Presented by Nasser Alatawi Saud Alqahtani Mazen almohammadi SPUTUM Presented by Nasser Alatawi Saud Alqahtani Mazen almohammadi

Sputum Sputum is a mucusey substance secreted into the airways of the respiratory tract. It can be coughed, spit out or swallowed. produced by surface epithelial cells and sub-mucous glands. It is a 5 µm thick that covers the airways and protects bronchial epithelium against inhaled noxious substances.

Sputum Mucus is transported by the respiratory cilia towards the oropharynx. Normally it is colorless, odorless . overnight sputum is more viscose than day sputum. Normal amount of secretion is 100ml per day. Sputum production is increased by injury of the bronchial tree or lung parenchyma, caused by inhaled noxious substances or by inflammation.

Chemical composition 95% water 5 % organic components: Carbohydrates ( such as sialic acid which contribute to its high viscosity) Proteins ( enzymes, immunoglobulin) which also contributes to the viscosity of sputum. Lipids DNA from broken WBC Macrophages Bronchial epithelial cells

Clinical features Normal sputum is either white or colorless. Yellow to green sputum (Purulent : increased WBC or abscesses fluid or fibers ) can be an indication of pus or infection such as pneumonia. Blood in sputum is called hemoptysis which could be due to lung cancer, tuberculosis, lung abscess , hemorrhage. Rust color is due to decomposed Hemoglobin. Very thick (viscose) sputum is a characteristic of cystic fibrosis . Ascaris can be seen in sputum (because of its life cycle).

Sputum VS Saliva Saliva Sputum Criteria colorless White/colorless Less but can`t roll out Densest Density Viscose Appearance More than 25/LPF Less than 5/LPF Many/LPF (abundant/many)/HPF Less than 25/LPF More than 5/LPF (None/few)/LPF (Few/moderate)/HPF Microscopy: Epithelial cells WBCs Food particles Bacteria

Collecting Sputum Samples

Smear preparation

Fix the smear by passing it through a Bunsen flame several times Smear preparation Fix the smear by passing it through a Bunsen flame several times

Sputum test A sputum test can include a culture (gram stain) and / or a cytology test on a sample of sputum. Stained by (cytology) Hematoxylin stain Leishman stain Giemsa stain

Sputum test PMNs in a sample of sputum Sputum cytology ; Examines a sample of sputum (mucus) under a microscope to determine whether abnormal cells are present , such as tumor cells.

Collecting Sputum Samples Bronchoscope; . An instrument (bronchoscope) is inserted into the airways, usually through the nose or mouth, or occasionally through a tracheotomy. It can be used to collect samples of tissue or sputum for analysis.

Type of specimen few blood stained flecks Normal saliva with a small amount of material Normal few blood stained flecks heavily stained with blood

Report form Macroscopic Microscopic Report notes Volume Color Viscosity Microscopic WBCs RBCs Epithelial cells Blood Any other abnormality Report notes Describe any abnormal result Describe any conclusion and recommendation For example - Cystic fibrosis test indicated - No abnormal findings seen