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SPUTUM ANALYSIS

WHAT IS SPUTUM?
Secretion that is produced in the lungs and the
bronchi
Also known as phlegm
Mucus-like secretion may become infected,
bloodstained, or contain abnormal cells that may lead
to a diagnosis
Usually a mixture of plasma, water, electrolytes and
mucin

SPUTUM COLLECTION
1.

Ask the patient to drinking a lot of water and other fluids the night before
the test may help to get the sample. Do not eat, drink or smoke before
collection.

2.

Rinse the mouth with water before collection.

3.

Collect away from other people either outside or beside an open window

4.

Cough hard from deep inside the chest

5.

Spit the sputum directly to the container and recap after collection at least
2ml

6. The sputum is then taken to the laboratory


7. There, it is placed in a special substance (medium) under conditions that
allow the organisms to grow

PHYSICAL PROPERTIES OF
SPUTUM
APPEARANCE AND COLOR
Serous- normal, clear sputum
Salivary- samples from mouth or might be held in the mouth prior
to putting them in collection pots
Mucoid- sign of non-infectious airway disease. May occur in early
stage of infection.
Purulent- indicator of infection may be acute bronchitis &
pneumonia. Contains WBC, cellular debris, serious and viscous fluid.
color: white or gray, yellow, green, rust-colored or brown. May also
have a pink tinge.

PHYSICAL PROPERTIES OF
SPUTUM

Blood stained- indicate lung destruction and may be consistent with


infection. It can be due to tuberculosis, pulmonary embolism or lung
cancer.

ODOR

Usually no odor is present in normal and pathological sputum, but if


bacterial decomposition has been taken place within the body or after
expectoration, a variety of odor will be present

MISCELLANEOUS FINDINGS
IN
SPUTUM
1. Cheesy Masses

These are fragments of necrotic pulmonary tissue seen in


such disease as pulmonary gangrene or tuberculosis

2. Bronchial Casts

These are branching tree like casts of bronchi whose size


varies with that of bronchi in which they are formed

They are composed of fibrin and are white or gray color

MISCELLANEOUS FINDINGS
IN SPUTUM
3. Broncholiths (Lung Stones)
They are formed by calcification of necrotic or infected tissues
Chronic tuberculosis is the most common cause for their
formation
4. Dietrich's Plugs
They are frequently observed in putrid bronchitis and
bronchiectasis
They are composed of cellular debris, fatty acids, crystals, fat
globules and bacteria

AIMS OF SPUTUM
MICROSCOPY

Diagnosis of patients with infectious tuberculosis


Monitoring progress of patients on treatment

ADVANTAGE
Easy to read
More reliable than x-ray in diagnosis of TB
Inexpensive
Simple to perform

MICROSCOPIC EXAMINATION
1cm x 2cm

ZIEHL-NEELSEN (ZN) STAINING TECHNIQUE


Process:
Staining for 5 minutes (carbolfuchin)
Decolorizing for 3 minutes (acid alcohol)
Counterstaining for 1 minute (methylene blue)

REPORTING
AFB counts
No AFB in at least 100 fields
1 to 9 AFB in 100 fields*
1 to 10 AFB per fields in at least 50 fields
10 to 99 AFB in 100 fields
> 10 AFB per field in at least 20 fields

Recording/reporting
0/negative
Actual AFB counts
+
++
+++

MICROSCOPIC EXAMINATION
SPUTUM SMEAR FLUORESCENCE MICROSCOPY
same approach as Z-N staining
carbol fuchsin is replaced by a fluorescent dye (auramine-O, rhodamine,
auramine-rhodamine, acridine orange etc)
the acid for decolorization is milder
the counter stain is potassium permanganate though not essential, is useful to
quench
background fluorescence
With auramine staining, the bacilli appear as 5 slender bright yellow luminous rods,
standing
out clearly against a dark background.

REPORTING
Auramine O fluorescent staining
grading (using 20 or 25x objective
and 10x eye piece)
>100 AFB/field after examination
of 20 fields
1-10 AFB/ field after examination
of 100 fields
1-9 AFB/100 field

Reporting /Grading

1-3 AFB/100 fields

doubtful positive /repeat

No AFB per 100 fields

negative

Positive, 3+
Positive, 2+
Positive, 1+

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