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Lorraine Doucette, MS, MLS(ASCP)CMAssociate Professor and Medical Laboratory Technician Program CoordinatorAnne Arundel Community CollegeArnold, Maryland
Pamela B. Lonergan, MS, MT(ASCP)SCMedical Technology Program DirectorDepartment of Nursing and Allied HealthNorfolk State UniversityNorfolk, Virginia
Jessica Loontjer, MLS(ASCP)CM, LS(ASCP)CMClinical Instructor, Special Chemistry and Urinalysis/Body FluidsNebraska Methodist Hospital LaboratoryOmaha, Nebraska
Michelle Moy, MAd Ed, MT(ASCP)SCProgram DirectorClinical Laboratory Science ProgramLoyola UniversityChicago, Illinois
C. Thomas Somma, PhDAssociate ProfessorSchool of Medical Diagnostics and Translational SciencesCollege of Health SciencesOld Dominion UniversityNorfolk, Virginia
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Contents
Suprapubic Aspiration 34Prostatitis Specimen 34Pediatric Specimens 34Drug Specimen Collection 35
CHAPTER 3
Renal Function 39
Renal Physiology 40
Renal Blood Flow 40Glomerular Filtration 41Tubular Reabsorption 43Tubular Secretion 45
Renal Function Tests 46
Glomerular Filtration Tests 47Cystatin C 49Tubular Reabsorption Tests 50Tubular Secretion and Renal Blood Flow Tests 52
PART TWO: Urinalysis
CHAPTER 4
Physical Examination of Urine 59
Color 60
Normal Urine Color 60Abnormal Urine Color 61
Clarity 62
Normal Clarity 62Nonpathologic Turbidity 63Pathologic Turbidity 63
Specific Gravity 63
Refractometer 64Osmolality 65Reagent Strip Specific Gravity 66
Odor 66
CHAPTER 5
Chemical Examination of Urine 71
Reagent Strips 72
Reagent Strip Technique 72Handling and Storing Reagent Strips 73Quality Control of Reagent Strips 73Confirmatory Testing 73
pH 73
Clinical Significance 73Reagent Strip Reactions 75
Protein 75
Clinical Significance 75Prerenal Proteinuria 75
PART ONE: Background
CHAPTER 1
Safety and Quality Assessment 3
SAFETY 4
Biologic Hazards 4
Personal Protective Equipment 7Hand Hygiene 7Biologic Waste Disposal 9
Sharp Hazards 9
Chemical Hazards 10
Chemical Spills and Exposure 10Chemical Handling 10Chemical Hygiene Plan 10Chemical Labeling 10Material Safety Data Sheets 10
Radioactive Hazards 11
Electrical Hazards 11
Fire/Explosive Hazards 12
Physical Hazards 13
QUALITY ASSESSMENT 13
Urinalysis Procedure Manual 14
Preexamination Variables 14Examination Variables 16Postexamination Variables 20
CHAPTER 2
Introduction to Urinalysis 27
History and Importance 28
Urine Formation 29
Urine Composition 29
Urine Volume 29
Specimen Collection 30
Containers 30Labels 30Requisitions 31
Specimen Rejection 31
Specimen Handling 31
Specimen Integrity 31Specimen Preservation 31
Types of Specimens 32
Random Specimen 32First Morning Specimen 3324-Hour (or Timed) Specimen 33Catheterized Specimen 34Midstream Clean-Catch Specimen 34
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Renal Proteinuria 76Postrenal Proteinuria 76Reagent Strip Reactions 77Reaction Interference 77
Glucose 79
Clinical Significance 79Reagent Strip (Glucose Oxidase) Reaction 81Reaction Interference 81Copper Reduction Test (Clinitest) 81Clinical Significance of Clinitest 82
Ketones 82
Clinical Significance 82Reagent Strip Reactions 83Reaction Interference 83
Blood 83
Clinical Significance 84Hematuria 84Hemoglobinuria 84Myoglobinuria 84Reagent Strip Reactions 84Reaction Interference 85
Bilirubin 85
Bilirubin Production 85Clinical Significance 86Reagent Strip (Diazo) Reactions 87Reaction Interference 87
Urobilinogen 87
Clinical Significance 88Reagent Strip Reactions and Interference 88Reaction Interference 88
Nitrite 88
Clinical Significance 88Reagent Strip Reactions 89Reaction Interference 89
Leukocyte Esterase 90
Clinical Significance 90Reagent Strip Reaction 90Reaction Interference 91
Specific Gravity 91
Reagent Strip Reaction 91Reaction Interference 92
CHAPTER 6
Microscopic Examination of Urine 99
Macroscopic Screening 100
Specimen Preparation 100Specimen Volume 100Centrifugation 100Sediment Preparation 101Volume of Sediment Examined 101Commercial Systems 101Examining the Sediment 101Reporting the Microscopic Examination 101Correlating Results 102
Sediment Examination Techniques 102
Sediment Stains 103Cytodiagnostic Urine Testing 105Microscopy 105Types of Microscopy 107
Urine Sediment Constituents 110
Red Blood Cells 110White Blood Cells 112Epithelial Cells 113Bacteria 118Yeast 119Parasites 119Spermatozoa 120Mucus 120Casts 121Urinary Crystals 128Urinary Sediment Artifacts 138
CHAPTER 7
Renal Disease 147
Glomerular Disorders 148
Glomerulonephritis 148Nephrotic Syndrome 149
Tubular Disorders 150
Acute Tubular Necrosis 150Hereditary and Metabolic Tubular Disorders 153
Interstitial Disorders 154
Acute Pyelonephritis 155Chronic Pyelonephritis 155Acute Interstitial Nephritis 155
Renal Failure 155
Renal Lithiasis 157
CHAPTER 8
Urine Screening for Metabolic Disorders 163
Overflow Versus Renal Disorders 164
Newborn Screening Tests 164
Amino Acid Disorders 165
Phenylalanine-Tyrosine Disorders 165Branched-Chain Amino Acid Disorders 167Tryptophan Disorders 168Cystine Disorders 169
Porphyrin Disorders 170
Mucopolysaccharide Disorders 172
Purine Disorders 174
Carbohydrate Disorders 174
PART THREE: Other Body Fluids
CHAPTER 9
Cerebrospinal Fluid 181
Formation and Physiology 182
Specimen Collection and Handling 182
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Appearance 183
Traumatic Collection (Tap) 184
Uneven Blood Distribution 184Clot Formation 184Xanthochromic Supernatant 185
Cell Count 185
Methodology 185Total Cell Count 186WBC Count 186Quality Control of CSF and Other Body Fluid Cell
Counts 186
Differential Count on a CSF Specimen 186
Cytocentrifugation 186CSF Cellular Constituents 187
Chemistry Tests 193
Cerebrospinal Protein 193CSF Glucose 196CSF Lactate 195CSF Glutamine 195
Microbiology Tests 195
Gram Stain 196
Serologic Testing 197
CHAPTER 10
Semen 203
Physiology 204
Specimen Collection 205
Specimen Handling 205
Semen Analysis 205
Appearance 205Liquefaction 206Volume 206Viscosity 206pH 207Sperm Concentration and Sperm Count 207Sperm Motility 208Sperm Morphology 209
Additional Testing 210
Sperm Vitality 211Seminal Fluid Fructose 211Antisperm Antibodies 212Microbial and Chemical Testing 212Postvasectomy Semen Analysis 213Sperm Function Tests 213Semen Analysis Quality Control 213
CHAPTER 11
Synovial Fluid 217
Physiology 218
Specimen Collection and Handling 218
Color and Clarity 219
Viscosity 219
Cell Counts 220
Differential Count 220
Crystal Identification 221
Types of Crystals 221Slide Preparation 222Crystal Polarization 222
Chemistry Tests 224
Microbiologic Tests 224
Serologic Tests 224
CHAPTER 12
Serous Fluid 229
Formation 230
Specimen Collection and Handling 230
Transudates and Exudates 231
General Laboratory Procedures 231
Pleural Fluid 232
Appearance 232Hematology Tests 232Chemistry Tests 235Microbiologic and Serologic Tests 236
Pericardial Fluid 236
Appearance 237Laboratory Tests 237
Peritoneal Fluid 237
Transudates Versus Exudates 237Appearance 238Laboratory Tests 238
CHAPTER 13
Amniotic Fluid 243
Physiology 244
Function 244Volume 244Chemical Composition 244Differentiating Maternal Urine From Amniotic
Fluid 245
Specimen Collection 245
Indications for Amniocentesis 245Collection 246
Specimen Handling and Processing 246
Color and Appearance 246
Tests for Fetal Distress 246
Hemolytic Disease of the Newborn 246Neural Tube Defects 247
Tests for Fetal Maturity 248
Fetal Lung Maturity 248Lecithin-Sphingomyelin Ratio 248Phosphatidyl Glycerol 249Foam Stability Index 249Lamellar Bodies 249
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CHAPTER 14
Fecal Analysis 255
Physiology 256
Diarrhea and Steatorrhea 257
Diarrhea 257Steatorrhea 258
Specimen Collection 258
Macroscopic Screening 258
Color 258Appearance 259
Microscopic Examination of Feces 259
Fecal Leukocytes 259Muscle Fibers 259Qualitative Fecal Fats 260
Chemical Testing of Feces 261
Occult Blood 261Quantitative Fecal Fat Testing 262APT Test (Fetal Hemoglobin) 263Fecal Enzymes 264Carbohydrates 264
CHAPTER 15
Vaginal Secretions 269
Specimen Collection and Handling 270
Color and Appearance 271
Diagnostic Tests 271
pH 271Microscopic Procedures 272
Vaginal Disorders 277
Bacterial Vaginosis 277Trichomoniasis 278Candidiasis 278Desquamative Inflammatory Vaginitis 279Atrophic Vaginitis 279
Additional Vaginal Secretion Procedures 279
Fetal Fibronectin Test 279AmniSure Test 279
APPENDIX A Urine and Body Fluid Analysis Automation 283
APPENDIX B Bronchoalveolar Lavage 293
Answers to Study Questions and Case Studies andClinical Situations 297
Abbreviations 305
Glossary 307
Index 315
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