2. SPECIMEN Collection Handling and Transport

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Diurnal variationDietTobacco smokingStressPostureAge


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Clinical Specimens

Blood Urine Stool CSF Other BFs

Laboratory Examination

Hematology

Chemistry Immunology

Microbiology


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Kinds:capillary, vein, arterialTime:fasting, ad random, timed (2 hrs pp, serial)Anticoagulant: Anticoagulant (-) serum Anticoagulant (+) plasma


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Stoppercolor

Anticoagulant

Specimentype/use

Mechanismof action

Red None Serum(chemistry &

serology

N/A

Lavender(plastic)

K2EDTA(Spray)-dried

Plasma/Hematology

Chelates(binds)Calcium

Light blue SodiumCitrate Plasma/coagulation Chelates(binds)Calcium

Light

green/black

Lithium

Heparin

Plasma/che

mistry

Inhibits

thrombinformation


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Skin punctureMethod of choice in pediatric patients(infants) iatrogenic anemia.

Adults: extreme obesity, severe burns,thrombotic tendencyGeriatric patients skin less thinner, lesselastic prevent hematoma


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Venipuncture, phlebotomy phlebotomistComplication (in pediatric patients): Cardiac arrest, hemorrhage, thrombosis, venous constriction (gangrene), damage to organ, infection.


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More difficult to perform high pressure difficult to stop bleeding.Preference: radial, brachial, femoral arteries


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Ensure valid results procedure Urine testing :

Chemicals Bacteriologic Microscopic (sediment)


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Collection: Random (first morning voided)

Clean catch Timed 24 hrs Catheterized

Container: chemically clean sterile ? Pediatric collection Special collection suprapubic aspiration Urine storage preservation Freshly voided and concentrated urine

identify cast, RBC, WBC


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Stool : end product of bodymetabolism Early detection ofgastrointestinal bleeding, liverand biliary duct disorders,malabsorption syndromes, &detection parasites Normal: contains bacteria,cellulose & undigestedfoodstuffs, GI secretions, bilepigments, cells from intestinalwalls, electrolytes & water


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Clean, dry, widemouth, leakproof, tight-fitting lid

Not contaminated with urine or water Within 2 hours after collection

Name:

Date :

Time:


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Collection routinely by lumbar puncturebetween 3 rd , 4 th or 5 th vertebrae

Up to 20 mL CSF may normally be moved Collected in 3 sterile tubes:

Tube 1: chemical & serologic tests

Tube 2: microbiologyTube 3: cell count & differential

Examination should be performed immediately(


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Functions:Physical support to brainProtect sudden changes in blood pressure

Excretory wastePathway from hypothalamus to midbrainMaintains CNS ionic hemostatic


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1. Meningeal infection2. Subarachnoid hemorrhage3. CNS malignancy4. Demyelinating disease

CSF Examination:1. Gross examination2. Microscopic examination3. Chemical examination


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Normal CSF:clear and colorless

viscosity similar to waterTurbidity

leukocyte >200cells/L, erithrocyte > 400cells/LClot formationtraumatic tap, complete spinal block, suppurative andtuberculous meningitisViscous

metastatic mucin-producing adenomacarcinomas cryptococcal adenocarcinomas

Xanthochromia pink, orange or yellow due to RBC lysis or Hb breakdown

bilirubin, protein >150mg/dL, carotinoids, melanin,rifampicin therapi, contamination of detergent ormethiolate disinfectan


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Total Cell Count Leukocyte: normal 0-5 cells/L, neonates


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Total ProteinDerived from plasma, concentration


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Glucosederived from blood glucosefasting CSF glucose 50-80mg/dL60% plasma valuesHypoglycorrhacia:bacterial, tuberculous and fungal meningitis


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Enzymes1. Lactate Dehydrogenase (LDH)

Normal < 40U/L

elevated in bacterial meningitis2. Creatine Kinase (CK)Normal < 5 U/Lelevated in demyelinating disease,

seizures, stroke, malignant tumors,meningitis & head injury


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Gram stainBacterial Meningitisgroup B Streptococcus and Gram negativerodsViral meningitisEnteroviruses (polioviruses)Fungal meningitis

Cryptococcus (in AIDS patients)Tuberculous meningitis


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Bacterial Viral Tubercular FungalWBC count elevated elevated elevated Elevated

Cell present neutrophil Lymphocytes Lymphocytes

& monocytes

Lymphocytes

& monocytes

Proteinelevated

marked moderate Moderate tomarked

Moderate tomarked

Glucosa decreased normal decreased Normal todecrease


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Material cough up from the throat and lung(compare to saliva)

Examined to diagnose infection in Upperrespiratory tract or lung.

Early morning Collected in a wide-mouth glass bottle


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Pleural cavity: between mesothelium ofvisceral and parietal pleuraNormal: small amount of fluidPlasma filtrate derived from capillaries ofthe parietal pleura, reabsorbed through thelympatics and venules of the visceral pleuraEffusion: accumulation of fluidSpecimen collection: ThoracentesisIn EDTA tube: cell counts & differential


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Transudates:increased capillary hydrostatic pressure ordecreased plasma oncotic pressureCongestive heart faillureHepatic cirrhosisHypoproteinemia

Exudates:Increase capillary permeability or decreasedlymphatic resorptionInfections: Tb, bacterial, viral pneumoniaNeoplasms: metastatic CaExtrapleural sources: pancreatitis, rupturedesophagus


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Transudates Exudates

Color Pale yellow tostrawTurbidity Clear Turbid/milky/

bloody

Odor - Fecalent:anaerobic inf

Clot - +


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Transudates Exudates

Cell counting < 1000/L > 1000/L

Differential count :Mesothelial cell

Neutrophilia (>50%)

Lymphocytosis (>50%)

Eosinophilic (>10%)

negative

10% case

30% case

Cong heartfailure, trauma

Tb, empiema,rheumatoid

Bacterial pneu,pancreatitis

Tb, viral inf,malignancy, SLE

parasitic/fungal inf,drug rx, rheumato


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Transudates ExudatesProtein 3.0 g/dLGlucose = serum < 60mg/dL :

purulentLDH PF/S 200 IU/LAmylase serum serum pH >7.4 >/


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Immunologic:1. Rheumatoid Factor2. ANA titers3. Complement levels

Microbiological:1. rams stain 2. Acid-fast stain3. culture


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Fluid in the jointcavities

Arthrocentesis Anticoagulant 3 tubes


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Arthrocentesis Steril, disposable needles and plastic

syringe Specimen:

1. EDTA: cell count & diff count2. Na-Heparinized : chemical & immunologic test

3. Plain: microbiologic test & crystal examination Oxalate, Li-heparin and EDTA avoided (?)


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Colorevaluated in a clear glass tube against awhite backgroundNormal: colorless to pale yellownoninflammatory/ inflammatory dis: strawto yellow (xanthochromia)Septic: yellow, brown, green


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ClarityRelated to the number and type of particleswithin synoviaNormal: transparentTranslucent: leukocytesOpaque: massive crystalsMilky opalescent: abundance of cholesterolcrystal


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Total Cell Count1 hour after arthrocentesisHemacytometer or automated cell counterIncubated with hyaluronidaseNormal:


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Differential CountNormal:

Neutrophils 20Lymphocytes 15

Monocytes & macrophages 65Eosinophilia 2Elevated:

Neutrophils: inflammatory, Gout & RALymphocytes: early RA, chronic infectionMonocytes: viral arthritisEosinophilia: RA, metastatic carcinoma, parasitic inf


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Crystal ExaminationGout: crystal deposition in articular tissue1. monosodium urate monohydrate (MSU)2. calcium pyrophosphate dihydrate

(CPPD)3. apatite4. basic calcium phosphate (BCP)Polarized light microscope

1. MSU: Gout, septic arthritis2. CPPD: degenerative arthritis, hypo-Mg,hemochromatosis


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Crystal ShapeMonosodium urate Needles

Ca pyrophosphate Rods

cholesterol Notched rhombicplates

apatite Small needles

coricosteroid Flat, variable shapeplates


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Mucin clot test: add acetic acidGlucose: Normal


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1. Immunologic studiesRheumatoid Factor (RF)Complement

2. Microbiological Examination rams stinZiehl-NeelsonCulture


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Infection of upper respiratory tract (birdflu)

Sterile swab sterile test tube ortransport medium


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PeritoneocentesisUltrafiltrate of plasmaPeritoneal effusion: ascitesNormal: 500/L, >50 neutrophilEosinophilia (>10 ): chronic inflammatory process


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Chemical AnalysisProtein: little valueLow glucose: TB peritonitis & malignancyElevated amylase: pancreatitis,gastrointestinal perforationElevated alkaline phosphatase: intestinalperforationElevated urea/ creatinine: ruptured bladder


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Normal: 10-50 mLProduced by transudative processEffusion: Inflammatory, malignant, hemorrhagicprocessesObtained: pericardiotomy, pericardiocentesis

Gross ExaminationNormal: pale yellow and clearInfection: turbid effusion

Uremia: clear & straw colored effusionChylous effusion: milky appearanceMicroscopic Examination

Leukocyte count:>10 000/L: bacterial, TB, malignant


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Chemical AnalysisProtein

>3.0g/dL: exudatesGlucose

0.6: exudates


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1. Clinical Diagnosis and Management byLaboratory Methods.Henry JB. 20 th ed.2001. WB Saunders co: PhiladelphiaLondon

2. Urinalysis and Body Fluid. Strasinger SK.2 nd ed.1989. F.A. Davis Co: Philadelphia

3. Basic Medical Laboratory Techniques.

Estridge BH, Reynolds AP, Walters NJ. 4th

ed. 2000. Delmar: Africa Australia


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Documents

2. SPECIMEN Collection Handling and Transport