC, and
o 3rd layer: pus, bacteria, tissue debris charcot leyden crystals
Pneumoliths/ Small white gray fragments
If for microbiology, yung sputum, di na siya cinicentrifuge. Diretso broncholiths/ lung Calcified foreign matter seen in TB
na siya sa smear or culture media. Smear thinly so that if there’s a stones
need for staining edi hindi sobrang kapal. Tapos for AFB, ihiheat
Bronchial casts Tree-like cast in the sputum
fix muna para pag mag iistain, hindi siya mawawash off.
Mycetomas Round mass of fungal debris
(aspergilloma) – the fungus/mycelium
MACROSCOPIC EXAMINATION
piles up and then lodge to the lungs
Volume
Dependent on the number of active secreting mucus cells
Specific gravity
Increased Volume Decreased Volume
 Bronchiectasis (a type  Early pneumonia
Mucoid 1.004 – 1.008
of lung disease  Bronchial asthma
Purulent 1.015 – 1.060
wherein the diameter  Acute bronchitis
Serous 1.037 or higher
of air passage widens
and is filled with
mucus) MICROSCOPIC EXAMINATION
 Lung abscess Unstained
 Edema (build-up of Elastic fibers From alveolar and bronchial walls seen in
fluid in the lungs) lung gangrene and TB
 Gangrene (caused by Charcot-leyden Most significant
necrosis due to crystals Sharp slender pointed needle like
insufficient oxygen Colorless crystals
supply) Degradation product of eosinophil
 TB Seen in bronchial asthma (an allergic
 Lung cancer reaction)
Pigmented cells Endothelial leukocytes taking up
Color pigmented granules
Normal-colorless/ translucent or whitish to faint yellow and  Carbon-leyden or dust cells
orange to purulent (angular black granules)
 Heart failure cells (hemosiderin
Variations Disease Association
laden macrophage)
Yellowish- Advanced TB, Chronic bronchitis
Myelin globules
green
Fungi and Coccicodiodes immitis, Candida albicans,
Caseous pneumonia (resulted from TB),
Bright Green molds Cryptococcus neoformans, Actinomyces
pseudomonas infection
 Acquired thru inhalation of spores

Sa C.immitis na infectious particle which is

diagnostic of coccidiodomycosis is the
spherules or arthroconidia
Parasites TAPSHE
T. hominis
A. lumbricoides larva
P. westermani (lung fluke; hemoptysis)
S. stercoralis larva
Hookworm larva
Entamoeba histolytica

Stained (Stains used: Wright-Giemsa; Gram stain, AFB, India Ink,

Pap’s stain for neoplastic cells)
 Neoplastic cells
 Bronchial epithelial cells
 Lymphocytes and monocytes: normal but increased
during inflammation like in bronchitis
o HALLMARK OF SPUTUM: macrophages
containing dust cells and carbon-leyden
particles, fat droplets in pneumonia and
hemosiderin in heart failure
 Pus cells, RBCs
 Bacteria, fungi

CHEMICAL TESTS
 Neuramic acid is responsible for the viscosity of sputum
 Alpha anti-trypsin test - determination of neuramic acid

BRONCHOALVEOLAR LAVAGE
 Procedure in obtaining cellular, immunologic and
microbiological information from the lower respiratory tract
 Invasive process
 NSS is injected to wash off lungs or lower respiratory tract
 Often used in conjuction with high resolution computerized
tomography (HRCT), medical history and physical
examination to determined need for surgical biopsy
 Sx are kept at room temp during transport to lab and
processed immediately
 If delivery to lab is delayed longer than 30 mins, sx are
transported on ice at 4C
 Specimens are unacceptable for testing after 24 hours
 Particularly useful in evaluating;
o Immunocompromised patients
o Interstitial lung disease
o Airway diseases
o Suspected alveolar hemorrhage
o Pulmonary alveolar proteinosis
o Langerhans cell histiocytosis
o Dust exposure

Sputum Culture
 Gram stain
 Sputum:
 ACCEPT:
o PMNs (Polymorphonuclear cells/neutrophils) >
25/lpf
o and the squamous epithelium cell is < 100 lpf
 REJECT
o PMNs <25 lpf
o SEC > 100 lpf kasi pag ganto ibig sabihin ay
saliva lamang ang nakuha