Sputum, BAL, and sweat

Sputum

From upper and lower respiratory tract

Tracheobronchial secretions

Mixture of plasma, electrolytes, mucin and water

<10/LPF SEC, >25WBC/LPF

acceptable sputum specimen according to bartlet classification

First morning sample

Most preferred sample for routine tests

24-hour sputum

Used for volume measurement

Throat swab

Sample from pediatric patients

Sputum induction

Done in px that are non-cooperative

Tracheal aspiration

sample for debilitated/unconcious patients

Refregiration or 10% formalin

used in sputum preservation

Made up of mucus only

colorless or translucent sputum:

Increased pus (TB, bronchitis, jaundice, pneumonia)

White or yellow sputum:

Increased pus and epithelial cells

Gray sputum:

increased bile: PAE infection, lung abscess

Birhgt green or greenish sputum:

Fresh blood orhemorrhage, TB, Bronchiectasis

Red or bright red sputum:

Old blood, pneumonia, gangrene

Anchovy sauce or rusty brown sputum:

Pneumonia or chronic lung cancer

Prune juic colored sptum:

Cancer

Olive green or grass green sputum:

Dust or dirt, carbon, charcoal ,anthrocis,smoking

Black sputum:

Lobar pneumonia

Rusty (With pus) sputum:

Congestive heart failure

Rusty (without pus) sputum:

Klebsiella pneumoniae

Currant jelly-like sputum:

Dittrich's plug

Yellow or gray material, size of a PINHEAD; produces FOUL odor when crushed; Associated with Bronchial asthma

Lung stones (Pneumoliths or Broncholiths)

Hard CONCRETION in a bronchus; yellow or white calcified TB structures or foreign material

Bronchial casts

Banching tree-like material of the bronchi; associated with lobar pneumonia, hbronchitis, diphtheria

frothy mucus

top part of layer formation:

opaque,water material

Middle part in layer formation:

Pus, bacteria, tissues

Bottom part in layer formation

Foreign bodies

Bronichial calculi (Calcium carbonate and phosphate); asbestos bodies, and silica particles

Elastic fibers

Slender fibrils with double contour and curled ends; signifies tuberculosis

Charcot-leyden crystal

Colorless, hexagonal, double pyramid, often NEEDLE-LIKE; arise from disintegrated eosinophil; associated with Bronchial asthma

Heart failure cells

Hemosiderin-laden macrophages

Carbon-laden cells

Angular black granules

Curshmann's spiral

COILED MUCUS STRANDS; can also be observed macroscopically; bronchial asthma

Myelin globules

Colorless globules occuring in a variety of sizes and bizzare forms; NO significance, mistaken as BLASTOMYCES

Creola bodies

Clusters of columnar epithelial cells; assoc. with bronchial asthma

Bronchoalveolar lavage

A procedure for collecting the cellular millieu of the alveoli by use of bronchoscope through which saline is instilled into distal bronchi and then withdrawn

Pneumocystis jirovecii (P. carinii)

BAL is important diagnostic for _______ in immunocompromised patients

Alveolar macrophage

Most predominant cells in BAL

Lymphocyte (1-15%)

intersitial disease, pulmonary lymphoma, nonbacterial infection

Sialic acid

Most important single component of sputum viscosity

Grocotts Methenamiane silver stain

__________ best delineates the cysts of Pneumocystis jiroveci

Sweat test

Used to diagnosis Cystic fibrosis (Mucovisidosis)

Cystic fibrosis

Autosomal recessive metabolic disorder affecting the mucous secreting glands of the body

Gibson and cooke pilocarpine iontophoresis

Uses mild current around 0.16mA to induce sweat

Flame photometry, ion exchange electrode

Sodium is measured via (2):

Manual or automated titration

Chloride is mesured via (2):

70mEq/L

Diagnostic of Cystic fibrosis:

40 mEq/L

Borderline for Cystic fibrosis:

sputum odor: Orderless

Normal

sputum odor: Foul or Putrid

Lung gangrene, advanced necrotizing tumors

sputum odor: Sweetish

Bronchiectasis, tuberculosis

sputum odor: Cheesy

Necrosis, tumors,empyema

sputum odor: Fecal

Liver abscess, enteric gram-negative bacterial infection

sputum consistency: mucoid

Asthma, bronchitis

sputum consistency: Serous or frothy

Lung edema

sputum consistency: Mucopurulent

Bronchiectasis, tuberculosis with cavities