Columnar epithelium in a nasal smear

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General clinical examination of nasal mucus

In healthy people, smears obtained by scraping from the posterior part of the inferior turbinate and stained according to Wright-Giemsa reveal cylindrical, ciliated cylindrical, goblet and basal cells, which are stained pale blue; eosinophils, basophils and mast cells are absent, the number of neutrophils and bacteria is insignificant; the content of goblet cells does not exceed 50% of the total number of epithelial cells.

Table of contents:

Normally and in cases of banal inflammation, eosinophilic leukocytes are not absent from the secretion from the nasal cavity, or the ratio of eosinophils to neutrophils is 1:10. The detection of a large number of eosinophils in the secretions of the nasal cavity reflects the body's allergic reaction to the introduction of allergens into the upper respiratory tract. Local diagnosis of the allergic process is facilitated by the fact that the relative content of eosinophils in the tissues and on the surface of the mucous membrane of the upper respiratory tract in allergic diseases sharply exceeds their content in the peripheral blood. Particularly valuable research

Nasal mucus is useful for diagnosing allergic diseases of the nasal cavity and paranasal sinuses.

The number of eosinophils in the secretions of the nasal cavity increases during allergic processes in the mucous membrane of the upper respiratory tract, but to varying degrees depending on the type of allergen, the type of allergic reaction, exacerbation or remission of an allergic disease. Therefore, in some cases, during an exacerbation of allergic rhinosinusitis, a large number of eosinophils are detected in nasal smears, and only single eosinophils are detected in the inter-attack period; in other cases, there is no difference in the number of eosinophils in the secretion depending on the phase of the disease. The number of eosinophils in the secretions of the nasal cavity depends on the type of allergen and the routes of its penetration into the body. With inhalation allergies, pronounced eosinophilia is noted, and with food sensitization, the number of eosinophils is lower. The study of nasal secretions plays an important role in the differential diagnosis of allergic and vasomotor rhinitis. Eosinophilia is characteristic of allergic rhinitis. The presence of eosinophilia in the secretions of the nasal cavity is an important diagnostic sign not only of allergic rhinitis, but also of respiratory allergies in general.

In recent years, great importance in the diagnosis of allergic diseases has been attached to the detection of mast cells in the secretions of the nasal cavity. During the period of exacerbation of allergic rhinitis, a large number of mast cells and eosinophils are present in the secretions of the nasal cavity, that is, the increase in the number of these cells occurs in parallel, and during the period of remission the content of both decreases, but eosinophils are always to a greater extent than mast cells. When examining nasal secretions, pay attention to the number of goblet cells, if it exceeds 50% of all epithelial cells - this also indicates a local allergy.

An assessment of the activity of the allergic reaction based on the results of a study of scrapings from the nasal mucosa (average number of cells in 10 fields of view at 1000x microscope magnification) is given in the table.

Table Assessment of the degree of activity of the allergic reaction based on the results of a study of scrapings from the nasal mucosa [Lawlor Jr. G. et al., 2000]

Table Assessment of the degree of activity of the allergic reaction based on the results of a study of scrapings from the nasal mucosa [Lawlor Jr. G. et al., 2000]

The relationship between the nature of pathological changes in scrapings from the nasal mucosa and the presumptive diagnosis is presented in the table.

Table Changes in scrapings from the nasal mucosa and presumptive diagnosis

Table Changes in scrapings from the nasal mucosa and presumptive diagnosis

Similarly, the results of scraping from the conjunctiva for allergic eye diseases are examined and evaluated. An increase in the number of eosinophils, basophils and mast cells indicates allergic conjunctivitis; the predominance of neutrophils - about bacterial conjunctivitis, conjunctivitis caused by irritating substances (in combination with an increase in the content of eosinophils - about allergic conjunctivitis); lymphocytes - about viral conjunctivitis.

Source: http://medn.ru/statyi/obshhekliniches6.html

Norm and pathology in a nasal smear

When a runny nose bothers you, a person has to deal with more than just local symptoms. Lack of oxygen due to impaired nasal breathing causes fatigue, decreased attention and headaches, which negatively affects the quality of life. Allergic rhinitis is accompanied by much more unpleasant symptoms, and if a child is sick, then redoubled attention to the problem is required.

To effectively cure a runny nose, you need to undergo high-quality diagnostics, which necessarily includes a nasal smear for cytology. Why is it needed, how and to whom is it carried out, what are the standards of analysis - these questions worry many. But only a competent specialist can answer them.

General information

The nasal cavity is an important element of the respiratory tract. It is lined with mucous membrane covered with ciliated prismatic epithelium. The goblet and glandular cells located in it produce a secretion containing many useful substances. The mucus contains antimicrobial components: lysozyme, immunoglobulins and interferon, lactoferrin, enzymes, etc. The membrane itself contains macrophages and lymphocytes that absorb foreign agents, thereby inducing an immune response.

The movement of the epithelial cilia helps remove harmful particles (dust, aerosols, microbes) that have entered it from the nasal cavity. The air, passing through the initial section of the respiratory system, is not only purified, but also moistened and warmed. Therefore, the secretion of the mucous membrane plays an extremely important role in maintaining the normal state of the respiratory tract.

Indications

In the medical community, a nasal swab is called a rhinocytogram. The study is based on an analysis of the cellular composition of nasal secretions. This is necessary to determine the cause of the runny nose. Most often, cytology is performed for prolonged rhinitis (more than 2 weeks), especially in children. If the prescribed drugs do not help, then it is necessary to clarify the origin of the pathology and repeat the differential diagnosis.

The most common types of rhinitis are infectious, allergic and vasomotor. They can also become chronic when the symptoms last for a long time. Allergies occupy a special place among the causes of runny nose. Sensitization of the body to foreign antigens leads to seasonal or year-round runny nose, which is manifested by the following symptoms:

  • Copious discharge of watery mucus.
  • Nasal congestion.
  • Paroxysmal sneezing.
  • Itchy feeling in the nose.

This process is based on hypersensitivity reactions (usually immediate type). When faced with an allergen, macrophages engulf it and present it to B lymphocytes. Those, in turn, begin to synthesize class E immunoglobulins, which are deposited on mast cells and eosinophils. And upon repeated contact with the same agent, allergy mediators are released: bradykinin, histamine, serotonin, prostaglandins and leukotrienes. Vascular permeability increases, which leads to swelling, hypersecretion of mucus and other symptoms of rhinitis.

That is why a rhinocytogram becomes a key parameter in the differential diagnosis of a runny nose. By making a nasal swab for eosinophils, it will be possible to establish the cause of the pathology, confirming or denying its allergic origin. Indeed, according to statistics, a fifth of the population suffers from such rhinitis.

Analysis of nasal swabs is done in cases where it is necessary to find out the exact origin of rhinitis. Treatment measures will depend on this.

Preparation

Before taking a smear for eosinophils, it is worth making preliminary preparations. Before taking biomaterial, the patient is not recommended to:

  1. Blow your nose thoroughly.
  2. Toilet the nasal cavity.
  3. Use drops and sprays with vasoconstrictors and topical corticosteroids.
  4. Use hygienic creams and ointments.
  5. Take antiallergic and hormonal pills.

Thus, it is contraindicated to do anything that changes the composition of nasal secretions. Indeed, in this case, the result may turn out to be unreliable. The analysis is prescribed by a general practitioner, family doctor, otolaryngologist or allergist after a clinical examination and rhinoscopy. The patient is given a referral to a laboratory (for example, Invitro or others).

Carrying out

It is not difficult to make a rhinocytogram. Nasal swabs for eosinophils are taken by nursing staff working in laboratories. To do this, you need special sterile tuffers, which are passed along the mucous membrane. The procedure is completely painless and non-invasive.

The resulting biomaterial (nasal secretion) is applied to a glass slide and stained according to Romanovsky-Giemsa. Some structures acquire a blue tint (cytoplasm of lympho- and monocytes, basophil and neutrophil granules), while others become pink (eosinophil granules, leukocyte nuclei). Next, the cellular elements are counted under a microscope.

results

The results of a cytological examination should be interpreted in combination with other signs of pathology. For a more reliable result, it is recommended to repeat the analysis after a couple of days. Having received a form with the identified indicators, the doctor evaluates them in accordance with the reference values. And only he can make the appropriate conclusion.

Norm

In a nasal smear for eosinophils, the cell norm depends on age. For a child under 13 years of age, this value should not exceed 7%, and for older children and adults – 5%. The lower limit is at 0.5%. But rhinocytology allows us to identify other cellular elements (Table No. 1):

But it should be noted that reference values ​​may also depend on the location from which the smear was taken. Therefore, when conducting analysis, it is important to adhere to established techniques. Each laboratory (Sinevo, Invitro and others) indicates normal values ​​​​in the form next to the actual ones. And the patient, just like the doctor, can compare them.

Normal cytology indicates no changes in the mucous membrane. But the presence of clinical signs should be the basis for repeating the analysis.

Promotion

An increase in cellular elements in the smear indicates a pathological process affecting the nasal mucosa. The origin of violations can be judged by what indicators go beyond the norm.

Eosinophils

If more than 10% of eosinophils are detected in a child or adult, then one has to think about the allergic nature of the runny nose. But a similar phenomenon is often observed in other diseases with signs of immune disorders in the body:

  • Eosinophilic rhinitis (polyposis).
  • Periarteritis nodosa.
  • Leukemia.
  • Helminthic infestations.

In addition, eosinophilia alone cannot be a sufficient basis to confirm allergic rhinitis. As a rule, additional diagnostics should be carried out with a general blood test (these cells are also elevated in it) and determination of the level of immunoglobulins. Often it is necessary to identify the specific antigen to which sensitization occurred (allergy tests).

It should be noted that the level of eosinophils in the secretion correlates with the severity of the pathological process. The allergic reaction is also accompanied by a parallel growth of basophils and mast cells. The mentioned dependence is reflected in table No. 2:

Neutrophils

Neutrophilia in biological environments indicates the infectious nature of the pathology. These cells are the first to penetrate the site of inflammation, and therefore are most characteristic of acute rhinitis. With a chronic runny nose, their level is much lower, but still exceeds the norm. As a rule, we are talking about bacterial damage to the mucous membrane, but viral agents also provoke the growth of neutrophils.

Lymphocytes

Lymphocytic infiltration of the nasal mucosa is characteristic of acute viral inflammation and prolonged runny nose. Chronic rhinitis is often accompanied by hyper- or atrophic changes. Prolonged inflammation is certainly accompanied by a reaction from lymphocytes, since they are the main cellular elements of local defense. But their number does not grow as quickly as neutrophils.

Red blood cells

When a cytology smear shows the content of red blood cells, one can think about increased permeability of the vascular wall or deeper damage to the mucous membrane. This is possible with influenza, diphtheria, atrophic rhinitis (ozena), and ulcerative lesions of the nose. These situations require a more serious approach to diagnosis.

An increase in cellular elements in the rhinocytogram indicates a pathological process of allergic or inflammatory origin.

Demotion

If the analysis indicates a decrease in formed elements in the nasal secretion, then you have to think about a different nature of the runny nose. Most likely, inflammatory and allergic processes are not the cause of the symptoms, but it is worth thinking about vasomotor (neuroreflex) rhinitis, which occurs due to the irrational use of vasoconstrictor drops, with hormonal and psycho-emotional disorders, and anomalies of the nasal passages.

A rhinocytogram is an important element in diagnosing a runny nose. And the determination of eosinophils in a smear allows us to assume with a high degree of certainty the allergic nature of rhinitis. But the doctor will not limit himself to just analyzing nasal mucus, but, most likely, will prescribe additional studies to the patient to clarify the nature of the process. After all, the effectiveness of treatment depends on the correct diagnosis.

Source: http://elaxsir.ru/simptomy/diagnostika/mazok-na-eozinofily-iz-nosa.html

About cytology tests: nasal swab, sputum analysis, how to do it

A nasal swab is taken for cytology to determine why the patient has a runny nose. A cytological test for sputum is taken to detect lung cancer.

If necessary, the doctor can prescribe a number of examinations to his patient, for example, a nasal swab for cytology or a sputum test for cytology.

Nasal swab

A therapist or an ENT specialist can ask you to take a nasal swab for cytology; sometimes an allergist gives a referral for analysis. There are cases when it is difficult to understand why a person has a runny nose, what kind of disease provoked it.

Why take a smear test?

Doctors already know that if the epithelium located in the nasal cavity is aggressively affected, they begin to secrete protective mucus. It is needed in order to neutralize this irritating factor (viruses, bacteria, allergens). Depending on the reasons that led to the formation of this mucus, its composition changes. That’s why a nasal swab is taken for cytology so that a more accurate analysis can be performed. If the doctor sees that the patient’s mucous membranes are inflamed, he cannot breathe, there is nasal discharge, the patient often sneezes, complains of itching and burning, but cannot make a diagnosis, he asks for a smear for cytology.

Preparation and results

How to prepare, how to properly take a nasal swab for cytology? It is important to follow only two rules:

  1. Before taking a nasal swab, you should not take medications, namely antihistamines and corticosteroids, i.e. nasal sprays.
  2. Before being examined, you need to blow your nose to clear your nose of mucus crusts.

Taking a nasal swab does not hurt. The cotton wool will be placed in the nasal passages and will be kept there until they are saturated with moisture. Then it will be placed between two glasses and squeezed out, and the liquid will be collected in a special test tube.

What could be the results?

  1. Neutrophils should be in the range of 40-45%; if there are more of them, then the runny nose is due to some kind of infection.
  2. Lymphocytes normally do not exceed 1%; if there are more of them, then bacteria are to blame.
  3. Eosinophils - no more than 1%; if there are more than 10%, this indicates that the runny nose is allergic.
  4. Macrophages – no more than 1%
  5. Columnar epithelium is normally from 20 to 36%.
  6. Flat epithelium – 3-7%
  7. Scales. They can be from 8 to 25%.

But the diagnosis must be made by a doctor who relies not only on the data provided by the nasal swab, but also on other symptoms of the disease.

Sputum analysis

A therapist, phthisiatrician or pulmonologist may prescribe a cytological analysis of sputum.

Why get tested?

This test is necessary to make sure that the patient does not have abnormal cells in the sputum that could indicate that he has cancer. Such a cell changes its structure, and this can be seen under a microscope. If a person has cancer, then in 85% of cases these degenerated cells will be excreted in the sputum. We are talking about lung cancer. A sputum test is prescribed if the doctor suspects that the patient has this disease. But this examination is carried out not once, but several times (preferably 5 times), then the result will be the most reliable.

Sometimes the person being examined may not have signs of the disease, but the doctor will still insist that a sputum cytological test be taken to identify the disease at an early stage. This applies to those who work in hazardous industries, whose close relatives had patients diagnosed with lung cancer, and experienced smokers are also examined.

If the patient is not at risk, but complains of a constant cough and suffers from frequent pneumonia, then this may also be due to lung cancer. Other symptoms of this disease are weight loss, constant weakness, and poor appetite. But a sputum test is not always taken only to determine whether a person has cancer. Sometimes this examination is needed to confirm diagnoses such as bronchial asthma, the presence of heart defects, tuberculosis, etc.

How to get tested

How to take a sputum test correctly? The patient had to receive a special container at the clinic. In the morning, upon waking up, he should brush his teeth and then rinse his mouth and throat. It is better to use boiled water for this. When sputum is formed during a cough, it should be spat into a container, but it should be sputum, not saliva. If there is not enough sputum, you should tell your doctor about it. He will prescribe expectorants and ask the patient to drink plenty. After several days of such treatment, it will be possible to increase the amount of sputum. If a person does not have lung cancer, a sputum test will show that no atypical cells are found. When such cells are present, this indicates lung cancer. The patient needs to undergo a thorough examination and begin treatment.

Source: http://testanaliz.ru/mazok-iz-nosa-na-citologiyu

Rhinocytogram • Rhinocytogram is a characteristic of relative quantitative

Description of the presentation Rhinocytogram • Rhinocytogram - characteristic of relative quantitative on slides

• Rhinocytogram - a characteristic of the relative quantitative composition of cellular elements in a smear from the nasal mucosa • Synonyms: nasocytogram, • method of imprint smears from the nasal mucosa • cytological examination of secretions from the nasal cavity, • smear for eosinophilia.

Rhinocytogram - examination of nasal discharge under a microscope. With its help, you can identify changes characteristic of allergic reactions of the body or infection. In this way, the cause of inflammation of the nasal mucosa (rhinitis) is determined.

The mucous membrane of the nasal cavity and paranasal sinuses represents the “line of defense” of the internal environment of the body against the penetration of foreign agents: viruses, bacteria, fungi, allergens.

The structure of the nasal mucosa

The epithelium of the mucous membrane of the respiratory tract is multirow ciliated (ciliary). It consists of ciliated cells, goblet cells that secrete mucus, and basal (undifferentiated) cells.

• The mucociliary system is the most important protective mechanism of the respiratory tract. Mucociliary clearance is ensured by the beating of the cilia of the ciliary epithelium and the properties of mucus. • The movement of the cilia of the ciliated epithelium towards the upper respiratory tract ensures the removal of mucus and foreign particles (dust, microbes, etc.) that enter the respiratory tract during breathing. The mucous layer is renewed every 10–20 minutes.

An acute inflammatory viral process causes gross morphological changes in the surface epithelium and leads to disruption of the mucociliary transport system. Under these conditions, bacteria settling on the mucous membrane are retained on its surface. The destruction of epithelial cells opens the way for the bacterial flora, which is activated, from non-pathogenic to pathogenic.

With catarrhal inflammation in the nasal mucosa, the number of goblet cells in the epithelial layer increases, as a result of which the normal ratio of ciliated and goblet cells changes.

With purulent inflammation, the exudate consists mainly of leukocytes, a significant part of which are in a state of decay. Leukocytes released into the tissue due to increased vascular permeability perform a phagocytic function. In addition, the various proteolytic enzymes they contain are capable of melting non-viable (necrotic) tissue.

Stage I: dry, stage of irritation of the mucous membrane. Sneezing, slight fever. Stage II: stage of serous discharge. The permeability of the vascular wall increases. Swelling, copious clear discharge. Complete disruption of the ciliated epithelium. Stage III: stage of mucopurulent discharge. At this stage, the patient's condition improves. Acute rhinitis

Long-term inflammation leads to the replacement of ciliated epithelium with mucus-producing goblet cells or squamous epithelial cells (with atrophic rhinitis) Chronic rhinitis

Long-term: • copious nasal discharge, • intense itching and sneezing, • various inflammatory processes of the nasal mucosa, • difficulty breathing through the nose. Indications for a rhinocytogram

A rhinocytogram allows differentiation between different types of rhinitis: Infectious (bacterial) Allergic Atrophic Vasomotor

The occurrence is facilitated by endocrine disorders, diseases of the central nervous system, cardiovascular pathologies, long-term use of antihypertensive drugs, vasoconstrictors. Characterized by hyperactivity of the neurovegetative and vascular systems of the nasal mucosa, expressed by swelling and the appearance of mucous or watery discharge. Vasomotor (neurovegetative) rhinitis

Preparation for the study: the patient must completely refrain from using local medications 12 hours before the test.

Mucus must be taken from the middle nasal passage with a rotational movement of the padded probe and applied to a glass slide with reverse rotation, trying to distribute the material evenly. Before taking the material, the patient can be gently massaged from the outside of the nasal turbinates to better obtain the material. Fixation and staining of smears are performed using the Romanovsky-Giemsa method, similar to blood smears. Method of collecting material

Interpretation of cytological examination Cytology data may depend on a number of reasons that affect the true exfoliative picture: local and systemic drug therapy, secretion collection technique, the patient’s presence in a dusty environment prior to collection of the material, poor preparation of slides, drying of preparations in sunlight, incomplete drying drug, transportation and delivery of material in an unfixed form, violation of staining and counting methods.

The cytological picture of nasal secretions in acute infectious rhinitis is determined by an increase in the proportion of neutrophils, squamous epithelium, and the severity of the mucous component and microflora is often noted

The cytological picture of nasal secretions in chronic rhinosinusitis is determined by an increase in the proportion of neutrophils, squamous epithelium, the severity of the mucous component and microflora is noted, especially during the period of exacerbation, the content of destroyed cells increases,

The cytological picture of nasal secretions in allergic rhinitis shows an increased content of eosinophils, the proportion of which can reach 90%. With severe allergic inflammation, an increase in squamous and ciliated epithelium and a corresponding decrease in the proportion of neutrophils are noted; microbes were detected in small quantities or absent; the mucous component may be pronounced or absent

Cytological picture of nasal secretion in vasomotor rhinitis (predominance of squamous epithelium): the content of squamous epithelium is increased, the amount of which can reach 90%; with an exacerbation of the process, the content of ciliated epithelium slightly increases; neutrophils are practically absent; germs and mucus are detected infrequently and in small quantities;

Molds during cytological examination

Mycelium of mold fungi

There are no uniform standards for assessing rhinocytogram. It can be counted by visual fields, some authors include epithelial and destroyed cells in the percentage count of 100 cells (in this case it is considered as non-cells) The norm of eosinophils is up to 5% when calculating the leukocyte formula as in blood

Neutrophils. An increase in the number of these cells in a smear may indicate that the cause of a runny nose is infectious agents (bacteria or viruses). An increase in the level of neutrophils is especially characteristic of the acute stage of the disease. Lymphocytes. An increased content of lymphocytes may be associated with chronic infectious inflammation of the nasal mucosa. Change in the number of individual cells

Red blood cells. The appearance of red blood cells in a smear may indicate increased permeability of the vascular wall of the nasal mucosa, which is typical for some types of rhinitis, in particular those caused by diphtheria or influenza. Occurs in atrophic rhinitis.

The absence of eosinophils, neutrophils, and other types of leukocytes in the smear may indicate vasomotor rhinitis - a runny nose not associated with allergies or infection: rhinitis associated with the abuse of vasoconstrictor nasal sprays; rhinitis caused by other reasons (hormonal disorders, disorders of the psycho-emotional state, disorders of the anatomy of the nasal passages, etc.). Decrease in indicators

Reference values ​​Allergic rhinitis Infectious rhinitis Squamous epithelium small amount in the field of view Moderate quantity moderate leukocytes small amount in the field of vision pronounced moderate red blood cells 0 in the field of vision 0 — mucus in the field of vision + ++ ++ flora Cocci small amount + Cocci+ + Yeast no — — neutrophils 65 – 75% 35% 94% eosinophils 0 – 5% 63% 2% lymphocytes 0 – 10% 1% 4% monocytes 0 – 10% 1% — — insignificant amount (+) , - moderate amount (++), - pronounced amount (+++).

Red blood cells: 0 leukocytes: 5 -8 epithelial cells: mucus: ++ microflora: + neutrophils: 94% eosinophils: 2% lymphocytes: 4% flat epithelium - moderate number of leukocytes - large number of neutrophils - 50 lymphocytes - 10 eosinophils

Parameter Result % Nuclei of unidentified cells 5 – 10 Ciliated epithelium 0 – 1 Squamous epithelium 0 – 10 Neutrophils 65 – 70 Eosinophils 0 – 5 Basophils 0 Monocytes 0 – 1 Lymphocytes 0 – 5 Erythrocytes — Cocci microflora (up to + +) Mucus up to + + Note: (+) - insignificant, (+ +) - average, (+ + +) - pronounced amount. Average result of cytological parameters of nasal secretions against the background of clinical well-being

Indicator Relative decrease Relative increase Nuclei of unidentified cells (destroyed cells, cellular detritus) Low cytosis (decrease in the total number of cells) Severe infectious inflammation (pus), poor preparation of the drug Ciliated epithelium Severe swelling of the mucous membrane with pronounced desquamation, local vasoconstriction therapy Flat epithelium Swelling of the mucous membrane with severe desquamation, viral inflammation, local vasoconstrictor therapy Neutrophils Suppression of exudation, “non-purulent” process, low cytosis Bacterial inflammation, bacterial-fungal association, possible with tuberculosis Eosinophils Allergic inflammation, fungal infection, bacterial-fungal association, infectious and allergic (combined) inflammation, eosinophilia (local, general). Basophils Allergic process, interstitial inflammation Monocytes Granulomatous (proliferative) inflammation Lymphocytes Granulomatous (proliferative) inflammation. Reasons for changes in cytogram parameters

Indicator Relative decrease Relative increase Red blood cells Pronounced destructive process, mechanical damage to the mucous membrane. Mucus Serous exudate, mucolytic therapy at the final stage, local vasoconstrictor therapy Mucolytic therapy at the initial stage, allergic inflammation, infectious and allergic (combined) inflammation. Flora (cocci, rods) Sanitation Bacterial process, suppression of cellular exudation Yeast and spore-like elements Fungal infection, carriage, street and/or house dust, mold mycelium. Fibers Street and/or house dust, particles of cotton fibers

Important: The rhinocytogram (especially if the allergic nature of the runny nose is suspected) should be evaluated together with the CBC, Ig E.

Source: http://present5.com/rinocitogramma-%E2%80%A2-rinocitogramma-xarakteristika-otnositelnogo-kolichestvennogo/

Nasal swab for cytology

Nasal smear cytology can provide useful information, particularly in the diagnosis of allergic and vasomotor rhinitis, but interpretation of the results of this test also presents significant difficulties and requires some experience.

The result of a nasal smear for cytology depends on the method of obtaining it, the quantity, the area in the nasal cavity from where the sample was taken and the processing method. In most cases, exfoliative material, that is, spontaneously rejected cellular elements, is examined. The biopsy method for uncomplicated rhinitis is used extremely rarely: in scientific studies in volunteers or in the case of differential diagnosis with a tumor process or systemic diseases, such as immobile cilia syndrome.

Methods for collecting a nasal smear for cytology

Blowing the secret. Nasal secretions can be obtained by simply blowing your nose onto a glass slide, but this method is not often used in clinical practice; its disadvantage is that not in all conditions there is a sufficient amount of secretion in the nasal cavity. The method is not always applicable to children and the elderly.

Collecting the contents with a swab (reprint smears). This is the most common exfoliative method, in which only cells lying freely or ready to be rejected from the surface of the mucous membrane are examined. The secretion obtained by this method contains only cells that freely reside in the nasal cavity and are located directly in the epithelial layer. The method is simple and atraumatic; it can be repeated many times without harm to the patient. A smear for cytology is taken with a cotton swab on a metal applicator. The cotton wool should be wrapped as tightly as possible around the probe and moistened with an isotonic solution.

When collecting with a swab, it is not enough to take mucus only from the anterior sections or from the bottom of the nasal cavity, since this does not give an idea of ​​​​the real cellular composition of the secretion. It is necessary to pass it three or four times along the surface of the inferior and middle nasal concha, bringing it to the posterior parts of the nasal cavity. The resulting material is transferred to a glass slide, rolling the probe over its surface, but without rubbing, since the latter leads to greater damage to the cells.

Aspiration by suction. Nasal secretions can be obtained by aspiration in the same way as for collection for microbiological examination.

Fingerprint method. A small glass slide or thin plastic strip, moistened with 1% albumin to make the surface sticky, is inserted into the nasal cavity and pressed against the mucous membrane of the inferior turbinate or nasal septum. This another exfoliative method gives a good idea of ​​the composition of the cell population, but does not always collect a sufficient number of cells for counting.

Introduction of absorbent sponge. Using this method, it is possible to conduct both qualitative and quantitative research of nasal secretions. To do this, standard strips of foam rubber or cotton wool measuring approximately 30x6x3 mm are inserted into the nasal cavity. The degree of wetting of the tampon and the moment of its removal are determined during anterior rhinoscopy, usually this time is 3-10 minutes; for quantitative measurements, a fixed time is used, for example, 20 minutes. For research, it is better to obtain a secretion that is not diluted with tear fluid, which enters the lower nasal passage through the nasolacrimal duct. To do this, it is better to place the strips in the area of ​​the middle nasal passage. After extraction, the contents are squeezed out of the foam rubber, placing it between two glass slides or into a syringe with a previously removed piston. To better preserve the cell material, the secretion-soaked swab can be placed on a grid in a conical tube and centrifuged for 20 seconds at low speed. The centrifugate is then homogenized by shaking or stirring with a glass rod, pipetted into a counting chamber (eg Fuchs-Rosenthal chamber) and the total number of cells counted. After this, the material is applied to glass and preparations are prepared for counting individual types of cells. This method of nasal smear for cytology is most often used for allergic rhinitis when conducting a provocative intranasal test with allergens.

Brush method. Similar to the brush biopsy method used in bronchoscopy. Material from the nasal cavity is obtained using a metal brush with nylon bristles, which is inserted between the nasal septum and the inferior turbinate, making several rotational movements. The material being studied for a nasal smear for cytology will be represented by both free cells and those contained in the epithelial layer.

Scraping method. The most complete morphological material for research is obtained by scraping the mucous membrane of the inferior or middle turbinate from the surface of the examined area with a plastic or metal curette (for example, a Volkmann spoon) under visual control. Scraping should be carried out with relatively light, individually varied pressure, since with strong pressure, blood is released and red blood cells are undesirably released into the preparation. The cells contained in the scraping are well preserved, and the study gives a good idea of ​​the cellular composition of the surface layer of the epithelium, although not of the entire nasal cavity, but only of the area under study. The obtained material can also be used for bacteriological, virological and biochemical research.

Washing method (nasal lavage). This method allows you to obtain the least damaged cellular material; it is most often used for immunological studies. Flushing can be obtained by introducing 5 ml of warm isotonic sodium chloride solution or Ringer's solution into one or both halves of the nasal cavity. The patient is asked to tilt his head back and pronounce the letter “k” or “cuckoo” to close the nasopharynx with the soft palate and prevent some of the lavage fluid from leaking into the pharynx. The injected liquid must remain in the nasal cavity for at least 10 seconds, after which the patient is asked to tilt his head forward, and the liquid pouring out of the nose is collected in a tray and transferred to a test tube. The tube is centrifuged for 15 minutes at 3000 rpm. The supernatant liquid is drained and used for immunological or biochemical studies, and the sediment itself is used for counting cellular elements.

In another nasal lavage technique, the material is obtained by washing the nasal mucosa using a device consisting of a measuring tube without a bottom, a nasal olive and a tube connecting them. Lifting the test tube up, the olive is inserted into the nostril with the head tilted forward, after which 10 ml of an isotonic solution is poured into the test tube. When the test tube is lowered, the liquid, according to the law of communicating vessels, enters the nasal cavity. After making 5 rocking movements, the test tube is raised up again and the lavage liquid is collected. The resulting wash is centrifuged, the supernatant is drained, and the sediment is examined under a microscope. Just as when collecting nasal secretions with a foam swab, swabs make it possible not only to study the cellular composition of nasal secretions, but also to count the number of cells in a cubic centimeter of a smear for nasal cytology.

Processing material for smears for cytology

To prepare cytological preparations, defatted glass slides are used. The material is evenly distributed on a glass slide by “rolling” a swab over it using the smear-reprint method or with a small ground glass with light pressure. The strokes should be thin, but you should avoid rubbing glass on glass, as this will destroy the cells.

The smears are air-dried or fixed with a buffered solution of formalin or 95% alcohol, after which they are stained using a hematological technique, which is chosen depending on the characteristics of the material being studied. Thus, the Romanovsky-Giemsa stain well identifies eosinophils, neutrophils and basophils, the May-Grunwald stain - neutrophils, and the toluidine blue stain - mainly basophils.

I.L. Theodor recommends the following method: after drying in air, the smears are placed in the May-Grunwald fixative dye for 3 minutes, after which they are washed with running water from the back of the glass and repainted for minutes using the Romanovsky method. Preparations can be microscoped immediately after fixation in May-Grunwald stain, but the structure of cells and nuclei is clearly revealed only after staining using the Romanovsky method.

Examination of nasal swabs for cytology

First, the smears are viewed under low magnification with an objective of 8 and an eyepiece of 10. This allows you to get a general idea and detect cellular complexes and isolated cells. A detailed study of cells is carried out under an immersion lens. When analyzing a nasal smear for cytology, pay attention to the number and ratio of the following cells:

  • eosinophils;
  • mast cells and basophils;
  • epithelial cells;
  • lymphocytes;
  • neutrophils;
  • goblet cells.

Same as with tank. By culture of a nasal smear, it is difficult to determine the composition of a “normal” cytogram of nasal secretions. Usually, in swabs and prints of healthy people, as well as patients with idiopathic vasomotor and medicinal rhinitis, small quantities of ciliated, intercalary and goblet epithelial cells, single neutrophils, eosinophils and rare bacteria are present. The normal ratio of ciliated to goblet cells is 5:1. Various pathological conditions are associated with characteristic changes in cellular composition.

Results of nasal swab for cytology

Allergic rhinitis is typically characterized by an increased content of eosinophils (over 10% of the total number of cells) and the appearance of basophilic cells. In respiratory viral infections, polymorphism of cellular material and a large number of desquamated ciliated epithelial cells in various stages of degeneration are usually observed. With the development of acute bacterial inflammation of the mucous membrane, polynuclear neutrophils begin to predominate, which usually completely cover the visual field, red blood cells and a large number of phagocytosed and free bacteria are detected.

In chronic infectious rhinitis and rhinosinusitis, lymphocytes and macrophages can be found in significant quantities. The presence of mycelium or spores indicates a possible fungal etiology of rhinitis. With atrophic rhinitis, a meager number of epithelial cells is detected, but a large number of metaplastic elements and squamous epithelial cells, many neutrophils and bacteria appear, including Klebsiella.

Comparative studies have shown that the indicators of the total number and percentage composition of eosinophils and neutrophils obtained by scrapings and washings correlate quite well with each other, especially with a provocative test in patients with allergic rhinitis. The results of analysis of nasal secretions obtained by blowing the nose are less reliable, and they correlate much less well with the results of scrapings.

In addition to the basic technique for examining stained nasal smears for cytology, fluorescence microscopy can be used. The nature of luminescence is determined by the chemical composition of cells and makes it possible to judge, in particular, the degree of maturity of cellular elements.

Nasal biopsy

Samples of the nasal mucosa for histological examination can be easily obtained on an outpatient basis by instrumental biopsy. Small pieces of mucous membrane are taken using auricular cutting (not tearing!) forceps from the anterior end of the lower or middle nasal concha. Conventional hematoxylin-eosin staining is sufficient to study the cellular composition of tissue. It is believed that the study of biopsy material is more informative than the study of smears and swabs, especially when determining the percentage of eosinophils, for example, in the differential diagnosis of various forms of allergic and non-allergic rhinitis.

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Allergic rhinitis

SEKHMET

Allergic rhinitis

Allergic rhinitis (AR) is a disease of the nasal mucosa characterized by IgE-mediated inflammation of the mucous membranes of the nasal cavity and the presence of at least two of the following symptoms for an hour or more every day: nasal congestion (obstruction), nasal discharge (rhinorrhea), sneezing. , itching in the nose.

New classification of allergic rhinitis (ARIA, 2002):

  • takes into account symptoms of allergic rhinitis and quality of life indicators;
  • involves highlighting:
  • intermittent and persistent rhinitis based on the duration of symptoms;
  • mild, moderate and severe rhinitis, taking into account the severity of symptoms and the degree of deterioration in quality of life.

The term “episodic (or intermittent)” means that manifestations of allergic rhinitis bother the patient less than 4 days a week or less than 4 weeks. per year.

The term “frequent (persistent) presence of symptoms” means that the patient notes the manifestation of symptoms of the disease more than 4 days a week or more than 4 weeks. per year.

During AR there are several stages:

  • vasotonic, characterized by periodic nasal congestion associated with disturbances of vascular tone, and requiring occasional use of decongestants;
  • vasodilation, characterized by frequent nasal congestion, accompanied by dilation of the vessels of the nasal mucosa and requiring frequent use of decongestants;
  • the stage of chronic edema, characterized by constant nasal congestion, the nasal mucosa becomes bluish in color, the use of decongestants is ineffective;
  • hyperplasia, characterized by constant nasal congestion, proliferation of the nasal mucosa, and the formation of polyps; often the paranasal sinuses are involved in the process, secondary otitis develops, and a secondary infection occurs; the use of decongestants is ineffective.

Differential diagnosis of allergic rhinitis:

  • vasomotor rhinitis;
  • rhinitis of pregnant women;
  • rhinitis, described as a non-allergic side effect of rauwolfia preparations;
  • rhinitis associated with local use of sympathomimetics (naphthisin, sanorin, galazolin, otrivin, privin), as well as ephedrine;
  • mastocytosis of the nasal mucosa.
  • Eosinophilic nonallergic rhinitis occurs mainly in adults and occurs with year-round symptoms. Often the paranasal sinuses are involved in the process, and polyps appear. Eosinophils are detected in nasal discharge, while serum IgE levels are within normal limits, and allergy tests are negative.

Mandatory laboratory examination methods for allergic rhinitis include:

• detailed clinical blood test;

• -cytological examination of smears from the nasal cavity (nasocytogram).

Additional examination methods for allergic rhinitis include:

  • bacteriological cultures for infectious flora
  • determination of total serum IgE;
  • determination of specific IgE in blood serum;
  • determination of IgA, IgM, IgG.

Nasocytogram

A nasocytogram is a study of a smear from the nasal cavity under a microscope, which is carried out to diagnose allergies, identify bacterial or fungal infections, and the presence of inflammatory changes.

Analysis of cytological processes in nasal secretions can expand the diagnostic capabilities of assessing pathophysiological changes in the respiratory tract.

Preparing the patient for the examination:

  • On the eve of the test, do not rinse or rinse your nose.
  • Do not put medications in your nose for 4-5 hours.

Rules for taking material and processing it in the laboratory:

  • A smear is taken with a sterile brush of a urological probe from the lower nasal passage and applied to a glass slide (2 probes, 2 glasses - for each half of the nose separately).
  • Each glass is pre-signed: left, right half of the nose, respectively.
  • The smears are air dried and wrapped, each glass separately , in a sheet of paper.
  • A referral is issued for a nasocytogram of the nose, 2 points, indicating the patient’s full name, age, diagnosis and with the doctor’s stamp.

Interpretation of nasocytogram results:

  • The smear evaluates the qualitative and quantitative composition of the cells of neutrophils, eosinophils, lymphocytes, monocytes, the presence of mast and plasma cells, the amount of epithelium, its characteristics (proliferation, dystrophy, metaplasia).
  • Indirect signs of intracellular infection (nuclear and cytoplasmic inclusions), presence and characteristics of flora:
    • Neisseria meningitidis (meningococcus) leads to the development of inflammation (nasopharyngitis, catarrhal tonsillitis, meningococcal pneumonia, carriage of meningococci)
    • Streptococcus pneumoniae - pneumonia, meningitis, pharyngitis, otitis, sinusitis, etc.
    • Staphylococcus haemolyticus, S.aureus and S.epidermidis
    • Rods of the family Enterobacteriacea
  • When describing cytological preparations, the predominance of one or another type of cell is assessed as purulent, inflammatory or eosinophilic.
    1. A large number of eosinophils is characteristic of the allergic etiology of rhinitis.
    2. A large number of neutrophils is evidence of an acute infection.
    3. A large number of eosinophils and neutrophils is characteristic of allergic rhinitis complicated by secondary infection.
    4. The absence or insignificant amount of both esinophils and neutrophils is characteristic of vasomotor rhinitis.
  • The presence of classic cilia of the ciliated epithelium of the nasal mucosa indicates the presence of normal ciliated columnar cells of the nasal epithelium .

Nasocytogram in healthy individuals:

  1. neutrophils - single,
  2. single lymphoid elements and eosinophils
  3. single anucleate cells of squamous epithelium scales,
  4. squamous epithelial cells in the form of individual elements (from 0 to 2%.),
  5. columnar epithelium. with moderate signs of proliferation, preserved cuticular border and cilia

Nasocytogram for allergic rhinitis (AR):

  1. Leukocytosis
  2. Eosinophils (from 10 to 100%).
    • AR in remission – single eosinophils.
  3. Destructive processes of leukocytes and mucosal cells.
  4. Flat epithelium (sometimes in layers), performing the main protective function
    • up to 15 in the field of view during exacerbation
    • up to 5-8 in the field of view with AR in remission

The phenomena of destruction of squamous epithelial cells are most pronounced in smears of nasal secretions of patients with AR in combination with bronchial asthma (BA). Cells of the parabasal, basal layer of the epithelium with signs of dystrophy are detected, which reflects the depth, activity and degree of the inflammatory process.

  1. The cylindrical epithelium may be in a state of hypersecretion, varying degrees of hyperplasia
  2. Mast cells, the most powerful producers of interleukins (in particular, IL-4) may occur.
  3. Slime

The decrease in the degree of destruction of neutrophils, squamous and cylindrical epithelial cells and lymphocytes is due to the effect of endogenously produced IFN on metabolic processes in the cells of the nasal mucosa.

Which leads to the restoration of the colloidal properties of the cytoplasm of epithelial cells and strengthening of the cell membrane.

Due to the lysis of microflora, there is no need for the local phagocytic function of neutrophils, due to which their structure is preserved.

In patients with rhinosinusitis, presumably of viral etiology

  1. the cylindrical epithelium is changed (dystrophy, metaplasia) without cilia, accumulation of secretion in the cytoplasm.
  2. inclusions are noted in the nuclei and cytoplasm of columnar epithelial cells:
    • Provacek bodies - the etiological factor is C. psitaci and C. pneumoniae
    • "peacock eye" - CMV and herpes simplex virus..

The epithelium of the nasal mucosa is known to perform a protective function against viral and other intracellular infections.

The morphological changes in columnar epithelial cells revealed during the study indicate the presence of an intracellular infection, but do not allow us to determine the type of its causative agent.

In patients with chronic inflammation

  1. Inflammatory nature of the nasocytogram
  2. A significant number of destroyed leukocytes.
  3. Eosinophils -1-2 in the field of view.
  4. A large number of destroyed (holonuclear) cells, cocci, diplococci, mucus strands.

In patients with adenoiditis with purulent exudate

  1. Neutrophil-macrophage variant of nasocytogram
  2. A large number of coccal flora,
  3. A large number of neutrophils,
  4. High degree of destruction of columnar epithelial cells - many destroyed (holonuclear) cells.

Purulent character and eosinophilia are more often detected in severe cases of the disease.

Complications of allergic rhinitis

  • Allergic sinusitis.
  • Polypous rhinosinusitis
  • Serous otitis media is especially characteristic of childhood. Epidemiological data indicate a 40-50% incidence of otitis media in children over three years of age who have allergic rhinitis.

Most often, allergic rhinitis is combined with allergic conjunctivitis, atopic bronchial asthma, and atopic dermatitis.

The existence of a relationship with bronchial asthma is the most important rationale for the timely diagnosis of allergic rhinitis

For AR in combination with bronchial asthma (BA)

  1. Eosinophils (from 10 to 100%).
  2. Fibrin threads
  3. Cellular detritus
  4. Cells of the deeper layers of the epithelium (parabasal, basal), which illustrates the presence of destructive processes in the epithelium.

A cytogram of the nasal mucosa reflects the dynamics of local allergic inflammation and the condition of the mucous membrane of the respiratory tract.

Cytological monitoring of nasal secretions during treatment can be used as an additional criterion for assessing the effectiveness and adequacy of the therapy.

Source: http://www.sehmet.com.ua/sumy/poleznoe/allergicheskij-rinit-vidy-stadii-diagnostika-nazocitogramma-podgotovka-interpretaciya-rezultatov.html