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

[02-021 ] General sputum analysis

870 RUB

To order

Sputum is a pathological secret separated from the lungs and respiratory tract (trachea and bronchi). General analysis of sputum is a laboratory study that allows you to evaluate the nature, general properties and microscopic features of sputum and gives an idea of \u200b\u200bthe pathological process in the respiratory organs.

Synonyms Russian

Clinical analysis of sputum.

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 the study?

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

General information about the study

Sputum is a pathological secret of the lungs and respiratory tract (bronchi, trachea, larynx), which is separated by coughing up. Healthy people do not produce phlegm. Normally, the glands of the large bronchi and trachea constantly form a secret in an amount of up to 100 ml / day, which is swallowed when excreted. Tracheobronchial secretion is a mucus, which contains glycoproteins, immunoglobulins, bactericidal proteins, cellular elements (macrophages, lymphocytes, desquamated cells of the bronchial epithelium) and some other substances. This secret has a bactericidal effect, helps to remove inhaled small particles and cleanse the bronchi. In diseases of the trachea, bronchi and lungs, the formation of mucus increases, which is coughing up in the form of sputum. Smokers with no signs of respiratory disease also produce profuse sputum.

Clinical analysis of sputum is a laboratory study that allows you to assess 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.

Sputum composition is heterogeneous. It may contain mucus, pus, serous fluid, blood, fibrin, and the simultaneous presence of all these elements is not necessary. Pus forms clusters that occur at the site of the inflammatory process. The inflammatory exudate is secreted as serous fluid. Blood in sputum appears with changes in the walls of the pulmonary capillaries or vascular damage. The composition and associated properties of sputum depend on the nature of the pathological process in the respiratory system.

Microscopic analysis makes it possible, under multiple magnification, to examine the presence of various formed elements in sputum. 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 recommended to simultaneously 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 needs to remember that for the study, sputum secreted during coughing is needed, and not saliva and mucus from the nasopharynx. You need to collect phlegm in the morning before meals, after rinsing your mouth and throat thoroughly, brushing your teeth.

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

What is research used for?

• For the diagnosis of a pathological process in the lungs and respiratory tract;
• to assess the nature of the pathological process in the respiratory organs;
• for dynamic monitoring of the state of the respiratory tract of patients with chronic respiratory diseases;
• to assess the effectiveness of the therapy.

When is the study scheduled?

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

What do the results mean?

Reference values

The amount of sputum for various pathological processes, it can be from a few milliliters to two liters per day.

A small amount of sputum is separated when:

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

A large amount of sputum can be secreted when:

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

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

Sputum color

More often the sputum is colorless.

A green tint may indicate the addition of purulent inflammation.

Various shades of red indicate 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 medications (such as rifampicin) can stain sputum.

Smell

The phlegm is usually odorless.

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

A peculiar "fruity" smell of sputum is characteristic of the opened one.

The nature of the 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 with pulmonary edema due to the release of plasma into the lumen of the alveoli.

Mucopurulent sputum is observed in bronchitis, pneumonia, bronchiectasis, 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 system.

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

Squamous epithelium more than 25 cells indicates contamination of the material with saliva.

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

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

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

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

Erythrocytes ... The detection of single erythrocytes 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 are present in malignant neoplasms.

Elastic fibers appear with the disintegration 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, neoplasms in the lungs.

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

Calcified elastic fibers - elastic fibers impregnated with salts. Their detection in sputum is typical for tuberculosis.

Kurshman spirals are formed with a spastic state of the bronchi and the presence of mucus in them; typical for bronchial asthma, bronchitis, lung tumors.

Charcot crystals – Leiden - decay products of eosinophils. Typical for bronchial asthma, eosinophilic infiltrates in the lungs, pulmonary fluke.

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

Other flora . Detection of bacteria (cocci, bacilli), especially in large numbers, indicates the presence of a bacterial infection.



Literature

• Laboratory and instrumental research in diagnostics: Handbook / Per. from English V. Yu. Khalatova; under. ed. V. N. Titov. - M .: GEOTAR-MED, 2004 .-- P. 960 .
• Nazarenko G.I., Kishkun A. Clinical evaluation of laboratory research results. - M .: Medicine, 2000. - S. 84-87.
• Roitberg 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 carry out 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 with a spatula and a needle until a translucent layer is obtained (the spatula and the needle are grasped with the right and left hand in the form of a writing pen); this is done very carefully so as not to destroy the formations in the sputum. The translucent layer of sputum is examined in order to identify linear and rounded particles and formations in it, scraps that differ in color and consistency. For this, a Petri dish with sputum is placed alternately on a white and black background. Found formations are isolated from the bulk (mucus, pus, blood) with cutting movements of tools, trying not to damage the separated particles. The prepared preparation will be complete only if all particles and formations of interest to the researcher are selected sequentially. The selected material is placed on a glass slide. In this case, particles that are denser in consistency are placed closer to the center of the intended preparation, and less dense, as well as mucopurulent, purulent-mucous, bloody formations, are placed along the periphery. The material is covered with glass. Usually, two preparations are prepared on one slide, which provides maximum viewing of the selected material. In properly prepared preparations, sputum does not go beyond the coverslip.

If the sputum is viscous or viscous, press lightly on the cover glass to distribute the material evenly. Preparations intended for microscopic examination are studied first under a low magnification and then under a 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 reticular, together with shaped elements (leukocytes, erythrocytes), grayish.

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

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

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

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

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

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

3. Myelin (fig. 51, 4) - various shapes opaque gray formations that can be found in sputum extracellularly, as well as within 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; the myelin is colored in shades from purple to red.

4. Neutrophils ... Morphologically, neutrophils resemble leukocytes found in urine. In purulent sputum, the destruction of leukocytes occurs, therefore, in some places of the drug, a granular, structureless mass (detritus) is found.

5. Eosinophils ... They have a number of characteristics that differ from neutrophils. They are slightly larger in size, contain coarse grain, making them appear darker. Their clusters at low magnification have a yellowish tint. Especially a lot of eosinophils are contained in yellowish crumbly scraps of sputum from patients with bronchial asthma. Sometimes Charcot-Leiden crystals are found among eosinophils. For more accurate identification of eosinophils, the preparation is stained.

Eosinophil staining technique. Sputum is spread over 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 stained for several seconds with 0.5-1% aqueous solution of methylene blue. Rinse again with water, dry and examine under an immersion microscope. Eosinophils show red granularity (Fig. 53). You can also stain eosinophils using the Romanovsky method. For this purpose, the preparation is stained in the same way as blood smears, but only for less time (8-10 minutes).

Figure: 53. Eosinophilic leukocytes in sputum (oil immersion).

6. Erythrocytes - unchanged look the same as in urine. They are usually not found in brown bloody particles.

7. Fatty granular cells (Fig. 54, 1) - rounded, several times more leukocytes, contain fatty droplets that strongly refract light.

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

Figure: 54. 1 - fat-granular cells; 2 - glandular group of atypical epithelium with glandular lung cancer. Native drug. Magnification 300x. Micrograph.

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

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

b) coral elastic fibers. They are simple elastic fibers coated with soaps. In this regard, they are devoid of gloss, 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 decay. Calcifying fatty caseous decay, calcified elastic fibers, cholesterol crystals and mycobacterium tuberculosis are called Ehrlich's tetrade.

Elements of Ehrlich's tetrad are easier to detect if, with a careful macroscopic examination of sputum, whitish crumbly shreds are selected.

In some cases, a microchemical reaction is used to distinguish coral fibers from calcified ones. 1-2 drops of 10-20% NaOH solution are added 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 found in the native preparation, the preparation must be stained according to Ziehl-Nielsen. In some cases, sputum processing is used to detect simple elastic fibers.

Sputum treatment technique 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% alcoholic solution of eosin. A preparation is prepared from the sediment and examined under a microscope. The elastic fibers are colored orange-red (Fig. 55).

Figure: 55. Elastic fibers in sputum.

10. Fibrin - has the form of thin filaments located in parallel bundles or reticulately.

11. Hematoidin Crystals - diamond-shaped or needle-shaped, reddish-orange.

12. Cholesterol - colorless plates with stepped ledges.

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

Figure: 56. Eosinophils, Charcot-Leiden crystals, Kurshman's spiral.

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

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

16. Dietrich plug (see fig. 57) - whitish or yellowish-grayish lumps of curdled copsistency, sometimes with a fetid odor, similar in shape to lentil grains. They are composed of crystals of fatty acids, neutral fat, detritus and bacterial clumps.

Figure: 57. Dietrich plug. Fatty acid needles; fat is neutral; detritus. Native drug. Magnification 280x.

17. Rice-shaped bodies - rounded, dense formations. They contain accumulations of coral fibers, fatty decay products, soaps, cholesterol crystals and a large number of Mycobacterium tuberculosis.

18. Druzy actin itcetes (Fig. 58) - at low magnification, they are rounded formations with sharply outlined contours, yellowish in color, with an amorphous middle and with a darker color around the edges; at high magnification, the center of the druse is an accumulation of radiant fungus, the filaments of which end in flask-shaped swellings at the periphery. When stained according to Gram, the filaments of the mycelium of the fungus are gram-positive, and the bulbous swellings are gram-negative.

Figure: 58. Druses 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 scolexes of echinococcus.

Figure: 59. Elements of echinococcus. 1 - film of an echinococcal bladder, 2 - hooks of an echinococcus, 3 - scolexes

Microscopic examination of sputum includes the study of native (natural, untreated) and stained preparations. For the first, purulent, bloody, tiny lumps are selected, transferred to a glass slide in such an amount that, when covered with a cover glass, a thin translucent preparation is formed. At low magnification the microscope can be detected kurshmann spirals in the form of dense cords of mucus of various sizes. They consist of a central dense, shiny, twisted axial filament and a spiral-like mantle enveloping it (Fig. 9), into which they are impregnated. Kurshmann spirals appear in the sputum in the bronchi. At high magnification in the native preparation (Fig. 11), leukocytes, alveolar macrophages, cells of heart defects, cylindrical and flat, cells of malignant tumors, actinomycete drusen, fungi, Charcot-Leiden crystals, eosinophils can be detected. Leukocytes - gray granular round cells. A large number of leukocytes can be found in the inflammatory process in the respiratory organs. Erythrocytes - small homogeneous yellowish discs that appear in sputum during congestion in the pulmonary circulation, pulmonary infarction and tissue destruction. Alveolar macrophages - cells 2-3 times larger than leukocytes with abundant coarse granularity c. In this way, they cleanse the lungs of particles (dust, cell decay) falling into them. By capturing erythrocytes, alveolar macrophages turn into heart disease cells (Fig. 12 and 13) with yellow-brown grains of hemosiderin, giving a reaction to Prussian blue. To do this, add 1-2 drops of a 5% solution of yellow blood salt and the same 2% solution to a lump of sputum on a glass slide, mix, cover with a cover glass. After a few minutes, microscopy. Hemosiderin grains turn blue.

Cylindrical 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; it is a lot in acute bronchitis and acute catarrh of the upper respiratory tract. Squamous epithelium - large polygonal cells from the oral cavity have no diagnostic value. Malignant tumor cells - large, of various irregular shapes with large nuclei (very extensive experience of the researcher is required to recognize them). Elastic fibers - thin, convoluted, two-circuit colorless filaments of the same thickness throughout, branching in two at the ends. They often fold in annular bundles. They occur 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% alcoholic solution of eosin to it. The sediment is microscoped. The elastic fibers look as described above, but in a bright pink color (fig. 15). Druses of actinomycetes for microscopy, crush in a drop of glycerin or alkali. The central part of the druse consists of a plexus fine threads mycelium, it is surrounded by radiant flask-shaped formations (Fig. 14). When the crushed drusen is stained according to Gram, the mycelium turns purple, the cones in 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 crystals - Leiden - colorless rhombic crystals of various sizes (Fig. 9), formed from the decay products of eosinophils, are found in sputum along with a large number of eosinophils in bronchial asthma, eosinophilic infiltrates and helminthic invasions of the lung. Eosinophils in the native preparation, they differ from other leukocytes in large shiny granularity, they are better distinguishable in a smear stained sequentially with 1% eosin solution (2-3 minutes) and 0.2% methylene blue solution (0.5 minutes) or according to Romanovsky - Giemsa (fig. 16). At the last staining, as well as at staining according to May - Grunwald, tumor cells are recognized (Fig. 21).

Figure: 9. Kurshman's spiral (above) and Charcot-Leiden crystals in sputum (native preparation). Figure: 10. Candida albicans (center) - budding yeast-like cells and mycelium with spores in sputum (native preparation). Figure: 11. Sputum cells (native preparation): 1 - leukocytes; 2 - erythrocytes; 3 - alveolar macrophages; 4 - cells of columnar epithelium. Figure: 12. Cells of heart defects in sputum (reaction to Prussian blue). Figure: 13. Cells of heart defects in sputum (native preparation). Figure: 14. Druse actinomycetes in sputum (native preparation). Figure: 15. Elastic fibers in sputum (eosin staining). Figure: 16. Eosinophils in sputum (Romanovsky - Giemsa stain): 1 - eosinophils; 2 - neutrophils. Figure: 17. Pneumococci and in sputum (Gram stain). Figure: 18. Friedlander diplobacillus in sputum (Gram stain). Figure: 19. Pfeiffer's wand in sputum (staining with fuchsin). Figure: 20. Mycobacterium tuberculosis (staining according to Tsilu-Nelsen). Figure: 21. Conglomerate of cancer cells in sputum (staining according to May - Grunwald).

At low magnification, Kurshman's spirals are found in the form of mucus strands of various sizes, consisting of a central axial thread and a spiral-like mantle enveloping it (tsvetn. Fig. 9). The latter is often interspersed with leukocytes, cells of columnar epithelium, Charcot-Leiden crystals. When the microscrew turns, the axial thread sometimes shines brightly, sometimes it becomes dark, it can be invisible, and often only one is visible. Kurshman's spirals appear with spasm of the bronchi, most often with bronchial asthma, less often with pneumonia, cancer.

At high magnification, the following is found. Leukocytes are always present in sputum, there are many of them in inflammatory and suppurative processes; among them there are eosinophils (with bronchial asthma, asthmoid bronchitis, helminthic invasions of the lungs), characterized by large shiny granularity (printing. Fig. 7). Single erythrocytes can be in any sputum, there can be a lot of them with destruction of lung tissue, with pneumonia and blood stagnation in the pulmonary circulation. The epithelium is flat - large polygonal cells with a small nucleus that enter the sputum from the pharynx and oral cavity have no diagnostic value. The epithelium of the cylindrical ciliated appears in the sputum in a significant amount with lesions of the respiratory tract. Single cells can be in any sputum, they are elongated, one end is pointed, the other is dull, carries cilia, found only in fresh sputum; in bronchial asthma, there are round groups of these cells, surrounded by mobile cilia, giving them a resemblance to ciliated ciliates.

Cytological examination. Native and colored preparations are studied. To study cells, sputum lumps are gently stretched on a glass slide using splinters. When looking for tumor cells, the material is selected in a native preparation. The dried smear is fixed with methanol and stained according to Romanovsky - Giemsa (or Papanicolaou). Cancer cells are characterized by a homogeneous, sometimes vacuolated cytoplasm from blue-gray to of blue color, a large loose, and often hyperchromic, purple nucleus with nucleoli. There can be 2-3 or more nuclei, sometimes they are of irregular shape; polymorphism of nuclei in one cell is characteristic.

The most convincing are the complexes of polymorphic cells of the described nature (color. Fig. 13 and 14). Eosinophils are stained either according to Romanovsky-Giemsa, or sequentially with 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 in chronic processes and at the stage of resolution of acute processes in the bronchopulmonary system. Alveolar macrophages containing hemosiderin ("heart disease cells") are detected in pulmonary infarction, hemorrhage, and stagnation in the pulmonary circulation. Macrophages with lipid drops are a sign of an obstructive process in the bronchi and bronchioles.

■ Xanthoma cells (fatty macrophages) are found in abscess, actinomycosis, pulmonary echinococcosis.

■ Cells of columnar 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.

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

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

■ Erythrocytes. The detection of single erythrocytes in sputum has no diagnostic value. In the presence of fresh blood in the sputum, unchanged erythrocytes are determined, but if blood that has been in the respiratory tract for a long time leaves with sputum, leached erythrocytes are detected.

■ Malignant tumor cells are found in malignant neoplasms.

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

■ Coral fibers are found 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 tuberculous petrification.

Spirals, crystals

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

■ Charcot-Leiden crystals are degradation products of eosinophils. Usually appear in sputum containing eosinophils; typical for bronchial asthma, allergic conditions, eosinophilic infiltrates in the lungs, pulmonary fluke.

■ Crystals of cholesterol appear with abscess, echinococcosis of the lung, neoplasms in the lungs.

■ Crystals of hematoidin are characteristic of abscess and lung gangrene.

■ Actinomycete drusen are detected in lung actinomycosis.

■ Elements of echinococcosis appear in pulmonary echinococcosis.

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

■ Ehrlich's tetrad consists of four elements: calcified detritus, calcified elastic fibers, CS crystals and Mycobacterium tuberculosis. Appears with the decay of a calcified primary tuberculous focus.

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

Pneumocysts appear with Pneumocystis pneumonia.

Spherules of fungi are detected in coccidioidomycosis of the lungs.

Ascaris larvae are detected with ascariasis.

Intestinal acne larvae are detected with strongyloidosis.

Pulmonary fluke eggs are detected in paragonimiasis.

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

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 (Kurshman's spiral), and then at high magnification to differentiate the shaped elements.

Kurshman spirals

Spirals of Kurshman (H. Curchmann, 1846-1910, German doctor) are whitish-transparent corkscrew-like convoluted tubular formations formed from mucin in the bronchioles. The mucus strands consist of a central dense axial thread and a spiral-like mantle enveloping it, into which leukocytes (usually eosinophils) and Charcot-Leiden crystals are interspersed. Sputum analysis, in which Kurshman's spirals were found, is characteristic of bronchial spasm (most often with bronchial asthma, less often with pneumonia and lung cancer).

Charcot-Leiden crystals

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

Corpuscular elements of blood

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

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

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

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

Epithelial cells

Squamous 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 secretions from the oral cavity.

Cylindrical ciliated epithelium is present in small amounts in any sputum, in large amounts in case of respiratory tract damage (bronchitis, bronchial asthma).

Alveolar macrophages

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

Elastic fibers

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

Sputum components. Decoding analysis

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

Charcot-Leiden 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.

Squamous 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 can contain cells of malignant tumors, especially if the tumor grows endobrochially or disintegrates. It is possible to define cells as tumor cells only if a complex of atypical polymorphic cells is found, especially if they are located together with elastic fibers.

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