1. Lab 13
Sputum

2. Definition
Sputum is a secretion produced in the lungs and the bronchi (tubes that carry the air to the lung).
This mucus-like secretion may become infected, blood stained, or contains abnormal cells that may lead to diagnosis

3. Composition
Tracheo bronchial secretions are an inconstant mixture of plasma, water, electrolytes and mucin.
In addition to contamination from upper and lower respiratory tract with cellular exfoliation, nasal and salivary gland secretions and normal bacterial flora of the oral cavity.

4. Sources
Submucous glands: present between the surface epithelium and cartilaginous plates
Surface epithelium: three types of secretory cells can be distinguished:
1. Serous cells
2. Celara
3. Goblet cell: thick mucin-type secretion that is diluted by a more serous mixture of acid glycoproteins, sialoproteins and sulfoproteins are secreted by submucous gland

5. Viscoelastic character of sputum
The physical properties of sputum reveal secretions to be viscoelastic that is some of the properties of liquid and some of solid.
The consistency is dependent mainly on the molecular structure of the glycoproteins and on the degree of hydration.
Sialic acid is the most important single component of sputum viscosity.

6. Sample collection
Sputum comes up with deep coughing. Increasing the amount of fluids in the night before the test may help to get the sample.
First morning specimen is best, most tracheobronchial secretions are not ejected from the mouth but are swallowed during sleep
Patient cooperation and understanding, instruct patient to rinse mouth with water prior to each collection.
Cough up from deep down in the chest, the specimen should be collected in a sterile container and then send immediately to lab and not be allowed to stand for long time
Specimen expectorated sputum, not saliva or nasal aspirates three consecutive mornings is advisable.

7. Work with sputum collection should always be in safety cabinet

8. Macroscopic & Microscopic Examination

9. 1st :Consistency and appearance:
viscoelastic, clear and watery, usually specific diseases have characteristic consistencies and appearance.
2nd : Color
Color is determined by the material contained and can indicate the pathologic process
1. Yellow color:
Pus and epithelium cells
Pneumonia

10. 2. Green: 3. Rust red: 4. Bright red Decomposed Hb Recent hemorrhage.
Pseudomonas
Decomposed Hb
Recent hemorrhage.
Sputum left standing more than 24 hrs tend to become greenish through the break down of neutrophils and the release of neuroperoxidase enzyme.
Pneumococcal pneumonia
Acute cardiac failure
Pulmonary gangrene
Pulmonary infection TB
Ruptured blood vessels.

11. Sputum Exam for Mycobacterium
3rd :Odor: No odor
4th : Miscellaneous finding: (cheesy masses, bronchial cast, broncholiths, parasites).
Sputum Exam for Mycobacterium
Acid fast organisms
Sputum gram stain
Sputum Culture
Acid fast bacteria
(mycobacterium tuberculosis )