Professional Documents
Culture Documents
INTERPRETATIONS
Goals
Standardize technical details
Standardize reporting
Introduce interpretive reporting
Microbiology consultations are our future
Improving the Gram stain
Standardize Reporting
Reporting Level I:
Minimum competency for everyone
Reporting Level II:
Advanced competency for senior technologists and
supervisors
Improving the Gram Stain
Visualize specimen
Consult technologist, director or pathologist
as necessary
Select best portion
Purulence
Mucous/tenacious
Blood
Necrosis (black)
PREPARING THE SMEAR WITH
SEMI-SOLID SPECIMEN
Make a Monolayer of Cells
PREPARING THE SMEAR WITH A FLUID SPECIMEN
Concentrating fluids using a cytospin
LOW POWER (10X) EXAMINATION
1+ (very rare)
Less than 10 in all fields examined
2+ (few)
More than 10 in all fields but less than 1/field
3+ (moderate)
More than 1/field but less than 25/field
4+ (many)
More than 25 in one field
1. Requested by technologist
2. Requested by laboratory director
GRAM STAIN POLICY FOR
SLIDE REVIEW AND INTERPRETATION
Director-Requested Review
Sterile fluid or tissue
Microorganism reported
Non-sterile source
Report is diagnostic
Gram stain and culture results do not agree
Technologist-Requested Review
Technologist unsure of finding
Physician-requested review
Interpretation
Results of review added to lab work card or patient
report
GRAM STAIN SLIDE REVIEW AND
INTERPRETATION
Gram Stain Report with Clinician Requested
Review and Interpretation by Medical Microbiologist
BACTERIAL MORPHOLOGIES
LEVEL I
MINIMUM COMPETENCY-EVERYONE
PMNs
Squamous epithelial cells
Sputum screens
BACTERIAL MORPHOLOGIES
LEVEL II
Senior Technologists/Supervisors
Level I plus
Gram-positive diplococci (lancet) S. pneumoniae
Gram-positive rod diphtheroid Corynebacterium, etc.
Gram-positive rod boxcar Bacillus/Clostridium
Gram-positive rod endospores Bacillus/Clostridium
Gram-positive rod filamentous/branching
Nocardia/Actinomyces
Hyphae septate Aspergillus, etc.
BACTERIAL MORPHOLOGIES
Level II
Senior Technologists/Supervisors
MORPHOLOGY REPORTED ORGANISM IMPLIED
Continued
Cells
White blood cells (polymorphonuclear
leukocytes)
Alveolar macrophages
Squamous/columnar epithelial cells
Interpretations
Laboratory Directors/Pathologists
Medical Microbiologists
Indicators of Pathology
Inflammatory cells
Kirschmanns spirals and corpora amylacea
Casts and crystals
Cell necrosis (elastin and collagen)
Intracellular bacteria/yeasts
Other oddities
Contaminated agar in transport tubes
Gram Stain
Gram Stain
Diagnosis
Pap Stain
Pap Stain
Pelger-Huet Anomaly
MICROBIOLOGY MODEL???
Comment: Gram stain reviewed by
Dr. Thomson. Branching septate
hyphae also present among PMNs.
Morphology suggests Aspergillus or
morphologically similar mold. See
attached image.
How To Make Gram Stain
Reporting Relevant in the Future
Gram Stain:
< 25 Squamous Epithelial Cells
3+ Gram-positive diplococci
2+ Mixed respiratory flora
Culture Report:
1+ Staph aureus
1+ Streptococcus pneumoniae
Gram Stain: Culture Report:
< 25 Squamous Epithelial Cells 1+ Staph aureus
3+ Gram-positive diplococci 1+ Streptococcus pneumoniae
2+ Mixed respiratory flora
Interpretation by Dr Thomson:
Gram stain suggests pneumococcal LRT disease. Many diplococci are Gram-
negative possibly reflecting early antimicrobial damage. Staphylococci in the
Gram-stain are a minor component equivalent in quantity to other usual bacterial
flora. Clinical correlation necessary. Images attached.
Pelger-Hut Anomaly