AUBF Sputum

• Sputum is a mixture of plasma, electrolytes, mucin and water, collected in the first morning 24hr-sputum.
• Sputum induction is a method of collecting sputum.
• Tracheal aspiration is a method of collecting sputum.
• Throat swab is a method of collecting sputum.
• Sputum analysis is done on sputum from the upper and lower respiratory tract.
• Sputum can be transparent/colorless, normal, yellow green, TB, bronchiectasis, green, or pus.
• Physical appearance of sputum can also be blood-streaked/ red, TB, bronchiectasis, or rusty/anchovy red, early lobar pneumonia.
• Sputum can have an odor that is odorless which is normal, foul/putrid for tumors and cavitary TB,or sweetish for bronchiectasis and TB cavities, or fruity for P. auruginosa
• Sputum can have a certain amount/volume that is scanty, bronchial asthma, acute bronchitis, or ample, bronchiectasis, lung abscess, edema, gangrene, edema or advanced TB.
• Sputum can have a certain consistency that is mucoid for asthma, bronchitis, serous/frothy for lung edema, or mucopurulent for bronchiectasis, TB cavities.
• Organisms such as P.carinii, T.gondii, S.stercoralis, L.pneumophila, C.neoformans, H.capsulatum, M.tuberculosis, M.pneumoniae, influenza A and B viruses, and respiratory syncytial virus can be detected in cytology specimens.
• The microscopic appearance of cytology specimens can reveal characteristic amorphous material in LPO and organisms in HPO.
• Detection of Pneumocystis carinii in immunosuppressed patients is a clinical significance of cytology specimens.
• Eosinophils are less than 1-2% of the differential count in cytology specimens.
• Ciliated Columnar Bronchial Epithelial cells make up 4 -17% of the differential count in cytology specimens.
• Lymphocytes make up 1-15% of the differential count in cytology specimens.
• Neutrophils are less than 3% of the differential count in cytology specimens.
• Fungal elements and viral inclusions may be seen in cytology specimens.
• C.neoformans is a significant opportunistic pathogen in patients with AIDS.
• Alveolar Macrophages are a hallmark of BAL and make up 56 to 80% of the differential count.
• Macroscopic structures found in sputum can include bronchial casts, made of fibrin; Bronchial cast which is a branching tree-like cast found in cases of lobar pneumonia; Cheesy masses, fragments of necrotic pulmonary tissues seen in PTB and pulmonary gangrene; Dittrich’s plugs, grayish to yellowish, seen in bronchiectasis and bronchitis, and Pneumolith (lung stones), formed from calcified pulmonary tissues, seen in Histoplasmosis.
• Macroscopic structures can also include Curshmann’s spirals, twisted mucoid threads, seen in bronchial asthma, acute bronchitis.
• Bronchoalveolar lavage (BAL) is a procedure in obtaining cellular, immunologic & microbiological information from the lower respiratory tract.
• Alveolar proteinosis is characterized by PAS positive macrophages.
• Charcot-Leyden crystals are observed in asthma.
• Bronchoalveolar lavage (BAL) is often used in conjunction with high-resolution computerized tomography (HRCT), medical history and physical examination to determine need for surgical biopsy.
• Dense, crystalline concretions are observed in brocholithiasis.
• Carchotschlens spirals are observed in asthma.
• PAS positive rounded bodies that take silver stain are observed in P.carinii infection.
• If delivery to the lab is delayed for longer than 30 minutes, specimens from bronchoalveolar lavage (BAL) are transported on ice at 4 o C.
• Specimens from bronchoalveolar lavage (BAL) are kept at room temperature during transport to the laboratory and processed immediately.
• asthma or pulmonary hypersensitivity reaction is characterized by numerous eosinophils.
• Lipid droplets in macrophages are observed in lipoid or aspiration pneumonia.
• Chronic bronchitis or bronchiectasis is characterized by numerous eosinophils, abundant mucus, and few or no organisms.
• Specimens from bronchoalveolar lavage (BAL) are unacceptable for testing after 24 hours.
• Alveolar proteinosis is characterized by microscopic formed elements.
• Bronchoalveolar lavage (BAL) is particularly useful in evaluating immunocompromised patients, interstitial lung disease, airway diseases, suspected alveolar hemorrhage, pulmonary alveolar proteinosis, Langerhans cell histiocytosis, and dust exposure.
• Epithelial cells are mostly found in saliva and are numerous in neutrophils with intra-/extracellular organisms.