Reviewers

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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