Eosinophils in sputum are normal. Respiratory system. Lymphopenia in a general blood test is characteristic of

[02-021 ] General sputum analysis

870 rub.

Order

Sputum - discharge from the lungs and respiratory tract(trachea and bronchi) pathological secretion. General sputum analysis is a laboratory test that allows you to evaluate the character, general properties and microscopic features of sputum and gives an idea of ​​the pathological process in the respiratory organs.

Synonyms Russian

Clinical sputum analysis.

English synonyms

Sputum analysis.

Research method

Microscopy.

Units

Mg/dL (milligram per deciliter).

What biomaterial can be used for research?

How to properly prepare for research?

• It is recommended to drink a large amount of liquid (water) 8-12 hours before collecting sputum.

General information about the study

Sputum is a pathological secretion of the lungs and respiratory tract (bronchi, trachea, larynx), which is separated when coughing. Healthy people do not produce sputum. Normally, the glands of the large bronchi and trachea constantly produce a secretion in amounts of up to 100 ml/day, which is swallowed when secreted. Tracheobronchial secretion is a mucus that contains glycoproteins, immunoglobulins, bactericidal proteins, cellular elements (macrophages, lymphocytes, desquamated bronchial epithelial cells) and some other substances. This secretion has a bactericidal effect, promotes the removal of inhaled small particles and cleanses the bronchi. In diseases of the trachea, bronchi and lungs, the formation of mucus increases, which is expectorated in the form of sputum. Smokers without signs of respiratory diseases also produce copious amounts of sputum.

Clinical sputum analysis is a laboratory test that allows you to evaluate the nature, general properties and microscopic features of sputum. Based on this analysis, the inflammatory process in the respiratory organs is judged, and in some cases a diagnosis is made.

The composition of sputum is heterogeneous. It may contain mucus, pus, serous fluid, blood, fibrin, and the simultaneous presence of all these elements is not necessary. Pus forms accumulations that occur at the site of the inflammatory process. Inflammatory exudate is released in the form of serous fluid. Blood in the sputum appears when there are changes in the walls of the pulmonary capillaries or damage to blood vessels. The composition and associated properties of sputum depend on the nature of the pathological process in the respiratory organs.

Microscopic analysis makes it possible to examine the presence of various formed elements in sputum under multiple magnification. If microscopic examination does not reveal the presence of pathogenic microorganisms, this does not exclude the presence of infection. Therefore, if a bacterial infection is suspected, it is simultaneously recommended to perform a bacteriological examination of sputum to determine the sensitivity of pathogens to antibiotics.

The material for analysis is collected in a sterile disposable container. The patient must remember that the study requires sputum released during coughing, and not saliva and mucus from the nasopharynx. You need to collect sputum in the morning before meals, after thoroughly rinsing your mouth and throat, and brushing your teeth.

The results of the analysis should be assessed by a doctor in combination, taking into account the clinical picture of the disease, examination data and the results of other laboratory and instrumental research methods.

What is the research used for?

• To diagnose pathological processes in the lungs and respiratory tract;
• to assess the nature of the pathological process in the respiratory organs;
• for dynamic monitoring of the condition of the respiratory tract of patients with chronic respiratory diseases;
• to assess the effectiveness of the therapy.

When is the study scheduled?

• For diseases of the lungs and bronchi (bronchiectasis, fungal or helminthic invasion of the lungs, interstitial lung diseases);
• if you have a cough with sputum production;
• with a specified or unclear process in the chest according to auscultation or x-ray examination.

What do the results mean?

Reference values

Amount of sputum for various pathological processes it can range from several milliliters to two liters per day.

A small amount of sputum is released when:

• acute bronchitis,
• pneumonia,
• congestion in the lungs, at the beginning of an attack of bronchial asthma.

Large amounts of sputum may be produced when:

• pulmonary edema,
• suppurative processes in the lungs (with an abscess, bronchiectasis, gangrene of the lung, with a tuberculosis process accompanied by tissue decay).

By changing the amount of sputum, it is sometimes possible to assess the dynamics of the inflammatory process.

Sputum color

Most often the sputum is colorless.

A green tint may indicate the addition of purulent inflammation.

Various shades of red indicate an admixture of fresh blood, and rusty indicates signs of decay.

Bright yellow sputum is observed when a large number of eosinophils accumulate (for example, in bronchial asthma).

Blackish or grayish sputum contains coal dust and is observed in pneumoconiosis and in smokers.

Some may also stain sputum. medicines(eg rifampicin).

Smell

Sputum is usually odorless.

A putrid odor is observed as a result of the addition of a putrefactive infection (for example, with an abscess, gangrene of the lung, with putrefactive bronchitis, bronchiectasis, lung cancer complicated by necrosis).

A peculiar “fruity” smell of sputum is characteristic of opened sputum.

Character of sputum

Mucous sputum is observed with catarrhal inflammation in the respiratory tract, for example, against the background of acute and chronic bronchitis, tracheitis.

Serous sputum is determined by pulmonary edema due to the release of plasma into the lumen of the alveoli.

Mucopurulent sputum is observed in bronchitis, pneumonia, bronchiectasis, and tuberculosis.

Purulent sputum is possible with purulent bronchitis, abscess, pulmonary actinomycosis, gangrene.

Bloody sputum is released during pulmonary infarction, neoplasms, lung injury, actinomycosis and other factors of bleeding in the respiratory organs.

Consistency sputum depends on the amount of mucus and formed elements and can be liquid, thick or viscous .

Flat epithelium in an amount of more than 25 cells indicates contamination of the material with saliva.

Columnar ciliated epithelial cells – cells of the mucous membrane of the larynx, trachea and bronchi; they are found in bronchitis, tracheitis, bronchial asthma, and malignant neoplasms.

Alveolar macrophages in increased quantities in sputum are detected during chronic processes and at the stage of resolution of acute processes in the bronchopulmonary system.

Leukocytes are detected in large quantities with severe inflammation, as part of mucopurulent and purulent sputum.

Eosinophils found in bronchial asthma, eosinophilic pneumonia, helminthic lesions of the lungs, and pulmonary infarction.

Red blood cells . Detection of single red blood cells in sputum has no diagnostic value. In the presence of fresh blood, unchanged red blood cells are detected in the sputum.

Cells with signs of atypia present in malignant neoplasms.

Elastic fibers appear during the breakdown of lung tissue, which is accompanied by the destruction of the epithelial layer and the release of elastic fibers; they are found in tuberculosis, abscess, echinococcosis, and tumors in the lungs.

Coral fibers detected in chronic diseases (for example, cavernous tuberculosis).

Calcified elastic fibers – elastic fibers impregnated with salts. Their detection in sputum is characteristic of tuberculosis.

Kurshman spirals are formed due to the spastic condition of the bronchi and the presence of mucus in them; characteristic of bronchial asthma, bronchitis, lung tumors.

Charcot crystals – Leiden - eosinophil breakdown products. Characteristic of bronchial asthma, eosinophilic infiltrates in the lungs, pulmonary fluke.

Mushroom mycelium appears with fungal infections of the bronchopulmonary system (for example, in the lungs).

Other flora . The detection of bacteria (cocci, bacilli), especially in large quantities, indicates the presence of a bacterial infection.



Literature

• Laboratory and instrumental studies in diagnostics: Handbook / Transl. from English V. Yu. Khalatova; under. ed. V. N. Titova. – M.: GEOTAR-MED, 2004. – P. 960 .
• Nazarenko G.I., Kishkun A. Clinical assessment of laboratory research results. – M.: Medicine, 2000. – P. 84-87.
• Roytberg G. E., Strutinsky A. V. Internal diseases. Respiratory system. M.: Binom, 2005. – P. 464.
• Kincaid-Smith P., Larkins R., Whelan G. Problems in clinical medicine. – Sydney: MacLennan and Petty, 1990, 105-108.

To conduct these studies, the following workplace equipment is required:

1. Slides and coverslips.
2. Petri dishes.
3. Dental spatula and needle.
4. Black and white paper.
5. Microscope.
6. Gas or alcohol burner.
7. Nikiforov's mixture.
8. Romanovsky paint.
9. Sodium hydroxide.
10. Eosin.
11. Yellow blood salt.
12. Concentrated hydrochloric acid.
13. Methylene blue.
14. Water.
15. Matches.

Selection of material and preparation of preparations for microscopic examination

The sputum placed in a Petri dish is spread out using a spatula and a needle until a translucent layer is obtained (the spatula and needle are grasped with the right and left hands in the form of a writing pen); This is done very carefully so as not to destroy the formations present in the sputum. The translucent layer of sputum is studied to identify linear and round particles and formations, shreds, differing in color and consistency. To do this, a Petri dish with sputum is placed alternately on a white and black background. The found formations are isolated from the main mass (mucus, pus, blood) using cutting movements of instruments, trying not to damage the isolated particles. The prepared preparation will be complete only if all particles and formations of interest to the researcher are consistently selected. The selected material is placed on a glass slide. In this case, particles that are more dense in consistency are placed closer to the center of the intended preparation, and less dense ones, as well as mucopurulent, purulent-mucosal, and blood-stained formations, are placed at the periphery. The material is covered with glass. Typically, two preparations are prepared on one piece of glass, which ensures maximum viewing of the selected material. In properly prepared preparations, sputum does not extend beyond the coverslip.

If the sputum has a viscous or viscous consistency, then lightly press on the cover slip to distribute the material more evenly. Preparations intended for microscopic examination are studied first under low and then under high magnification of the microscope with the condenser lowered.

It is important to be able to find various elements of sputum not only at high, but also at low magnification.

Study of sputum elements found in preparations during microscopic examination

1. Slime- fibrous or network-like, together with formed elements (leukocytes, erythrocytes), grayish in color.

2. Epithelium- flat, round (alveolar macrophages), cylindrical (ciliated).

Squamous epithelium has the form of polygonal colorless cells with abundant cytoplasm and a single nucleus.
The epithelium is cylindrical, ciliated (bronchi) (Fig. 51, 3) is an elongated cell, one of the ends of which is narrowed, and at the other - blunt - cilia are often visible; the nucleus, round or oval in shape, is located eccentrically in the wide part of the cell; the cytoplasm contains fine granularity. Sometimes (in bronchial asthma) the bronchial epithelium is detected in the form of glandular formations, which have moving cilia in freshly secreted sputum.

Rice. 51. Cellular elements in sputum and elastic fibers: leukocytes (1), alveolar macrophages (2), bronchial epithelium (3), myelin (4), simple elastic fibers (5), coral-shaped (6), calcified (7).

Alveolar macrophages - This round shape the cells are several times larger in size than leukocytes, with pronounced granularity in the cytoplasm, due to which in most cases the nucleus is not visible. The grain is usually grayish in color. Undergoing fatty degeneration, alveolar macrophages become darker, since the drops of fat accumulating in the cell refract the rays of light passing through them more strongly.

In the presence of carbon pigment, part of the grain becomes black. In smokers, alveolar macrophages contain brownish-yellow granules. The golden-yellow granularity is due to the presence of blood pigment containing iron (hemosiderin) in alveolar macrophages. To detect hemosiderin in sputum, a chemical reaction is used.

A cover glass is removed from the preparation in which alveolar macrophages with lemon-yellow or golden-yellow granularity were found. The sputum is dried in air. A reagent (a mixture of equal volumes of 3% hydrochloric acid solution and 5% yellow blood salt solution) is poured onto the preparation for 8-10 minutes. After 8-10 minutes, the reagent is drained. The preparation is covered with a coverslip and examined under high magnification.
In the presence of hemosiderin, alveolar macrophages are stained blue (cyan) (Fig. 52).

Rice. 52. Reaction to hemosiderin in sputum. 1 - before painting, 2 - after painting.

3. Myelin(Fig. 51, 4) - various shapes dull gray formations that can be found extracellularly in sputum, as well as inside alveolar macrophages.

To distinguish myelin from fat droplets, a microreaction is used: one drop of concentrated H2SO4 is carefully added to the material in which myelin was found; in this case, the myelin is colored in shades from violet to red.

4. Neutrophils. Morphologically, neutrophils resemble leukocytes found in urine. In purulent sputum, leukocytes are destroyed, so in some places of the preparation a granular, structureless mass (detritus) is found.

5. Eosinophils. They have a number of characteristics distinctive from neutrophils. They are slightly larger in size and contain coarse grains, making them appear darker. Their clusters at low magnification have a yellowish tint. There are especially many eosinophils in yellowish crumbly pieces of sputum from patients with bronchial asthma. Sometimes Charcot-Leyden crystals are found among eosinophils. For more accurate recognition of eosinophils, the preparation is stained.

Eosinophil staining technique. The sputum is spread onto a glass slide. The preparation is dried in air and fixed over a burner flame. Warm glass is placed for 3 minutes in a 0.5% alcohol solution of eosin, and then washed with water and painted for several seconds with a 0.5-1% aqueous solution of methylene blue. Wash again with water, dry and examine under an immersion microscope. In eosinophils, red granularity is detected (Fig. 53). Eosinophils can also be stained using the Romanowsky method. For this purpose, the preparation is stained in the same way as blood smears, but only in less time (8-10 minutes).

Rice. 53. Eosinophilic leukocytes in sputum (oil immersion).

6. Red blood cells- Unchanged ones look the same as in urine. They are usually not found in brown bloody particles.

7. Fatty granular cells (Fig. 54, 1) - round in shape, several times larger than leukocytes, contain fat droplets that strongly refract light.

8. Cells of malignant neoplasms (Fig. 54, 2) - different sizes, fat- and vacuole-degenerated. They are found separately and in the form of close rounded groups or rod-shaped formations, bulbs, etc.

Rice. 54. 1 - fatty granular cells; 2—glandular-like group of atypical epithelium in glandular lung cancer. Native drug. Magnification 300x. Microphotography.

9. Elastic fibers (see Fig. 51, 5, 6, 7):

a) simple elastic fibers - shiny, thin, delicate double-circuit formations, the thickness of which is uniform throughout. They are found in clusters among purulent particles and in small dense shreds, in the form of scraps and single fibers among caseous decay;

b) coral-shaped elastic fibers. They are simple elastic fibers coated with soaps. In this regard, they lack shine, are coarser and thicker than simple elastic fibers;

c) calcified elastic fibers. They are coarser and thicker than simple elastic fibers, often fragmented, some of them resemble rod-shaped formations. Most often, this type of fiber is located among an amorphous mass of lime salts and fat droplets, which is called calcifying fatty caseous decomposition. Calcifying fatty caseous decay, calcified elastic fibers, cholesterol crystals and Mycobacterium tuberculosis are called Ehrlich's tetralogy.

Elements of Ehrlich's tetralogy are easier to detect if whitish crumbly shreds are selected during a thorough macroscopic examination of the sputum.

In some cases, a microchemical reaction is used to distinguish coral fibers from calcified ones. Add 1-2 drops of 10-20% NaOH solution to the test material; the soaps covering the coral fibers dissolve, and simple elastic fibers are released from under their cover; Calcified elastic fibers do not change under the influence of alkali. If elastic fibers are detected in the native preparation, the preparation must be stained according to Ziehl-Neelsen. In some cases, they resort to processing sputum in order to detect simple elastic fibers.

Technique for processing sputum to identify elastic fibers . An equal volume of 10% alkali solution is added to a small amount of sputum; the mixture is heated until dissolved, and then poured into two centrifuge tubes and centrifuged, after adding 5-8 drops of a 1% alcohol solution of eosin. A preparation is prepared from the sediment and examined under a microscope. Elastic fibers are colored orange-red (Fig. 55).

Rice. 55. Elastic fibers in sputum.

10. Fibrin- has the form of thin fibers arranged in parallel bundles or in a network-like manner.

11. Hematoidin crystals - diamond-shaped or needle-shaped, reddish-orange in color.

12. Cholesterol— colorless signs with stepped ledges.

13. Charcot-Leyden crystals (Fig. 56) - diamond-shaped, colorless crystals, reminiscent of a magnetic compass needle.

Rice. 56. Eosinophils, Charcot-Leyden crystals, Kurshman spiral.

14. Fatty acid crystals (Fig. 57) - look like long, slightly curved gray needle-like formations.

15. Kurshman spiral (see Fig. 56) is a mucous, spiral-shaped, rounded formation with a central thread and a mantle. In some cases, the spiral has either a central thread or a mantle. Along with the spiral, eosinophils and Charcot-Leyden crystals are often found in the same preparation.

16. Dietrich's cork (see Fig. 57) - whitish or yellowish-grayish lumps of curdled consistency, sometimes with a fetid odor, similar in shape to lentil grains. They consist of crystals of fatty acids, neutral fat, detritus and accumulations of bacteria.

Rice. 57. Dietrich's cork. Fatty acid needles; neutral fat; detritus. Native drug. Magnification 280x.

17. Rice bodies - round, dense formations. They contain accumulations of coral fibers, fat breakdown products, soap, cholesterol crystals and a large number of mycobacterium tuberculosis.

18. Drusen actinum iceets (Fig. 58) - at low magnification they appear as round formations with sharply defined contours, yellowish in color, with an amorphous middle and a darker color at the edges; at high magnification, the center of the drusen is an accumulation of radiant fungus, the filaments of which end in flask-shaped swellings at the periphery. When stained with Gram stain, the filaments of the fungal mycelium are gram-positive, and the flask-shaped swellings are gram-negative.

Rice. 58. Drusen of actinomycetes.

19. (Fig. 59) - the chitinous membrane of the echinococcal bladder (in thin places it is transparent and has a delicate parallel striation), hooks and scolex of the echinococcus.

Rice. 59. Echinococcus elements. 1 - film of echinococcal bladder, 2 - hooks of echinococcus, 3 - scolex

Microscopic examination of sputum includes the study of native (natural, unprocessed) and colored preparations. For the first, purulent, bloody, crumbly lumps are selected and transferred to a glass slide in such quantity that when covered with a cover glass, a thin translucent preparation is formed. At low microscope magnification can be detected Kurschmann spirals in the form of dense strands of mucus of various sizes. They consist of a central dense shiny convoluted axial thread and a spiral-shaped mantle enveloping it (Fig. 9), in which they are interspersed. Kurschmann spirals appear in bronchial sputum. At high magnification, in the native preparation (Fig. 11) one can detect leukocytes, alveolar macrophages, cells of cardiac defects, cylindrical and flat, malignant tumor cells, drusen of actinomycetes, fungi, Charcot-Leyden crystals, eosinophils. Leukocytes- gray granular round cells. A large number of leukocytes can be found during the inflammatory process in the respiratory organs. Red blood cells- small homogeneous yellowish discs that appear in sputum during stagnation in the pulmonary circulation, pulmonary infarction and tissue destruction. Alveolar macrophages- cells 2-3 times larger than leukocytes with abundant coarse granularity. By doing this, they cleanse the lungs of particles that enter them (dust, cell decay). By capturing red blood cells, alveolar macrophages turn into heart defect cells(Fig. 12 and 13) with yellow-brown hemosiderin grains, giving a reaction to Prussian blue. To do this, add 1-2 drops of a 5% solution of yellow blood salt and the same amount of a 2% solution to a lump of sputum on a glass slide, mix, and cover with a coverslip. After a few minutes, they are examined under a microscope. Hemosiderin grains turn blue.

Columnar epithelium the respiratory tract is recognized by the wedge-shaped or goblet-shaped cells, at the blunt end of which cilia are visible in fresh sputum; there is a lot of it in acute bronchitis and acute catarrh of the upper respiratory tract. Flat epithelium- large polygonal cells from the oral cavity have no diagnostic value. Malignant tumor cells- large, of various irregular shapes with large nuclei (recognizing them requires a lot of experience of the researcher). Elastic fibers- thin, crimped, double-circuit colorless fibers of equal thickness throughout, branching in two at the ends. They are often folded into ring-shaped bundles. Occurs during the breakdown of lung tissue. For more reliable detection, several milliliters of sputum are boiled with an equal amount of 10% caustic until the mucus dissolves. After cooling, the liquid is centrifuged by adding 3-5 drops of a 1% alcohol solution of eosin. The sediment is microscopically examined. The elastic fibers appear as described above, but are bright pink in color (Fig. 15). Drusen of actinomycetes for microscopy, crush in a drop of glycerin or alkali. The central part of the drusen consists of a plexus thin threads mycelium, it is surrounded by radiant flask-shaped formations (Fig. 14). When a crushed drusen is stained with a Gram stain, the mycelium turns violet, the cones turn pink color. Candida albicans fungus has the character of budding yeast cells or short branched mycelium with a small number of spores (Fig. 10). Charcot - Leiden crystals- colorless rhombic crystals of various sizes (Fig. 9), formed from the breakdown products of eosinophils, are found in sputum along with a large number of eosinophils in bronchial asthma, eosinophilic infiltrates and helminthic infestations of the lung. Eosinophils in the native preparation they differ from other leukocytes by their large shiny granularity, they are better distinguishable in a smear stained sequentially with a 1% eosin solution (2-3 min.) and a 0.2% solution of methylene blue (0.5 min.) or according to Romanovsky-Giemsa (Fig. 16). With the last staining, as well as with May-Grunwald staining, tumor cells are recognized (Fig. 21).

Rice. 9. Kurshman spiral (top) and Charcot-Leyden crystals in sputum (native preparation). Rice. 10. Candida albicans (in the center) - budding yeast-like cells and mycelium with spores in sputum (native preparation). Rice. 11. Sputum cells (native preparation): 1 - leukocytes; 2 - red blood cells; 3 - alveolar macrophages; 4 - columnar epithelial cells. Rice. 12. Cells of cardiac defects in sputum (reaction to Prussian blue). Rice. 13. Cells of cardiac defects in sputum (native preparation). Rice. 14. Drusen of actinomycetes in sputum (native preparation). Rice. 15. Elastic fibers in sputum (eosin staining). Rice. 16. Eosinophils in sputum (Romanovsky-Giemsa stain): 1 - eosinophils; 2 - neutrophils. Rice. 17. Pneumococci and in sputum (Gram stain). Rice. 18. Friedlander's diplobacillus in sputum (Gram stain). Rice. 19. Pfeiffer bacillus in sputum (muchsin staining). Rice. 20. Mycobacterium tuberculosis (Ziehl-Neelsen staining). Rice. 21. Conglomerate of cancer cells in sputum (May-Grunwald staining).

At low magnification, Kurshman spirals are found in the form of strands of mucus of various sizes, consisting of a central axial thread and a spiral-shaped mantle enveloping it (tsvetn. Fig. 9). The latter is often interspersed with leukocytes, columnar epithelial cells, and Charcot-Leyden crystals. When the microscrew is turned, the axial thread sometimes shines brightly, sometimes becomes dark, may be invisible, and often only it alone is visible. Kurshman spirals appear during bronchospasm, most often with bronchial asthma, less often with pneumonia and cancer.

At high magnification the following is found. Leukocytes are always present in sputum; there are many of them during inflammatory and suppurative processes; among them there are eosinophils (with bronchial asthma, asthmatic bronchitis, helminthic infestations of the lungs), characterized by large shiny granularity (color. Fig. 7). Single red blood cells can be present in any sputum; there can be many of them when lung tissue is destroyed, with pneumonia and blood stagnation in the pulmonary circulation. Squamous epithelium - large polygonal cells with a small nucleus that enter the sputum from the pharynx and oral cavity, have no diagnostic value. Columnar ciliated epithelium appears in sputum in significant quantities with lesions of the respiratory tract. Single cells can be in any sputum, they are elongated, one end is pointed, the other is blunt, bears cilia, found only in fresh sputum; in bronchial asthma, round groups of these cells are found, surrounded by mobile cilia, giving them a resemblance to ciliated ciliates.

Cytological examination. Native and colored preparations are studied. To examine cells, lumps of sputum are carefully stretched onto a glass slide using splinters. When searching for tumor cells, material is collected from the native specimen. The dried smear is fixed with methanol and stained with Romanovsky-Giemsa (or Papanicolaou). Cancer cells are characterized by homogeneous, sometimes vacuolated cytoplasm ranging from blue-gray to of blue color, a large loose, and often hyperchromatic, purple nucleus with nucleoli. There may be 2-3 or more nuclei, sometimes they are irregular in shape; characterized by polymorphism of nuclei in one cell.

The most convincing are complexes of polymorphic cells of the described nature (tsvetn. fig. 13 and 14). Eosinophils are stained either according to Romanovsky - Giemsa, or sequentially with a 1% eosin solution (2 min.) and 0.2% methylene blue solution (0.5-1 min.).

■ Alveolar macrophages are cells of reticulohistiocytic origin. A large number of macrophages in sputum are detected during chronic processes and at the stage of resolution of acute processes in the bronchopulmonary system. Alveolar macrophages containing hemosiderin (“cells of heart defects”) are detected in pulmonary infarction, hemorrhage, and congestion in the pulmonary circulation. Macrophages with lipid droplets are a sign of an obstructive process in the bronchi and bronchioles.

■ Xanthoma cells (fat macrophages) are found in abscesses, actinomycosis, and pulmonary echinococcosis.

■ Cells of the cylindrical ciliated epithelium - cells of the mucous membrane of the larynx, trachea and bronchi; they are found in bronchitis, tracheitis, bronchial asthma, and malignant neoplasms of the lungs.

■ Flat epithelium is detected when saliva enters the sputum; it has no diagnostic value.

■ Leukocytes are present in varying quantities in any sputum. A large number of neutrophils are detected in mucopurulent and purulent sputum. Sputum is rich in eosinophils in bronchial asthma, eosinophilic pneumonia, helminthic lesions of the lungs, and pulmonary infarction. Eosinophils can appear in the sputum of tuberculosis and lung cancer. Lymphocytes are found in large numbers in whooping cough and, less commonly, in tuberculosis.

■ Red blood cells. The detection of single red blood cells in sputum has no diagnostic value. If there is fresh blood in the sputum, unchanged erythrocytes are determined, but if blood that has been in the respiratory tract for a long time is removed with sputum, leached erythrocytes are detected.

■ Malignant tumor cells are found in malignant neoplasms.

■ Elastic fibers appear during the breakdown of lung tissue, which is accompanied by the destruction of the epithelial layer and the release of elastic fibers; they are found in tuberculosis, abscess, echinococcosis, and tumors in the lungs.

■ Coral fibers are detected in chronic lung diseases, such as cavernous tuberculosis.

■ Calcified elastic fibers - elastic fibers impregnated with calcium salts. Their detection in sputum is characteristic of the disintegration of tuberculosis petrification.

Spirals, crystals

■ Kurshman spirals are formed when the bronchi are spastic and there is mucus in them. During a cough push, viscous mucus is thrown into the lumen of a larger bronchus, twisting into a spiral. Kurshman spirals appear in cases of bronchial asthma, bronchitis, and lung tumors that compress the bronchi.

■ Charcot-Leyden crystals are breakdown products of eosinophils. Typically appear in sputum containing eosinophils; characteristic of bronchial asthma, allergic conditions, eosinophilic infiltrates in the lungs, pulmonary fluke.

■ CS crystals appear with an abscess, pulmonary echinococcosis, and neoplasms in the lungs.

■ Hematoidin crystals are characteristic of abscess and gangrene of the lung.

■ Actinomycete drusen are detected in actinomycosis of the lungs.

■ Echinococcus elements appear in pulmonary echinococcosis.

■ Dietrich's plugs - yellowish-gray lumps with bad smell. They consist of detritus, bacteria, fatty acids, and fat droplets. They are characteristic of lung abscess and bronchiectasis.

■ Ehrlich's tetralogy consists of four elements: calcified detritus, calcified elastic fibers, cholesterol crystals and mycobacterium tuberculosis. Appears during the disintegration of a calcified primary tuberculosis focus.

Mycelium and budding fungal cells appear with fungal infections of the bronchopulmonary system.

Pneumocystis appear in Pneumocystis pneumonia.

Fungal spherules are detected in pulmonary coccidioidomycosis.

Ascaris larvae are identified in ascariasis.

Intestinal eel larvae are detected in strongyloidiasis.

Pulmonary fluke eggs are detected during paragonimiasis.

Elements found in sputum in bronchial asthma. With bronchial asthma, a small amount of mucous, viscous sputum is usually released. Macroscopically you can see the Kurshman spirals. Microscopic examination is characterized by the presence of eosinophils, columnar epithelium, and Charcot-Leyden crystals.

Sputum microscopy

Microscopic analysis of sputum is carried out in both native and stained preparations. The specimen is first viewed at low magnification for initial orientation and search for large elements (Curshman spirals), and then at high magnification to differentiate formed elements.

Kurshman spirals

Curschmann's spirals (H. Curschmann, 1846-1910, German physician) are whitish-transparent corkscrew-shaped tubular formations formed from mucin in the bronchioles. Strands of mucus consist of a central dense axial thread and a spiral-shaped mantle enveloping it, in which leukocytes (usually eosinophils) and Charcot-Leyden crystals are interspersed. Sputum analysis, in which Kurshman spirals are detected, is characteristic of bronchospasm (most often with bronchial asthma, less often with pneumonia and lung cancer).

Charcot-Leyden crystals

Charcot-Leyden crystals (J.M. Charcot, 1825-1893, French neurologist; E.V. Leyden, 1832-1910, German neurologist) look like smooth, colorless crystals in the shape of octahedrons. Charcot-Leyden crystals consist of a protein that releases eosinophils during the breakdown, so they are found in sputum containing many eosinophils (allergic processes, bronchial asthma).

Formed elements of blood

A small number of leukocytes can be found in any sputum; during inflammatory (and especially suppurative) processes, their number increases.

Neutrophils in sputum. The detection of more than 25 neutrophils in the field of view indicates an infection (pneumonia, bronchitis).

Eosinophils in sputum. Single eosinophils can be found in any sputum; in large quantities (up to 50-90% of all leukocytes) they are found in bronchial asthma, eosinophilic infiltrates, helminthic infestations of the lungs, etc.

Red blood cells in sputum. Red blood cells appear in sputum during the destruction of lung tissue, pneumonia, stagnation in the pulmonary circulation, pulmonary infarction, etc.

Epithelial cells

Flat epithelium enters the sputum from the oral cavity and has no diagnostic value. The presence of more than 25 squamous epithelial cells in the sputum indicates that the sputum sample is contaminated with oral secretions.

Columnar ciliated epithelium is present in small quantities in any sputum, and in large quantities in cases of damage to the respiratory tract (bronchitis, bronchial asthma).

Alveolar macrophages

Alveolar macrophages are localized mainly in the interalveolar septa. Therefore, analysis of sputum, where at least 1 macrophage is present, indicates that the lower parts of the respiratory system are affected.

Elastic fibers

Elastic fibers have the appearance of thin double-circuit fibers of equal thickness throughout, dichotomously branching. Elastic fibers originate from the pulmonary parenchyma. The detection of elastic fibers in sputum indicates destruction of the pulmonary parenchyma (tuberculosis, cancer, abscess). Sometimes their presence in sputum is used to confirm the diagnosis of abscess pneumonia.

Components of sputum. Analysis transcript

Kurshman spirals - Bronchospastic syndrome, the most likely diagnosis is asthma.

Charcot-Leyden crystals - Allergic processes, bronchial asthma.

Eosinophils, up to 50-90% of all leukocytes - Allergic processes, bronchial asthma, eosinophilic infiltrates, helminthic invasion of the lungs.

Neutrophils, more than 25 in the field of view - Infectious process. It is impossible to judge the localization of the inflammatory process.

Flat epithelium, more than 25 cells in the field of view - An admixture of discharge from the oral cavity.

Alveolar Macrophages - The sputum sample comes from the lower respiratory tract.

Elastic fibers - Destruction of lung tissue, abscess pneumonia.

Atypical cells

Sputum may contain malignant tumor cells, especially if the tumor grows endobrochially or disintegrates. Cells can only be identified as tumor cells if a complex of atypical polymorphic cells is found, especially if they are located together with elastic fibers.

Trophozoites of E.histolytica - pulmonary amoebiasis.
Larvae and adults of Ascaris lumbricoides - pneumonitis.
Cysts and larvae of E. granulosus - hydatid echinococcosis.
P. westermani eggs are paragonimiasis.
Larvae of Strongyloides stercoralis - strongyloidiasis.
N.americanus larvae - hookworm.