laboratory tests for respiratory system disease

7/29/2019 Laboratory Tests for Respiratory System Disease

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LABORATORY TESTS FOR

RESPIRATORY SYSTEMDISEASE

Kemas Yakub R, dr., SpPK

Dept. of Clinical PathologyMedical School University of Sriwijaya


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dr. Kemas Yakub SpPK 2

Infection

Non-Infection

Tumor


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INTRODUCTION

The laboratory examination has an important

role as a diagnostic tools

The accuracy of any laboratory result beginsat the beginning, with proper laboratoryspecimen collection

The foundation of reliable and validlaboratory results starts with the specimencollection and the way in which it wasobtained


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The nature of the test dictates themanner in which the specimen iscollected

Some specimen collections are

complicated and require speciallytrained technical personal

Most specimen collections are not

complicated


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Proper collection depends on givingclear and concise instruction to thepatient

Patient instruction is the responsibilityof clinical laboratorians


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THE TEST REQUEST

The specimen testing initiated by physicianwho request the certain test be performed on

a patient

The request form usually contains all relevantinformation regarding the patient identity


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DOCUMENTATION

The variety of biologic specimens, themultitude of analytes and the variousmethods of specimen and transport all

provide opportunities where inaccuracies anderrors may be introduced into the testprocedure

The laboratory requires that documentationof specimen collection procedure areavailable.


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PROCEDURE MANUAL

Name of the test

Specimen type and quantity

Method of collection

Patient preparation Labeling information

Special handling

Criteria of rejection Stability and time constrains


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TRANSPORTATION

For transportation all special requirementsnecessary to preserve the specimen must befollowed

Every specimens needs the proper condition,e.g refrigerated, iced, preservatives

Some specimens collections involves test thatare very personal and highly confidential


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Specimens from Upper Respiratory Tract

Nose swab: useful to identify carriers ofMethycilinresistant Staphylococcus aureus (MRSA),SARS

(severe acute respiratory syndrome).


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Use tongue depressor

to prevent contact

with tongue or buccal

mucosa


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NASOPHARYNX


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SPUTUM SPECIMEN

Sputum must be deliberately coughed upfrom the lungs and lower bronchial tree

The patient must be gargle prior tocollection to reduce the number of normalflora


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Many patients with Lower Tract Infection (LRTI) cough up

purulent sputum which may be cultured & examined grossly

& microscopically.The most common infections :

acute & chronic bronchitis

lung abscess

pneumonia & bronchopmneumonia

pulmonary tuberculosis

Because the bacteriologic procedure for the diagnosis of

other LRTI & Pulmonary tuberculosis are different, thephysician must make it clear to the Lab. wether they wishes

examinations for :

pyogenic bacteria, tubercle bacteria or both types


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Collection of sputum specimen :

Best time : first sputum which is cough up early morningFor TBC : 3 x from 2 visits: spot - morning - spot.

Patient must informed how to cough to yield a good sputum

Collect in a sterile wide-mouthed container, tight-fitting cover,

sentto the Lab. without delay & not allowed 1 hour at room

temperature

before being processed in the lab.

Sputum to be examined : mucous with air bubbles containing

solid

or purulent particles, saliva is not acceptable.


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A. Saliva

B. Good quality sputum: mucopurulent

A B

Use Sterile sputum container widemouth,

disposable,made of clear thin plastic, unbreakable, leakproof.


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SPUTUM

Color in various conditions

Rusty Lobar pneumonia

Anchovy paste (dark brown) Amebic liver abscess rupture

into bronchus

Red currant jelly Klebsiella pneumoniae

Red (pigment, not blood) Serratia marcescens; rifampinoverdose

Black Bacteroides melaninogenicus

pneumonia; anthracosilicosis

Green (with WBCs, sweet odor) Pseudomonas infection

Milky Bronchioalveolar carcinoma

Yellow (without WBCs) Jaundice


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Phlebotomy technique

Educational program of phlebotomy technique

Side ofVenipucture

(vp)

Scrubbed firmly but gently

directly over the side of vp

outward directioncircular strokes

3 times

Wiped alcohol padPlace over the septum

Inoculation time


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BacT/ALERT for adult BacT/ALERT for kid

Blood Culture Boullion


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PLEURAL EFFUSION

Normal Values Specific gravity 1.0101.026

Total protein

Albumin 0.3

4.1 gm/dL Globulin 5070%

Fibrinogen 3045%

pH 6.8

7.6

Transudate Exudate


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BLOOD GAS ANALYSIS

1. pH : 7.40 + 0.05

2. pCO2 : 40 + 5 mmHg

3. pO2 : 80 - 100 mmHg

4. (HCO3-) : 24 + 2 mmol/L

5. TCO2 : 25,2 + 2 mmol/L

6. O2 - saturation : 95 - 98 %

7. Base, Negative (Base, deficient) : - 2,5

8. Base, Posotive (Base, Excess) : + 2,5


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III. Compensatory Mechanisms

1. Buffer System :a. Carbonic acid Bicarbonate Buffer System :

CO2 + H20 H2CO3 H+ + HCO3-

b. Non Bicarbonate Buffer System :Hbuf H+ + Buf -


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2. Lungs :

Compensate by altering the acid or respiratorycomponent during :

a. Hypoventilationb. Hypervertilation

3. Kidneys : Na+ - H+ ExchangeThe kidneys tend to correct for primaryabnormalities in the basic or metabolic (HCO3-)component.


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Henderson - Hasselbalch Equation :

pH = 6.1 + Log [HCO3-] / [H2CO3] 24/1.2

6.1 + Log [HCO3-] / 0.03 x pCO2 24/1.2

6.1 + Log 24/1.2 = 6.1 + Log 20/1= 6.1 + 1.3 = 7.40

The mechanism for bicarbonate synthesis

reabsoption

( Na + - H+ exchange ) is illustrated in Fig.1,2,3


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Steps in Laboratory Investigation of an Infected patient :


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Steps in Laboratory Investigation of an Infected patient :

patient with infection

sampling transport,labelling

Storage Specimen, clinical data

Macroscopic evaluation,odour

Preliminary Report to PhysicianMicroscopy, interpretation

Culture, choice of medium,Toatmosph

Isolation of pure culture

Antibiogram Final Report to Physician

Identification, Interpretation

(contaminant, commensal/pathogen)


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RESPIRATORY DISEASES


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ABSCESS, LUNG

Sputum: marked increase; abundant, foul, purulent; maybe bloody; contains elastic fibers. Gram stain is diagnostic

Bacterial cultures (including tubercle bacilli)

Cytologic examination for malignant cells. Blood culture: may be positive in acute stage.

Increased WBC in acute stages (15,00030,000/cu mm)

Increased ESR

Normochromic normocytic anemia in chronic stage Albuminuria is frequent.

Findings of underlying disease


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ASTHMA, BRONCHIAL

Eosinophilia may be present.

Sputum is white and mucoid without blood or pus (unlessinfection is present).

Eosinophils, crystals (Curschmann's spirals), and mucuscasts of bronchioles may be found.

When patient requires hospitalization, arterial bloodgases should be measured frequently to assess status.

Earliest change is decreased pCO2 with respiratory alkalosis with

normal pO2. Then pO2 decreases before pCO2 increases.Normal pCO2 suggests that the patient is tiring.

Acidemia and increased pCO2 suggest impending respiratory

failure.

Mixed metabolic and respiratory acidosis occurs.


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BRONCHIECTASIS

WBC usually normal unless pneumonitis is present.

Mild to moderate normocytic normochromic anemia with

chronic severe infection

Sputum abundant and mucopurulent (often containsblood); sweetish smell

Sputum bacterial smears and cultures

Laboratory findings due to complications (pneumonia,

pulmonary hemorrhage, brain abscess, sepsis, cor

pulmonale)


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BRONCHITIS

ACUTE Viruses cause most cases.

Mycoplasma pneumoniae, Chlamydia pneumoniae,

Bordetella pertussis, Legionella spp.

WBC and ESR may be increased.

CHRONIC

WBC and ESR normal or increased

Eosinophil count increased if there is allergic basis orcomponent

Smears and cultures of sputum and bronchoscopic

secretions


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NASOPHARYNGITIS, ACUTE

Bacteria (e.g., Group A beta-hemolytic streptococci [1030%], H.influenzae, M. pneumoniae, etc.).

Virus (e.g., EBV, CMV, adenovirus, RSV, HSV, coxsackievirus)

Fungus, allergy, foreign body, trauma, neoplasm

Idiopathic (no cause is identified in ~50% of cases)

Microscopic Examination of Stained Nasal Smear

Large numbers of eosinophils suggest allergy. Does not correlatewith blood eosinophilia.

Eosinophils and neutrophils suggest chronic allergy withsuperimposed infection.

Large numbers of neutrophils suggest infection. Gram stain and culture of pharyngeal exudate may show significant

pathogen.


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CROUP(EPIGLOTTITIS, LARYNGOTRACHEITIS)

Group B H. influenzae causes >90% of cases of

epiglottitis; other bacteria include beta-hemolytic

streptococci and pneumococci.

Cultures, smears,

Blood cultures should be taken at the same time

as throat cultures.

Neutrophilic leukocytosis is present..

Laryngotracheitis is usually viral (especially

parainfluenza) but rarely bacterial in origin.


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Biochemical tumor markers

Serum CEA is increased in one-third to two-thirds of patients with all four types of lungcancer.

Principal uses are to monitor response totherapy and to correlate with staging.

Values 10 ng/mL correlate with higherincidence of extensive disease and extrathoracicmetastases.


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d K Y k b S PK 40

Serum neuron-specific enolase may be

increased in

7987% with small cell cancer

10% with non

small cell cancer and nonmalignantlung diseases.

May be used to monitor disease progression;

falls in response to therapy and becomes normal

in complete remission but not useful for initialscreening or detecting early recurrence.

laboratory tests for respiratory system disease

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