3. SPUTUM
oSputum is the secretion
of the tracheobronchial
oNORMALLY – these
secretion are carried
upward by the action of
the cilia (HAIR like
structures) of the
mucosal epithelial cells
4. o When they spill over into
the hypopharynx,they
are “swallowed “ carried
down into the
oesophagus and
stomach without the
individual being
consciously aware of it
o Only when the volume of
these secretions
increases does a person
being aware of their
presence
5. SPUTUM
oExcess is then evacuated by coughing “
oThis is done forcefully ,the material can be
brought into the mouth and then spat out
oSputum must be differentiated from saliva
oSputum contains approximately 95% percent
water and 5 % total solids
oSolid contains primarily carbohydrates ,
proteins ,lipids and DNA
6. COLLECTION OF SPUTUM
oInstruct the patients to collect only
material which is actually coughed
up from the trachea
oNot saliva or spit ,from the mouth
oUsually a specimen collected when
the patient first get up in the
morning is adequate
oSputum coughed up in a 24 hour
period
7. COLLECTION OF SPUTUM
oSputum should be collected in
closable sputum cups or in
wide – mouth bottles with
covers
oBest to examine sputum while
it is fresh
oIf this is not possible, smears
may be taken and fixed
o Preserved for staining and
examination later
12. QUANTITY or VOLUME
Even if they have a cough , it is a dry cough without any
sputum –(NON – PRODUCTIVE COUGH)
Large amount of sputum – PRODUCTIVE COUGH
Some patients do not bring up much sputum during the
day
But in the morning after a night lying down
They may bring up a large volume of sputum
13. COLOR
TEST NORMAL FINDINGS ABNORMAL FINDINGS CLINICAL CONDITIONS
COLOR CLEAR AND
COLORLESS
YELLOW PUS &EPITHELIAL
CELLS – PNEUMONIC
PROCESS
GREENISH PSEUDOMONAS
INFECTION
RUST COLORED PNEUMOCOCCAL
PNEUMONIA
BRIGHT RED RUPUTRE OF VESSEL
BLACK DUE TO INHALATION
OF DIRT
19. CONSISTENCY AND APPEARANCE
When saliva is watery ,sputum always contains mucus which
gives an uneven or lumpy consistency
Sputum may be classified into various types according to its
consistency and appearance
20. CONSISTENCY AND APPEARANCE
Test Normal findings Abnormal findings Clinical conditions
Consistency and
appearance
Colorless, watery and
opalescent
Mucoid Acute bronchitis
Lobar pneumonia
Purulent Ruputred emphyema
bronchiectasis
Bloody Mitral stenosis
serous Frothy colorless or
yellow found in
pulmonary edema
26. Miscellaneous findings
Occasionally various objects large
enough to be visible macroscopically
may be found in the sputum
BRONCHIAL CASTS
BRONCHOLITHS
FOREIGN BODIES
SULPHUR GRANULES
PARASITES
27. BRONCHIAL CASTS
oBranching structures of fibrin called
“fibrinous casts “
oFormed inside the bronchial tree in
some kinds of bronchitis and
pneumonia
oFound in the sputum when they
expelled by coughing
28. BRONCHOLITHS (LUNG STONES)
These are calcified bits of dead
or infected lung tissue
when found most likely would be
associated with chronic
tuberculosis or chronic fungus
infection in the lung
29. Sulphur granules
• Small yellowish lumps
• granules in the sputum
• Which are actually made up of colonies of
a fungus
• The yellow colour of Sulphur granules
• Seen in infection of the lungs by
actinomycosis species in actinomycosis
of the lung
30. parasites
• Misplaced intestinal parasites such
as round worm (Ascaris lumbricoides
) or the trematode
• ‘lung fluke’(paragoniums westermani
)
•In such countries as Japan,are
occasionally found in the sputum
31. FOREIGN BODIES
•These include any object a pateint,
especially a young child, has swallowed
and then aspirated by mistakes
including
• Pins
• Small glass marbles or beads
• Ground nuts etc
32. Chemical examination
•Usually no chemical tests are
done for sputum
•Occasionally test for occult blood
may be requested
•Same way as urine or stool
specimen
33. Concentration method for tubercle
bacilli in sputum
• Usually done on a 24 hour sputum
specimen collected in a sterile bottle
• Mix equal volume of sputum and 6%
sulphuric acid
• Let stand for 20 minutes
• Centrifuge at 3000 rpm for 30 minutes
34. Concentration method for tubercle
bacilli in sputum
•Decant the supernatant and carefully
wash the sediment with distilled water,
doing this three times
•Make a smear of the deposit
•Dry and fix the smear
•Stain it with ziel Neelsen stain
•The deposit may be cultured if desired
35. MICROSCOPIC EXAMINATION
• UNSTAINED SPUTUM
• A smear of unstained sputum ,on which a cover slip has been placed
• Usually examinaed first for any of the following features
• ELASTIC FIBRES
• CURSCHMANNS SPIRALS
• CHARCOT LEYDEN CRYSTALS
• PIGMENTED CELLS
• FUNGI
• PARASITES
36. Unstained sputum
• A smear of unstained sputum, on which a cover slip has been
placed
Usually examined first for any of the following features
1 .ELASTIC FIBRES
Appear ad wavy fibres in bundles
May be found by examining a number of wet coverslip
preparations
Also found in the concentration techniques
37. ELASTIC FIBRES
o10 ml of the sputum is mixed with
an equal volume of 10 g/dl sodium
hydroxide
oWhen the sputum is completely
emulsified it is centrifuges and the
sediment or deposit is examined
for the fibres
40. CRUSCHMANN,S SPIRALS
•Appear as wiry spiral structures
with a central thread
•Structures are found in the
sputum of patients with asthma
41. CHARCOT – LEYDEN CRYSTALS
Fine needle- shaped Or hexagonal
Colourless crystals
Usually about 20 – 30 micron meter
in length called charcot – leyden
crystals
Often seen in the sputum of patients
with asthma
42. CHARCOT – LEYDEN CRYSTALS
• May not be present in freshly collected
sputum
• Seems to form as the sputum sites for
some time
• They arise from the disintegration of
eosinophils
• Stain strongly with eosin
44. PIGMENTED CELLS
• LARGE MONONUCLEAR CELLS
CONTAINING PIGMENTS
• USUALLY MACROPHAGES
• TISSUE MONOCYTES
• SHOW DARK BLOOD PIGMENT OR
BLACK CARBON PIGMENT
45. FUNGI
• Colonies of
branching mycelia of
fungi
• Sulphur granules are
seen grossly
• Should be examined
microscopically to
see the branching
mycelia of fungus
46. PARASITES
• PARASITIC WORM LARVAE OR OVA
• OVA OF THE LUNG FLUKE - PARAGONIMUS
WESTERMANI
• HOOKLETS OF THE LARVAE FORM -
ECHINOCOCCUS GRANULOSA
• FILARIFORM LARVAE - STRONGYLOIDES
STERCORALIS
47. STAINED SPUTUM SMEAR
• SMEARS ARE MADE ON CLEAN ,DRY SLIDES
• SMEARS ARE DRIED AND FIXED OVER A FLAME
• STAINED WITH GRAMS STAIN FOR COCCOI OR BACILLI
• ZIEHL NEELSON STAIN FOR ACID FAST ORGANISMS
• FLUORESCENT STAINS - TUBERCLE BACILLI
• SPECIAL STAINS USED FOR FUNGI OR BACTERIA
• PAPANICOLAOU STAIN – DETAILED CYTOLOGIC STUDY FOR CANCER
CELLS
• WRIGHTS STAIN OR LEISHMAN STAIN – IDENTIFYING VARIOUS CELLS
INCLUDING
49. POLYMORPHONUCLEAR LEUKOCYTES
• USUALLY NEUTROPHILS
• OCCASIONALLY EOSINOPHILS ARE SEEN
• FEW NEUTROPHILS MAY BE SSEN IN ANY CONDITIONS IN WHICH
SPUTUM IS INCREASED
• FRANK PUS – LUNG ABSCESS
• MANY NEUTROPHILS – PYOGENIC BACTERIA
50. EOSINOPHILS
• SEEN IN ASTHMATIC CONDITIONS
• EOSINOPHILIC LUNG
• PARASITIC INFESTATIONS IN THE LUNG
51. LYMPHOCYTES
LARGE NUMBER OF LYMPHOCYTES ARE FOUND IN EARLY TUBERCULOSIS
FEW LYMPHOCYTES MAY BE SEEN ALONG WITH THE NEUTROPHIL
POLYMORPHS
52. LARGE MONONUCLEAR CELLS
• MACROPHAGES COME FROM THE ALVEOLI
• LOWER BRONCHIAL TRACT
• THEIR PRESENCE CONFIRMS THAT THE SPECIMEN IS FROM THE LUNG
• NOT FROM THE MOUTH
53. EPITHELIAL CELLS
• DERIVED FROM THE MUCOSAL LINING OF THE TRACHEOBRONCHIAL
TREE
• EVEN FROM THE PULMONARY ALVEOLI
• COLUMNAR CELLS WITH CILIA AT ONE END
• FLAT CELLS WITH A CENTRAL CIRCULAR NUCLEUS
• SQUAMOUS CELLS ARE VERY SMALL DARK NUCLEI AND ABUNDANT
CYTOPLASM
• MATERIAL BEING EXAMINED IS FROM THE THROAT OR MOUTH
