LABORATORY MEDICINE

MODULE

CBL 2
Laboratory approach to the patient with
pulmonary disease
 CASE
• A 50-year-old man, is brought to the emergency room with a cough
productive of bloody sputum.
• He first noticed a cough approximately 2 months ago, but there was not
much sputum. In the past several days his sputum production has increased
and become mixed with blood.
• He reports having lost approximately 15 lb in this time frame as well.
• He also notes that he’s had drenching night sweats 2 or 3 nights a week for
the past month.
• He has a 50-pack-year smoking history but no other medical history.
• On examination, he is a thin, frail-appearing male. His vital signs are normal.
His head and neck exam is normal. He has no palpable adenopathy in his neck
or axilla. His lung exam is notable only for decreased breath sounds diffusely.
A chest x-ray shows a cavitary infiltrate of the left upper lobe.
 Questions
 What type of organism is likely to be seen on Gram stain
of a sputum sample?
 What technique of staining is most commonly used to
identify this organism?
 What is the histologic characteristic of this case?
 What other laboratory investigations can help in this case
 Summary

 A 50-year-old man presents with chronic bloody sputum,

weight loss, and a cavitary lesion on chest radiograph, all
consistent with tuberculosis.
 Discussion
• Likely Gram stain findings of sputum sample: Mycobacterium
tuberculosis appear as colorless (“ghost”) cells.
• In the presence of gram-ghost cells by gram's staining is strongly
suspected to be mycobacteria. Gram's staining is useful as an easy and
rapid diagnostic clue to recognize infective mycobacteria

Gram's staining of the sputum

 Discussion
• Most commonly used staining technique for M. tuberculosis:
Acid-fast staining

Ziehl-Neelsen's staining
 Discussion
• Histologic characteristics of Langhans cells: Multinucleated
giant cells of fused macrophages
 Discussion
• Other laboratory investigations can help in this
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