Kuliah Undana Blok Respirasi 2

Pemeriksaan
Laboratorium untuk
Penyakit-penyakit
Respirasi
Ruland DN Pakasi
Pendahuuan
Diagnosis Lab.
Penakit Respirasi Kandungan Dahak
Pemeriksaan dahak
1. Pemeriksaan Cairan Efusi
2. Pemeriksaan Darah Rutin • Lendir (trakea, bronkus, farngs)
3. Mikrobiologik • Effusi (dari paru)
4. Blood Gas Analysis (BGA) • Ludah
5. Pencitraan (Imaging Studies)
R.Pakasi - FK-UNIVERSITAS HASANUDDIN 20113 12/26/19 2

• Pagi/ 24 jam
• dibatukkan
• Stimulasi aerosol/hiper tonik
Pendahuluan
• Wadah:
• Bersih, Mulut-lebar
Pengambilan sampel • Tightly Bertutup-ketat

• Ukuran: disesuaikan
• Botol, Cawan Petri, atau
Cardboard
• Steril

 Tuang sampel  cawan Petri lapis
an tipis
 Alas kertas karbon
Pendahuluan  Amati seluruh permukaan, fokus

materi tercuriga ab normal
Prosedur  Loupe utk bantu
Pemeriksaan  Pindahkan materi ke kaca obyek

 Biarkan kering
 Pulasan (Gram, Wright,ZN)
 Mikroskop

 Volume 24 jam
 Vol.besar: > 100
Pemeriksaan mL
Makroskopik
 Udem Paru
 Bronkiektasis
Volume  TBC Paru
 Abses Paru
 Perdarahan
Paru

 Besar = >100 mL
Pemeriksaan  Accumulation (pus or
fluid( from extenal origin
Makroskopik (subphrenic abscess)
 Index of prognosis
Volume
 Increasing: progression
 Gradual decreasing: healing
 Sudden decrease: obstruction

• Mixing of mucus & pus varies
the color
• Transparent to opaque
Pemeriksaan
Makroskopik • Green to yellow pus: advanced
TB
• Bright green: Icterus,
COLOR pneumonia, Lung infarction
• Bright red/patchy: early TB
• Rusty red: Lobar pneumonia
• Brown: Cardial decompensation

serous, mucous,
purulent seropurulent
 mucopurulent
Pemeriksaan • Lobar pneumonia
Makroskopik • rusty, sputum crudum
• Invert tube
CONSISTENCY &
• Early acute bronchitis &
asthma
APPEARANCE
• Thicky mucus
• Pulmonary edema
• Serous + blood spot

Macroscopic
SputumExamination
Examination
• Stratification
• Bronchectasis
• Gangrene Frosthy
• Abscess
More/less clear
Dense mucous
+ cellular elements

Examination
SputumExamination
Macroscopic
• DITTRICH PLUGS
• masses of minute, greyish fat globules, fatty
acid crystals, and bacteria
• seen in the bronchi in bronchitis and
bronchiectasis, in pulmonary gangrene & fetid
bronchitis

Sputum Examination
Macroscopic Examination
• DITTRICH PLUGS
• Yellowish or grey body formed in bronchi
• pin-head ~ bean size
• Sometimes expeactorated alone
• crushed  very putrid odor
• Microscopic: granular debris, fat globules, fatty acid
crystals, large clumps of bacteria
• Most common in
• Chronic bronchitis, bronchial
asthma,brochiectasis
CURSCHMANNS’ SPIRAL
• Yellowish white masses
• Composed of central thread,
delicate fibrils surround tightly
or loosely
• Adhered WBC & Charcot-
Leyden suggestive of
bronchial asthma, acute
bronchitis & pulm.TB

BRONCHIAL CASTS
• Composed of fibrin, white or
grayish; may be reddish brown
(blood pigment)
• Size & appearance : vary
• Small threadslarge tree-
branching
• Fibrinous, hemorrhage or
mucous
BRONCHIAL CASTS
• Size & appearance : vary
• Rolled into balls or tangled masses
• Floating out in water over a black
background
• Frequently seen in
¨Fibrinous bronchitis
¨Pneumonia (consolidation)
¨Chronic cardiac disease
¨TB
PNEUMOLITH, Lung stones

• Small concretions of calcarous material
• Vary in size: fine sandlike particles 
large stones
• Formated due to necrosis of infected
tissue and deposition of calcium salts,
may result from small foreign bodies,
bits of clothing,etc
• Chronic TB
PNEUMOLITH, Lung stones

• In long period
• Lung stones encrustedulceration
expectorate with hemorrhage 
active inflammationparoxysmal
cough, wheezing & dyspnea (stone
asthma)

CHEESY MASSES
• Small particles of caseous material
• Varying size: pinhead~bean
• Consisting of:
• Fragments of necrotic tissue or bits
of cartilagealenous rings
• Color:
• Considerable pusyellow
• Decomposed blood/pigments
dark
CHEESY MASSES
• Commonly seen in
 Pulmonary TB
 Pulmonary abscess
 Pumonary gangrene

FOREIGN BODY
• Particles of clothing, etc
• By gunshot or penetreting wound
• Other objects (peanut, buttons,
marbles, etc)
• Through mouth & inhale (children

Microscopic Examination
• Unstained preparation
1. Curshmann’s spiral
2. Elastic fibers
3. Crystals
• Charcot-Leydens crystals
• Fatty acid crystals
• Cholesterol crystals
• Leucin & tyrosine crystals
• Inorganic salts crystals
4. Pigment cells

5. Myelin globules
6. Fungi
7. Animal parasites

• Stained preparation
1. Leukocytes
2. Eosinophils
3. Lymphocytes
4. Endothelial
5. Erythrocytes
6. epithelium

Unstained preparation
1.Curshmann’s spiral
 Structures accompanying those on
Macroscopic description

•2.Elastic fibers
•Appear as slender, curled, highly
refractive, branching fibers of uniform

•As a network or in bundles;
sometimes retain alveoli
arrangement (differ from mold,
cotton, or hairs)
•2.Elastic fibers
•Derived from alveoli, bronchi or
blood vesselstheir presence
indicate destruction of pulmonary
tissue
• Advanced TB
• Ulcerating bronchiectasis]ulcerating
malignancy

3.Crystals
• Charcot-Leydens crystals
• Fatty acid crystals
• Cholesterol crystals
• Leucin & tyrosine crystals
• Inorganic salts crystals

3.Crystals Charcot-Leyden
• Colorless pointed hexagones; may
appear quite needlelike; may be
purplish-red
• Soluble in water & acetic acid
• Derived from eosinophil
desintegration, associated with
bronchial asthma

•3.Crystals: Charcot-Leyden
• Derived from alveoli, bronchi or blood
vesselstheir presence indicate
destruction of pulmonary tissue
• Advanced TB
• Ulcerating bronchiectasis]ulcerating
malignancy

3.Crystals Fatty acid
• Resemble long colorless
needles, straight or curved
• Seen singly or in tuft
• Soluble in acids, hot alcohol
chloro form & alkali; not in water
& acids (a way to differentaite
from elastic fibers)

3.Crystals Fatty acid
• Usually associated eith
• Chronic pulmonary TB
• Gangrene
• Putrid bronchitis
• Bronchiectasis

3.Crystals Cholesterol
• Colorless and transperrant thin
rhmobic, rectangular or oblique
plates with noched edges
• Siza: small or large
• Generally found in
• Chronic lung abscess
• Empyema
• Chronic TB
• Liver abscess (openinginto bronchi)
3.Crystals Leucin & Tyrosine
• Decomposition of protein
• Leucine
• Gray or yellowish spheres, resembling
fat cells, singly or in clumps
• Sometimes: disc with concentric
arrangement resembling the traverse
cut of a tree tunk

• Decomposition of protein
• Tyrosine
• Fine silky needles
• Appear singly, in groups or arranged in
single or double tufts
• Moore readily detected if sputum isa
evaporated in the air

• Both crystals my be found
• Rupture of empyema into the lung
• Perforation of liver abscess

3.Crystals Inorganic salts
• Little or no clinical significance

4.Pigmented cells
Heart-failure cells
• Contains hemosiderin (long continued
passive congestion of the lung resulting
from poorly compensated heart disease)
• To identify
• 1 drop 10% potassium ferrocyyanide
• 1 drop 0.1n HCl
• Prussian blue color

4.Pigmented cells
Heart-failure cells
• Cells are found in
o Chronic passive pulmonary
congestion
o Cardic decompesation
o Pulonary infarction
o Pulm.post hemorrhage

4.Pigmented cells
Dust cells
• Similar to heart failure cell
• Contain black/brownish black
angular granules
• Seen in sputum of anthracosis
• Less important

5.Myelin globules
 Appear as uncolor objects
 Irregulaly shaped, oval, round or
pear-shaped
 In groups of various sizes
 Highly refractile having a
greenish sheen
 Show spiral markings or
concentric rings
5.Myelin globules
 May be seen in scanty sputum in
the morning of healthy person
 Abundant in mucoid sputum of
bronchitis
 Little or no clinical significance

6.Fungi
• To identify
 10% KOH dissolve cellular
debris
 Apply coverglass and heated
over a slow flame
 Examine under 16-mm and 4-
mm microscope
7.Animal parasite
• Should be noted:
Larvae: Necator americanus,
Strongy loides, Ascaris
Ova: Paragonimus, Endamoeba
hysto lytica (tropozoit & cyst)
Flagelete protozoa
Echinococcus cyst

Leukocyte
Hampir selalu ada, menunjukkan
kontaminasi
Banyak : perdarahan atau eksu
dasi
Pneumonia, kavitas tbc, penyakit kronis ulse
ratif
Limfosit
• Dominan pada tbc ringan

 Sputum
Chemical Examination
Examination
• 1.Albumin
• Jumlah sedikit pd asma & bronkitis kronik
• 1-3 g/L : pada Pneumonia & TBC
• 2.Lemak
• No clinical significance
• 3.Darah
• Darah-samar (Occult blood)
• Benzidine test
 Sputum
Sputum Examination
Characteristics in Various
Diseases
• Bronkitis Akut
• Dahak sedikit, putih-keabuan
• Semi-transparan
• Kental & lengket
• Isi: eosinofil, kristal Charcot-Leyde, spiral
Curschmman

Sputum Sputum Examination
Diseases
• Bronkitis Fibrinosa
• Awal penyakit
• Dahak banyak, muoid
• Mengandung WBC, epitel, bekuan fibrin
(torak bronkial)
• Bisa ada darah dan mukus

Sputum Characteristics in Various

Diseases
Sputum Examination
• 5.Bronkiektasis
• Dahak purulent, banyak
• Sering bau tengik
• Warna kelabu
• Ada stratifikasi jika dibiarkan
• Bisa ada darah bila hemoragi/ kerusakan
jaringan

 Sputum
Sputum Examination
Diseases
• Abses Paru
• Dahak banyak, kuning atau hijau
• Bau bervariasi: agak manis sp tengik
menusuk
• Ruptur: nanah spt krim dlm jumlah banyak,
mengandung fragmen jar.paru
• Sel nanah banyak; bisa ada benang elastik
dan RBC

Sputum Sputum Examination
Diseases
• Gangren paru
• Dahak banyak, cair, warna hijau~coklat
• bau busuk
• Ada stratifikasi bila dibiarkan
• Mengandung jaringan nekrotik, benang
elastik
• Nanah & epitel tidak banyak
• Bakteria: bacili & spirocheta

Sputum Sputum Examination
Characteristics in Various
Diseases
• Pneumonia Lobaris
• Dahakbiasanya rusty, sangat lengket
• Warna orange~hijau
• Sel nanah, epitel dan pneumokokus
predominasi
• Biasa ada torak fibrinous

 Sputum Examination
Diseases
• Bronkopneumonia
• Dahak tak begitu banyak, mukopurulent
• Mengandung sel nanah, RBC, bakteri
• Sputum sangat tidak spesifik

 Sputum Examination
Diseases
• TBC Paru
• Awal
• Dahak sedikit, mukoid
• Bisa mengandung partikel kuning opak
• Lanjut
• Dahak sangat banyak
• Kavitas: partikel keju
• Darah bisa ada/ tidak
• BTA: bisa pada awal/ lanjut

Sputum Sputum Examination
Characteristics in Various
Diseases
• Udem Paru
• Dahak sangat banyak (1-2 L), serous-
eksudatif, encer, berbusa
• Warna pink~coklat gelap
• Mengandung massa hialin, RBC (variasi
jumlah), WBC & epitel (sedikit)

 Sputum
Sputum Examination
Diseases
• Infark Paru
• Dahak sedikit, lengket,mukoid
• Mukus campur darah
• Sel alveoler berpigment & RBC bisa ada
• Infeksi sekunder
• Purulent, banyak WBC & bakteria
• Bau tengik

BTK
12/26/19 R.PAKASI - FK-UNIVERSITAS HASANUDDIN 20113 55
Examination of Pleural
Fluid
Ruland D.N.Pakasi
 Examination of Pleural Effusion
Introduction
• A small amount of fluid in the pleura

cavity, facilitates the movement of visce
ral and parietal against each other, as
plasma filtrate derived from capillaries
in the parietal membranes

Specimen Collectng
• Thoracentesis
• Indications
• Undiagnosed pleural effusion
• Therapeutic: massive symptomatic effusion
• EDTA tubes  total & Differential cell
count
• Heparinized tubes
• Aerbic & anaerobic bacterial culture
blood agar
Specimen Collectng
• Thoracentesis
• Indications
• Undiagnosed pleural effusion
• Therapeutic: massive symptomatic effusion
• EDTA tubes  total & Differential cell
count
• Heparinized tubes
• Aerbic & anaerobic bacterial culture
blood agar
Classification of Pleural Effusion

TRANSUDATE EXUDATE
hydrostatic pressure or plasma  capillary permeability or 
oncotic pressure lymphatic resorption
• Congestive Heart Failure 1.Infections
• Hepatic cirrhosis • Bacterial pneumonia, Tuber
• Hypoproteinemia (e.g.nephrotic culosis,
syndrome)
• other granulomatous disease
(sarcoidosis, histoplamosis,
etc). Viral or mycoplasma pneu
monia

Classification of Pleural Effusion

TRANSUDATE EXUDATE
hydrostatic pressure or plasma  capillary permeability or 
oncotic pressure lymphatic resorption
2.Neoplasms
• Bronchogenic carcinoma, Me
tastatic carcinoma, Lympho
ma, Mesothelioma, Pulmo nary
infarct
3. Noninfectious inflammatory
disease involving pleura
4. Rheumatoid disease, SLE

Criteria for Pleural Exudates
Pleural effusion/serum protein ratio  0.50
Pleural effusion/serum LD ratio  0.60
Pleural effusion LD  2/3 upper limit of

normal serum LD
Pleural effusion cholesterol > 45 mg/dL
Pleural effusion/serum cholesterol  0.30

Examination of Pleural Fluid
• WBC count
• <1000 cells/L:
Transudates
• > 1000 cells/L: Exudates
• RBC count
• >100.000/L: suggestive Microscopic
of malignancy, trauma,
pulmonaru infarction
Examination
• Diff.Leucocyte Count &
Cytology
• Cytocentrifugation, air-
dried, and
Romanowsky’s staining
• For malignancies
esp.hematologic

• Diff.Leucocyte
Count & Cytology
• Mesothelial cells:
• inflammatory
processes
• Scarce in TBC
pleuritis,
empyema,
rheumatoid
pleuritis

• Diff.Leucocyte
Count & Cytology
• Well-differentiated
carcinoma
Microscopic • Highly
Examination undifferentiated
• Panel of
immuno chemical
stain for
confirmation

• Neutrophils: (>50%)
• Predominate in pleural
inflammations
Microscopic • Lymphocytes (>50%)

Examination • Predominate in TBC, viral
infection, malignancy,
Rheumatoid pleuritis, SLE
• Eosinophils (>10%)
• Pnumothorax, trauma,
Pulmonary infarction, CHF. etc
• Protein/ Albumin
• Little value of Dif.Diagnosis
Chemical • Glucose
Examination •  Serum level
• Low: < 60 mg/dL
• Low: Pl.eff/serum ratio < 0.5
Malignancy, Tuberculosis,
Nonpurulent bacterial infections,
Lupus pleuritis
• Lactate
• Significantly  in
Chemical bacterial and
Examinatio tuberculous pleural
infections
n • Moderate  in
malignant effusions

• Enzymes
• Amylase
•  Indicates pancreatitis,
esophageal rupture, or
malignant effusions
• Lactate Dehydrogenase
Chemical • Level rise in proportion to the
Examinatio degree of inflammtion
• Declining level means
n inflammatory process is
resolving
• Increasing levelworsening
R.Pakasi - FK-UNIVERSITAS HASANUDDIN 20113
condition equiring aggressive
12/26/19 69
workup/treatment
• Enzymes
• Adenosine deaminase (ADA)
• Rich in T
Lymphocytessignificantly
Chemical  in tbc pleuritis
Examination • Interferon-gamma (IFN-)
• Significantly  in tbc pleuritis
• > 3.7 IU/L 99% sensitivity &
98% specificity

• Lipids
• Effusion appear to be
chylous/ milky due to
the presence of
Chemical lecithin-globulin
Examination complex
• Require lipoprotein
electrophoresis to
confirm chylothorax

• C-Reactive Protein (CRP)
• 90 mg/L in
parapneumonic
infections
• 26 mg/L in tuberculous
effusion
Chemical • 23 mg/L in malignancy
Examination effusin
• Clinical useful
• Index of disease
acitivity
• Measure of response
to therapy

• Rheumatoid Factor (RF)
• RF titer of  1:320 is
reasonable evidence
of rheumatic pleuritis.
• RF titer up to 1: 1280
Immunologic identified in 41%
Studies patients with
malignant effusion,
14% with TBRF
routine test is of liitle
value
• Antinuclear Antibody
(ANA)
• Not clinically useful
Immunolo
• Elevated titers also
gic Studies occur in various
conditions

Click icon to add picture
BTK

Effects of Diseases on
Laboratory Tests
Ruland DN Pakasi
Rp.130.676.152,-
Laryngotracheo bronchitis (Croup)
• Leucocytosis
Blood
• Granulocytosis
Nasopharyngeal • Usually show H.influenzae

culture type B
• Positive for H.infle]uenzae

Blood culture
(50% cases)

Pertussis (Whooping Cough)
• Leucocytosis (<100.000/L with marked

Blood lymphocytosis (<90%)
• Granulocytosis
Nasopharyngeal • Fluorescent antibody staining provides a rapid and

smear specific diagnosis
Blood culture • Negative result

Viral Pneumonia
• WBC normal/decreased with relative lymphocytosis

Blood • WBC > 15.000/L2ndary bacteral infection
• Complement-fixing antibodies: antibody titer

Immuunologic against specific causative virus 4x rise
Blood culture • Negative result

Bacterial Pneumonia
• Leucocytosis with 70%-90%

granulocytes
Blood • Overwhelming infection/ aged: WBC
¨CBC + may be normal/ decreased
Differential • ESR 
• CRP  (nonspecific indicator)
• Na, K
• BUN
• Creatinin
¨Chemistry panel • Glucose
Bacterial Pneumonia
Blood • pH due to stimulated ventilation

(Resp.alkalosis)
¨Arterial Blood • CO2 due to stimulated
Gas (ABG) ventilation( Resp.alkalosis)
• PO2 due to impaired oxygenation
• SO2
• Albumin & 2-globulin: chronic

¨Others inflammation
• Serum free cortisol
Bacterial Pneumonia
• Proteinuria
Urine • WBC and Casts
• Culture
Sputum • Gram stain
Blood culture • Frequently positive

Fungal Pneumonia
Blood
• Proteinuria
Urine • WBC and Casts
• Culture
Sputum • Gram stain
Blood culture • Frequently positive

Respiratory Diseases
Clinical and Laboratory Studies
Ruland D.N.Pakasi
INFECTIOUS LUNG DISEASE
• Rapid antigen tests for group A

streptococci have excellent specificity,
Upper Respiratory
and yield results in 10-20 minutes.
Tract Infection
• Culture specimens may be obtained at
Suspected group A the time of presentation. Negative
streptococcal infection results on rapid antigen testing have
traditionally been followed up with
culturing because the rapid antigen
LABORATORY STUDIES
test is imperfectly sensitive.

Upper Respiratory • Streptococcal antibodies

Tract Infection (antistreptolysin O) levels do not peak
until 4-5 weeks after the onset of
Suspected group A pharyngitis. Therefore, testing for
streptococcal infection these antibodies has no role in the
diagnosis of acute pharyngitis.
LABORATORY STUDIES

• Rapid antigen tests for group A

streptococci have excellent specificity, and
yield results in 10-20 minutes.
• Culture specimens may be obtained
at the time of presentation. Negative
Upper Respiratory results on rapid antigen testing have
Tract Infection traditionally been followed up with
culturing because the rapid antigen
Suspected acute test is imperfectly sensitive.
bacterial rhinosinusitis • Streptococcal antibodies
(antistreptolysin O) levels do not peak
until 4-5 weeks after the onset of
LABORATORY STUDIES
pharyngitis. Therefore, testing for
these antibodies has no role in the
diagnosis of acute pharyngitis.

• Culture of a nasopharyngeal
aspirate is the criterion standard,
• Nasopharyngeal aspirates are
ideally collected 0-2 weeks after
symptom onset, but may provide
Upper Respiratory accurate results for as long as 4
Tract Infection weeks in infants or unvaccinated
Pertussis: patients.
• Serology is optimally timed 2-8
Special laboratory weeks post symptom onset, when
considerations for antibody titers are highest, yet
specific pathogens testing may be performed on
specimens as long as 12 weeks
after symptom onset.

• Special selective growth media are

required for C diphtheriae. This organism
must be distinguished from the
diphtheroids that commonly inhabit the
Upper Respiratory nasopharynx.
Tract Infection • HSV:
• In patients with mucocutaneous lesions
Diphtheria suggestive of HSV infection, isolation of
Special laboratory the virus in cell culture is the preferred
virologic testing strategy.
considerations for
specific pathogens • Gonorrhea:
• N gonorrhoeae requires special culture
media.

• Atypical bacteria: Insufficient

Upper Respiratory evidence suggests that testing
Tract Infection for atypical bacteria, such as C
pneumoniae or M pneumoniae,
would improve clinical
Special laboratory
considerations for
outcomes in persons with
specific pathogens pharyngitis

• CBC count with differential:

• WBC count with a left shift.
Upper Respiratory
• Atypical lymphocytes,
lymphocytosis, or lymphopenia may
Tract Infection be seen in some viral infections.
However, a CBC count is not likely to
be helpful in differentiating the
infectious agent or in directing
Other laboratory tests therapy in uncomplicated URIs in the
outpatient setting.
• Blood cultures:
• appropriate in hospitalized patients.

• may not be useful for diagnostic purposes but
are useful for classifying illness severity and
site-of-care/admission decisions
• Serum chemistry panel (sodium, potassium,
Bacterial bicarbonate, blood urea nitrogen [BUN],
creatinine, glucose)
Pneumonia
• ABG determination (serum pH, arterial oxygen
saturation, arterial oxygen pressure) – Hypoxia
and respiratory acidosis may be present.
LABORATORY STUDIES • Venous blood gas determination (central

venous oxygen saturation)
1.Routine Blood Test
• Complete blood cell (CBC) count with
differential
• Serum free cortisol value
• Serum lactate level

• CBC count with differential

• Wbc with a left shift may.
Bacterial • Leukopenia (usually defined as a WBC

count < 5000 cells/µL) may be an
Pneumonia ominous clinical sign of impending
sepsis.
• Coagulation studies
LABORATORY STUDIES • An elevated international normalized
ratio (INR) has been associated with
2.Blood Studies
more severe illness. This finding may
herald the development of
disseminated intravascular
coagulation.

• Blood cultures
Bacterial • before administering antibiotic

therapy. These cultures require 24
Pneumonia hours (minimum) to incubate. When
the findings are positive, they
correlate well with the causative
agent.
LABORATORY STUDIES • Unfortunately, blood cultures show
2.Blood Studies poor sensitivity in pneumonia; Their
yield may be better in patients with
more severe cases.

• Sputum Gram stain and culture should be

performed before initiating antibiotic therapy (if
a good-quality, contaminant-sparse specimen
containing < 10 squamous epithelial cells per
low-power field can be obtained). The white
Bacterial blood cell (WBC) count should be more than 25
per low-power field.
Pneumonia
• A single predominant microbe should be noted
at Gram staining, although mixed flora may be
observed with anaerobic infections.
• However, often, patients cannot produce an
LABORATORY STUDIES adequate specimen. Many specimens produced
3.Putum Evaluation are so contaminated by oral materials that they
are unusable.
• Cultures of the sputum have similar limitations.
To be accurate, only specimens that have been
examined microscopically and that have
satisfied the criteria above should be submitted
for culturing.

• In intubated patients admitted to the

ICU, some researchers suggest that
Bacterial upper airway samples and cultures
Pneumonia obtained initially on admission may aid
in directing antibiotic therapy should
ventilator-associated pneumonia (VAP)
LABORATORY STUDIES ensue during the first several days of
4. Transtracheal Aspiration admission.[52]
• Fiberoptic bronchoscopy has largely
replaced transtracheal aspiration for
obtaining lower respiratory secretions

Fungal • The total white blood cell (WBC) count may be

elevated in normal hosts with endemic mycoses.
Pneumonia
• Eosinophilia can be observed in the differentials,
particularly in persons with coccidioidomycosis.
• If the patient presents with neutropenia or
LABORATORY STUDIES leukopenia, the possibility of an opportunistic
infection with Candida or Aspergillus organisms is
1.CBC with Differential
increased.

• CBC with differential

• The total white blood cell (WBC) count may be
elevated in normal hosts with endemic mycoses.
• Eosinophilia can be observed in the differentials,
particularly in persons with coccidioidomycosis.
Fungal • If the patient presents with neutropenia or leukopenia,
Pneumonia the possibility of an opportunistic infection with
Candida or Aspergillus organisms is increased.
LABORATORY STUDIES • Sputum Examination and Potassium Hydroxide

Stain
1.CBC with Differential • This study may show fungal hyphae or yeasts.
However, the results must correlate with the clinical
2. Sputum Examination and
situation, because saprophytic colonization occurs in
Potassium Hydroxide Stain the oropharyngeal or respiratory tract of some
patients and may not necessarily indicate invasive
infection.
• Carefully transport, process, and culture specimens
that may be contaminated by bacteria, may be
saprophytic yeasts endogenous to the oral cavity, and
may be airborne Conidia of saprophytic fungi.

• Blood and Urine Cultures

• Obtain a blood culture to identify Candida species
(lysis centrifugation) or B dermatitidis if the patient
has disseminated disease.
Fungal • Obtain a urine fungal culture in men after a
prostatic massage, to identify Cryptococcus
Pneumonia species.
LABORATORY STUDIES • Serology

3. Blood and Urine Cultures • The utility of serology depends on the individual
fungal infectious agent. Antibody detection for the
4.Serology identification of C immitis is highly useful, but these
tests are of less utility if the pulmonary infection is
due to other fungi. Serology testing for
blastomycosis provides little clinical diagnostic
help because of the insensitivity of testing for this
fungus and the antibody cross-reactivity that
occurs with other fungal infections.

Metode Tes – pra-analitik
1. Persiapan pasien
• Diagnosis awal & keadaan pasien
• Anamnesis
• Pemakaian obat antikoagulan

• Kelainan pembekuan darah
• Penyakit infeksi
• Pasien dalam keadaan tenang
2. Persiapan sampel
• Whole blood + Heparin
• Lakukan tes : 5 menit pasca pengambilan darah arteri
• Bila tunda:
• simpan 1-2 jam

• suhu 1-5 C
3. Alat & Bahan

• OPTI Analyzer
• Semprit sekali-pakai (disposable syringe)
• Media transport, dilengkapi es
• Kain kasa & Plester
• Lithium-heparin
• Alkohol Lidocain 0.5% (jika diperlukan)

4. Pengambilan darah
• Arteri
• Vena
• Kapiler
• Pengambilan darah arteri

• Pengambilan darah arteri

Metode Tes – pasca-analitik
Arteri Vena Kapiler

7.40 7.36 7.36
pH
(7,37 - 7,44 ) (7,31 – 7,41) ( 7,31 – 7,41)
pO2 80 - 100 30 - 50 35 - 40
pCO2 35 - 45 40 - 52 41 - 51
Saturasi O2 > 95 60 - 85 60 - 80
HCO3 22 - 26 22 - 28 22 - 26
Base
-2 -+2 -2 -+2 -2 -+2
Excess
Langkah-langkah dalam penafsiran AGD
1. Tentukan asidosis atau alkalosis

Asidosis  bila pH < 7,35
Alkalosis  bila pH > 7,45
2 Tentukan penyebabnya primernya Respiratorik

atau metabolik
• Bila PCO2 menyimpang searah pH respiratorik
• Bila HCO3 menyimpang searah pH  metabolik

Tentukan apakah sudah ada kompensasi
3. Searah dgn pH  penyebab primer
Berlawanan dgn pH  ada kompensasi
asidosis normal alkalosis
pH < 7,35 > 7,45

pCO2 > 45 < 35
HCO3 < 22> 28
BE - 2 +2
Prinsip koreksi
• Pada dasarnya prinsip koreksi adanya gangguan asidosis

atau alkalosis respiratorik yang murni dapat dikoreksi
dengan perbaikan ventilasi
• Untuk koreksi adanya gangguan asidosis atau alkalosis
metabolik dikoreksi dengan pemberian basa atau asam

Contoh kasus
A B C D E F
pH 7,27 7,25 7,52 7,53 7,26 7,48
PCO2 60 40 25 41 22 21
HCO3 20 16 22 32 10 13
BE +2 - 10 -2 +8 - 15 -8
terima kasih

INTERPRETASI
ANALISIS GAS DARAH
Dr. Liong Boy Kurniawan,
NILAI NORMAL AGD
pH 7,35-7,45
pCO2 35-45
HCO3- 22-26
PEDOMAN INTERPRETASI
ASIDOSIS
pH ALKALOSIS
<7,35 >7,45
ALKALOSIS
RESPIRATORIK pCO2 ASIDOSIS RESPIRATORIK
<35 >45
ASIDOSIS
METABOLIK HCO3- ALKALOSIS
METABOLIK
<22 >26
BANTUAN UNTUK
MENGINTERPRETASI
• Perubahan pCO2 berhubungan dengan paru-paru

merupakan komponen respiratorik
• Semakin tinggi kadar pCO2semakin asammakin
asidosisdemikian sebaliknya
• Perubahan HCO3-  berhubungan dengan ginjal(fungsi
metabolik) komponen metabolik
• Dasar reaksi HCO3- + H+  H2CO3 CO2 + H2O
• HCO3- bersifat basa semakin tinggi HCO3- semakin alkalosis
demikian sebaliknya
BANTUAN UNTUK
MENGINTERPRETASI
• Range pH orang masih dapat hidup 6,8-7,8

• Apabila komponen metabolik dan respiratorik
berseberangan, lihat pHnya
• Apabila pH normal tetapi komponen metabolik dan
respiratorik berseberangan lihat penyakit yang
mendasari
CONTOH SOAL
• pH= 7,30, pCO2= 50, HCO3-= 26
Apa interpretasinya?
Asidosis pH
7,35-7,45
pCO2 ASIDOSIS
RESPIRATORIK
35-45
HCO3-
22-26
• Asidosis respiratorik
CONTOH SOAL
• pH= 7,55, pCO2= 28, HCO3-= 30, apa interpretasinya?
pH ALKALOSIS
7,35-7,45
ALKALOSIS
RESPIRATORIK
pCO2
35-45
HCO3- ALKALOSIS
METABOLIK
22-26
• Interpretasi: Alkalosis respiratorik + alkalosis metabolik

CONTOH SOAL
• pH= 7,32, pCO2= 51, HCO3-= 27, interpretasinya?
ASIDOSIS pH
7,35-7,45
pCO2 ASIDOSIS
RESPIRATORIK
35-45
HCO3- ALKALOSIS
METABOLIK
22-26
• Asidosis respiratorik terkompensasi sebagian

CONTOH SOAL
• pH= 7,41, pCO2= 50, HCO3-=29, pasien apnea,
interpretasinya?
pH
7,35-7,45
pCO2 ASIDOSIS
RESPIRATORIK
35-45
HCO3- ALKALOSIS
METABOLIK
22-26
• Asidosis respiratorik terkompensasi sempurna

TERIMA KASIH

Kuliah Undana Blok Respirasi 2

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Pemeriksaan

3. Mikrobiologik • Effusi (dari paru)

4. Blood Gas Analysis (BGA) • Ludah

5. Pencitraan (Imaging Studies)

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Pengambilan sampel • Tightly Bertutup-ketat

R.Pakasi - FK-UNIVERSITAS HASANUDDIN 20113 12/26/19 3

Pendahuluan  Amati seluruh permukaan, fokus

Prosedur  Loupe utk bantu

Pemeriksaan  Pindahkan materi ke kaca obyek

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PNEUMOLITH, Lung stones

PNEUMOLITH, Lung stones

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• A small amount of fluid in the pleura

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Classification of Pleural Effusion

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Classification of Pleural Effusion

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Pleural effusion LD  2/3 upper limit of

Pleural effusion cholesterol > 45 mg/dL

Pleural effusion/serum cholesterol  0.30

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