Microscopic examination consists of studying native and stained preparations. The elements of sputum that are found in the native preparation can be divided into three main groups: cellular, fibrous and crystalline.
Cellular elements
Leukocytes are always contained in sputum in greater or lesser quantities depending on the nature of the sputum. The more pus in the sputum, the more leukocytes.
Eosinophils are recognized in the native preparation by their darker color and the presence in the cytoplasm of clear, large, uniform, abundant, dark, light-refracting granularity. Eosinophils are found in bronchial asthma and other allergic conditions, in the presence of helminths, pulmonary echinococcus, eosinophilic infiltrates, and malignant neoplasms.
Red blood cells They look like yellowish discs. Single red blood cells can be found in any sputum. IN large quantities found in bloody sputum during pulmonary hemorrhage, pulmonary infarction, tuberculosis, congestion in the pulmonary circulation, lung tumors, etc.
Squamous epithelial cells enter the sputum from the oral mucosa. Single squamous epithelial cells are always found. A large number of cells indicates an admixture of saliva or insufficient oral hygiene before collecting sputum for examination, especially in the presence of dentures or inflammation in the oral cavity.
Columnar ciliated epithelium. Columnar epithelial cells are located singly, in groups, and sometimes in large clusters. Ciliated epithelial cells are found in large numbers during an acute attack of bronchial asthma, acute bronchitis, acute catarrhal lesions of the upper respiratory tract, and lung tumors.
Alveolar macrophages Occurs in various inflammatory processes in the bronchi and lung tissue (pneumonia, bronchitis, occupational lung diseases).
Dust cells with phagocytosed particles of dust and coal are often detected in people with occupational lung diseases (smokers, workers in the tobacco and flour milling industries).
Siderophages- alveolar macrophages containing haemosyderin and having golden-yellow inclusions in the cytoplasm. Siderophages are found in sputum during congestion in the lung, pulmonary infarction, and hemorrhage.
Fibrous formations
Elastic fibers are elements of connective tissue and are found in sputum during destructive processes in the lungs. In the native preparation, elastic fibers have the appearance of crimped, shiny, thin, delicate fibers of uniform thickness throughout, folded in bunches.
Calcified elastic fibers- rough, thick, rod-shaped formations impregnated with lime salts. Their fragments look like a dotted line consisting of grayish sticks that refract light. Found in sputum during the disintegration of a petrified tuberculosis focus. The elements of disintegration of a petrified focus are called Ehrlich's tetralogy and include: 1) calcified elastic fibers, 2) amorphous lime salts, calcified caseous detritus, 3) cholesterol crystals, 4) mycobacterium tuberculosis.
Kurishman spirals - compacted, spiral-shaped formations of mucus. The central axial thread sharply refracts light and looks like a shiny spiral. Along the periphery, the mucus lies more freely and forms the so-called mantle. They are often found in the sputum of patients with bronchial asthma or lung tumors.
Crystal formations
Charcot - Leiden crystals they look like elongated, shiny, colorless rhombuses with pointed ends of various sizes, reminiscent of the needle of a magnetic compass. Formed from decaying eosinophils. Freshly secreted sputum often does not contain Charcot-Leyden crystals; they appear in it after 24 hours. The presence of these crystals in bronchial asthma is characteristic not only at the height of the attack, but also in the interictal period. They also occur with helminthic lesions of the lungs.
Hematoidin crystals They have the shape of diamonds, sometimes golden-yellow needles. They are a product of hemoglobin breakdown and form in the depths of hematomas and extensive hemorrhages, in necrotic tissue. In preparations, sputum is located against the background of detritus, elastic fibers, and in necrotic tissue scraps.
Cholesterol crystals They look like colorless quadrangular tablets with a broken corner in the form of steps, they are formed during the breakdown of fat-degenerated cells, when sputum is retained in the cavities, they are located against the background of detritus, often in combination with elastic fibers. Occurs in tuberculosis, neoplasms, lung abscess, lung gangrene, echinococcosis.
Study of colored preparations
To study the morphology of cellular elements of sputum, Romanovsky and Papenheim staining is used. The following cellular elements are differentiated in stained preparations.
Neutrophils constitute the bulk of leukocytes. Eosinophils in sputum they are found in the form of individual cells, sometimes in clusters. Lymphocytes- cells are round in shape (7-14 microns), the nucleus occupies most of the cell, the cytoplasm surrounds the nucleus with a narrow rim, sometimes in the form of a crescent. Basophils(mast cells) have a round shape, 8-10 microns in size, with a nucleus often of an indeterminate palmate shape, filled with large dark purple (basophilic) granules, densely covering the nucleus. Histiocytes They are constantly found in sputum preparations. Alveolar macrophages round and oval in shape, with a diameter of 10-30 microns.. These cells, with abundant inclusions, can be colored brown, brown or black.
Giant multinucleated cells of chronic inflammation(foreign body cells). Epithelioid cells. Their shape is oval, less often round. The nuclei are bean-shaped, pear-shaped, oval or elongated, kidney-shaped, with clear As elements of tuberculous granuloma, epithelioid cells are present in the sputum of tuberculosis and sarcoidosis.
Pirogov-Langhans cells. Giant multinucleated cells contain up to 20 or more nuclei. Pirogov-Langhans cells are part of tuberculous granuloma, but are rarely found in sputum. During caseous decomposition they are quickly destroyed.
Flat epithelium represented by superficial and intermediate cells. Bronchial epithelium depending on the caliber of the bronchus, it has a shape from prismatic to cubic. Ciliated cells They have an elongated shape with one wide end and the second conically narrowed end. Goblet cells similar to ciliated ones in size and shape, but do not have a cuticular rim and cilia. The cytoplasm is weakly basophilic, vacuolated due to the high mucus content, the nucleus is sharply shifted to the narrow distal end of the cell.
Quantity.
The volume of sputum released per day varies widely: it can be small (1-2 ml), for example in acute bronchitis, bronchial asthma, and very significant (more than 200-300 ml), which is most typical for diseases accompanied by the formation of a cavity in the respiratory organs. To determine the amount of sputum excreted per day, it is collected and then poured into a graduated glass container.
Color.
Mucous and serous sputum are colorless or whitish. The addition of a purulent component to sputum gives it a greenish tint, which is associated with the action of the enzyme verdoperoxidase, contained in neutrophil leukocytes and released from them during decay (lung abscess, lung gangrene, bronchiectasis, actinomycosis of the lung).
When a large amount of fresh blood appears in the sputum, the sputum turns into various shades of red (such is the sputum during hemoptysis in patients with tuberculosis, actinomycosis, lung cancer, lung abscess, pulmonary infarction, cardiac asthma and pulmonary edema).
The appearance of rust-colored sputum (with lobar, focal and influenza pneumonia, with pulmonary tuberculosis with cheesy disintegration, congestion in the lungs, pulmonary edema, with pulmonary anthrax) or brown sputum (with pulmonary infarction) indicates the content of not fresh blood in the sputum , and its breakdown products (hematin).
Sputum released during various pathological processes in the lungs, combined with the presence of jaundice in patients, may have a dirty green or yellow-green color. In this case, the change in color of the sputum is associated with the appearance of bilirubin in it.
Sputum in eosinophilic pneumonia sometimes has a canary-yellow color.
The discharge of ocher-colored sputum is noted with pulmonary siderosis.
Blackish or grayish sputum occurs when there is an admixture of coal dust.
With pulmonary edema, serous sputum, often released in large quantities, is evenly colored in a faint pink color, which is due to the admixture of red blood cells. The appearance of such sputum is sometimes compared to liquid cranberry juice.
Some medications may stain sputum. For example, rifampicin turns it red.
Smell.
Typically, freshly secreted sputum has no odor. It acquires a putrid odor with an abscess, gangrene of the lung, as well as with putrefactive bronchitis as a result of the addition of a putrefactive infection; The appearance of odor is caused by impaired mucus outflow.
Consistency.
There are liquid, thick and viscous sputum. The rheological properties of sputum depend on its composition, as well as the elasticity and viscosity of the mucus.
Division into layers.
When there is copious discharge of not very thick sputum, it stratifies when standing. With putrefactive bronchitis, gangrene of the lungs, bronchiectasis, sputum is usually divided into three layers: the upper layer is foamy, consisting of mucopurulent lumps with a significant content of air bubbles; the middle one is a cloudy yellowish-green liquid and the bottom one is an opaque yellowish mass.
The separation of sputum into two layers is often observed with a lung abscess: the upper layer consists of serous fluid, and the lower layer consists of an opaque greenish-yellow purulent mass containing cellular elements. Everything described allows us to draw a conclusion about the nature of the sputum.
Impurities.
An admixture to the sputum of just eaten food is noted when the esophagus communicates with the trachea or bronchus, which can occur with esophageal cancer.
With gangrene and lung abscess, pieces of necrotic lung tissue may be found in the sputum.
With a lung tumor, pieces of tumor tissue are sometimes released with sputum.
Foreign bodies found in sputum enter the respiratory tract from the oral cavity.
Fibrinous clots, consisting of mucus and fibrin, are found in fibrinous bronchitis, tuberculosis, and pneumonia.
Rice-shaped bodies (lentils) or Koch lenses consist of detritus, elastic fibers and MBT and are found in sputum during tuberculosis (characteristic of its destructive forms). At modern methods treatments are rare.
Dietrich's plugs, consisting of decay products of bacteria and lung tissue, crystals fatty acids, found in putrefactive bronchitis and gangrene of the lung. In case of chronic tonsillitis, plugs resembling appearance Dietrich plugs. Plugs from the tonsils can be released even in the absence of sputum.
Character.
The composition of sputum is heterogeneous; its nature depends on the pathological process. When describing the nature of sputum, the predominant component is placed in second place. The following types of sputum are distinguished:
- mucous sputum - colorless, viscous, viscous (especially viscous - glassy - it happens with bronchial asthma);
- purulent sputum - without admixture of mucus is very rare (for example, when opening pleural empyema in the bronchial cavity), since when passing through the respiratory tract, mucus is usually mixed with sputum;
- mucopurulent and purulent mucous sputum is most common; it is formed in many diseases of the bronchi and lungs and is a cloudy viscous mass in which mucus and pus are closely mixed;
- bloody sputum containing streaks or blood clots; sometimes the blood admixture is altered and its presence can be suspected only by the color of the sputum (for example, rusty sputum in lobar pneumonia);
- serous sputum - transparent, foamy, liquid, sometimes slightly pinkish in color; can be observed with pulmonary edema.
Clinical significance. The results of a macroscopic examination of sputum with a conclusion about its nature allow us to draw a conclusion about the nature of the pathological process.
Definition of reaction pH.
The study is carried out using indicator paper to determine pH in the range from 5.0 to 9.0 or using a pH meter.
Clinical significance. The pH value is largely determined by the nature and intensity of bronchial inflammation. The reaction of sputum, as a rule, is slightly alkaline; it becomes acidic when the sputum decomposes or when gastric contents are mixed with it. It is important to determine the pH of sputum to resolve the issue of the source of bleeding.
Sputum is a pathological product secreted during respiratory diseases.
Amount of sputum produced
In some lung diseases (bronchiectasis, abscess, gangrene, etc.), accompanied by the release of a large amount of sputum, there is a need to determine its daily amount. In such cases, the sputum is either collected immediately into a graduated glass container or poured into one in the laboratory.
Sputum smell
Freshly secreted sputum usually has no odor. In severe pathological processes (abscess, gangrene of the lung), a putrid, gangrenous odor is noted, which intensifies when sputum stands in an open container.
Sputum color
The color of sputum depends on the number of leukocytes and the admixture of erythrocytes. Mucous sputum is usually gray or whitish-gray in color, while purulent sputum is yellow or greenish-yellow.
When describing the color and nature of sputum, the predominant factor is mentioned in second place: for example, the grayish-yellow color of sputum corresponds to its mucopurulent nature, i.e. pus predominates in the sputum. The admixture of red blood cells, depending on the nature of the changes in hemosiderin, causes the red, brownish or rusty color of the sputum. The sputum may only be blood-stained in places or have a slightly reddish (brownish) tint. Sputum of a crimson color or shade is observed with autolysis of cancer or other malignant neoplasms of the lung. Yellow color of sputum is observed with general jaundice and opening of a liver abscess into the lung. The black color of sputum is caused by a significant admixture of coal dust. Brown (chocolate) colored sputum is released during abscess, bronchiectasis of the lung, or rupture of pleural empyema through the bronchus due to the decomposition of hemosiderin by enzymes of anaerobic bacteria. The color of sputum may be due to impurities in wine, coffee, medicines etc.
Character of sputum
There are serous, mucous, purulent-mucous, mucopurulent, serous-purulent, bloody, asthmatic (in the presence of yellowish dense crumbly shreds containing a large number of eosinophilic granulocytes and Charcot-Leyden crystals) sputum. The nature of sputum is determined definitively by microscopic examination, taking into account its color. For example, the gray color of sputum corresponds to its mucous nature, yellowish-gray - purulent-mucous, grayish-yellow - mucopurulent, etc.
Consistency of sputum
Sputum can be liquid, viscous, gelatinous, moderately viscous, viscous consistency. There may be sputum of heterogeneous consistency, for example, gelatinous with moderately viscous or viscous lumps, liquid with gelatinous lumps or shreds, etc.
The viscosity of sputum largely depends on the content of microorganisms in it, the proteolytic enzymes of which contribute to the decomposition of sputum. When the inflammatory process in the bronchi intensifies, along with an increase in the amount of protein, leukocytes and the total number of pathogenic microorganisms, as a rule, there is a dilution of sputum. Antibacterial therapy helps thicken the sputum.
Form of sputum
The shape of sputum can be granular, lumpy, or patchy.
Pathological impurities of sputum
Sputum may contain food impurities that have no diagnostic value, and impurities emanating directly from the pathological focus, in the form of tissue shreds of varying density, stained with blood or black with coal pigment. There are also yellowish dense crumbly shreds consisting of fibrin and eosinophilic granulocytes, whitish-grayish lumps (Dietrich's plugs), grayish-whitish dense rice-like grains (from cavities in tuberculosis), yellowish small grains in the form of semolina (drusen of actinomycetes), whitish stripes (calcified decay), fragments of the chitinous membrane of the echinococcal bladder, etc.
When studying the chemical properties of sputum, attention is mainly paid to the protein content in it, which can serve as a criterion for the activity of the inflammatory process in the lungs.
The determination of protein in sputum is not of great importance in the diagnosis of respiratory diseases. With bronchitis, sputum contains traces of protein; for pneumonia - up to 0.1%, for purulent bronchiectasis, abscess and cavernous pulmonary tuberculosis - up to 0.2%.
Microscopic examination of sputum.
Microscopic examination of sputum is carried out in fresh unstained (native) and fixed stained preparations.
Diagnostic value.
Elements of sputum detected in the native preparation are divided into three groups:
· cellular;
· fibrous;
· crystalline.
Cellular elements of sputum.
The cellular elements of sputum include squamous epithelium, columnar epithelium, alveolar macrophages, tumor cells, leukocytes and erythrocytes.
Squamous epithelial cells enter the sputum from the oral cavity, nasopharynx, epiglottis and vocal cords.
Single cells of squamous epithelium are almost always found in sputum; in large quantities - with inflammatory processes in the oral cavity and a significant admixture of saliva to sputum.
Columnar epithelium, lining the mucous membrane of the trachea and bronchi, is found in sputum in large quantities (in the form of clusters or groups) in tracheitis, bronchitis, and bronchial asthma.
Alveolar macrophages- large round cells with dark brown inclusions in the cytoplasm. They belong to the cells of the reticulohistiocytic system and are found in various inflammatory processes in the bronchi and lung tissue (bronchitis, pneumonia, pneumoconiosis).
Siderophages or “cells of heart defects” - alveolar macrophages containing hemosiderin in their cytoplasm in the form of golden-yellow inclusions (pulmonary edema, pulmonary infarction).
Tumor cells- usually large with vacuolated cytoplasm and nuclei with a clear chromatin network, found in sputum in the form of single cells or conglomerates. If such cells are detected, this drug and the rest of the sputum are subjected to a special cytological examination.
Leukocytes are almost always found in sputum in greater or lesser quantities, depending on the nature of the sputum. The more pus there is in the sputum, the more neutrophilic leukocytes it contains. Eosinophils are found in bronchial asthma, eosinophilic infiltrates in the lungs (Leffler's syndrome), pulmonary echinococcosis and helminthiasis.
Red blood cells- round or slightly oval cells, yellowish-brownish (fresh) or colorless (lost pigment), smaller in size than leukocytes. Single red blood cells can be detected in any sputum. Found in large quantities in sputum, stained with blood and containing it in the form of streaks (lung cancer, pulmonary infarction, tuberculosis, bronchiectasis, pulmonary edema).
Fibrous formations
Fibrous formations in sputum can be represented by mucous cords, fibrinous fibers, Kurshman spirals and elastic fibers.
Mucous cords in sputum - these are gray shiny fibrous formations, located singly and (or) in clusters (bronchitis, bronchial asthma, bronchopneumonia).
Fibrinous fibers- these are thin fibers located in the form of a bundle or in separate formations (fibrinous bronchitis, lobar pneumonia).
Kurshman spirals- these are compacted, spirally twisted mucous formations, consisting of an axial thread surrounded by a mantle of spirally twisted thin fibrous formations. Kurshman spirals are observed in bronchial asthma and obstructive bronchitis.
Elastic fibers they look like twisted, shiny, light-refracting thin threads folded into bundles. They are located against the background of leukocytes and cellular detritus, which indicates the breakdown of lung tissue (tuberculosis, abscess, lung tumor).
Crystalline formations.
Charcot-Leyden crystals have the appearance of shiny, smooth, colorless rhombuses of various sizes, are formed during the breakdown of eosinophils and are considered a product of crystallization of their proteins (bronchial asthma, eosinophilic infiltrates). In this regard, Charcot-Leyden crystals are absent in freshly secreted sputum, but appear after 24 - 48 hours.
Hematoidin crystals located together with cellular detritus, elastic fibers, and are a product of hemoglobin breakdown (pulmonary infarction, abscess, cavernous tuberculosis).
Cholesterol crystals- are formed during the breakdown of fat-degenerated cells, long-term retention of sputum in cavities (abscess, cavity, bronchiectasis.). In these same cases, crystals of fatty acids in the form of long thin needles and droplets of fat can be seen in the sputum against the background of cellular detritus.
In the sputum you can find elements of echinococcus (hooks and fragments of the chitinous membrane of the bladder) with opened or suppurated echinococcus of the lung and drusen of accinomycetes.
| Parameter name | Meaning |
| Article topic: | Physical properties sputum |
| Rubric (thematic category) | Education |
Methods studied the physical properties of sputum, its morphological and bacterioscopic characteristics. Laboratory minimum when examining a patient for tuberculosis
Daily amount of sputum. The amount of sputum depends on the disease. In acute bronchitis and bronchial asthma, up to 1-2 ml is released during the day. In chronic bronchitis, adenomatosis, and pulmonary tuberculosis, up to 25-100 ml of sputum is released. In bronchiectasis and actinomycosis, its amount reaches 2 liters.
Usually only morning, freshly isolated sputum is delivered to the laboratory for research.
Division into layers. Division into layers is characteristic of sputum released in large quantities. The reason for the separation is the different relative densities of the constituent parts of sputum.
Smell. Fresh sputum has no odor. The putrid odor in freshly collected sputum is characteristic of putrefactive bronchitis, gangrene of the lung and malignant neoplasms of the lungs, accompanied by necrosis.
Color and transparency. The color and transparency of sputum depend on its nature. Mucous sputum is usually clear and colorless or whitish in color. Purulent and purulent-mucous sputum is gray, yellowish or greenish in color. Bloody sputum may be the color of blood if there is significant pulmonary hemorrhage. The rusty color is typical for lobar pneumonia, brown occurs in tuberculosis, gangrene, and lung tumors.
Character of sputum. The main components of sputum are mucus, pus, and blood. Depending on the predominance of any component, the following are distinguished:
Mucous sputum is secreted in acute and chronic bronchitis, asthmatic bronchitis, tracheitis. Formed as a result of increased secretion of mucus by the mucous glands of the respiratory tract under the influence of bacteria or other irritants.
Mucopurulent sputum is characteristic of abscess and gangrene of the lung, purulent bronchitis, exacerbation of chronic bronchitis, staphylococcal pneumonia. It is a fairly homogeneous cloudy and viscous mass.
Purulent mucous sputum is characteristic of bronchopneumonia. Heterogeneous, consists of mucus containing pus lumps.
Purulent sputum is possible with bronchiectasis, staphylococcal pneumonia, abscess, gangrene, and actinomycosis of the lungs. The sputum is semi-liquid in consistency and is released in larger quantities.
Serous sputum is discharged during pulmonary edema. The sputum is often colorless, foamy, liquid in consistency and quite transparent.
Serous-purulent sputum is possible with a lung abscess.
Bloody sputum is released during pulmonary infarction, neoplasms, pneumonia (sometimes), lung injury, actinomycosis and syphilis.
Physical properties of sputum - concept and types. Classification and features of the category "Physical properties of sputum" 2017, 2018.