Clinical Urinalysis and Body Fluids Review, part 1

1. Clinical Urinalysis and Body Fluids Review, part 1 Austin Community College Medical Laboratory Technology Clinical II Spring 09

2. Body Fluids other than urine • What general purposes do the body fluids serve? • Nutrition • Waste removal • Lubrication • Cushioning / protection

3. Body Fluids • Types • CSF • Serous (transudate versus exudate) • Peritoneal • Pleural • Pericardial • Synovial • Seminal • Amniotic • Sweat , gastric, feces, etc.

4. Body Fluids • Testing • Gross and hematological • Cell counts • Differential • Chemistry • TP • Glucose • Enzymes? • Amylase, Lipase and LDH • Microbiology – cultures • Serology? • Cytology ?

5. Body Fluids • CSF • Why evaluate?

6. Body Fluids • CSF • Why evaluate? • Diagnose meningitis • Evaluate for intracranial hemorrhage • Diagnose malignancies, leukemia • Investigate central nervous system disorders

7. Body Fluids • CSF • What normal term(s) are used to describe the color and clarity of CSF specimens? • Identify terms used for ‘abnormal’ colors and clarity. • What is that ‘special’ color term unique to CSF? • How do you differentiate between traumatic tap and cerebral hemorrhage?

8. Body Fluids • CSF • Reference ranges / normal or expected values

9. Body Fluids • What is the term used when there is increased numbers of cells in CSF? • Pleocytosis • Can be prefixed as • Neutrophilic pleocytosis • Lymphocytic pleocytosis, etc.

10. Body Fluids • Why evaluate serous and synovial? • To determine the reason for increased production • What’s the term that is used to indicate increased production of these fluids?

11. Body Fluids • What’s the term ? • Effusion – an increase in the serous fluid due to some disruption in production and/ re-absorption processes.

12. Seminal fluid • In what tissue are sperm produced? • Four reasons for analyzing seminal fluids

13. Seminal fluid In what tissue is sperm produced? Spermatozoa - produced in the testes, mature in the epididymis. Four reasons for analyzing seminal fluids Infertility issues Post- vasectomy Forensic analysis Sperm donors 13

14. Body Fluids other than Urine • What are the collection requirements? • Normal appearance? • Expected lab values? • Cell count • Motility • Morphology

15. Body Fluids other than Urine • What is the formula for calculating body fluid cells counted in a hemacytometer?

16. Body Fluids other than Urine What is the basic formula? What additional calculation is needed for sperm counts and why? 16

17. Body Fluids other than Urine What additional calculation is needed and why? the standard calculation provides results as per microliter (uL) And sperm normal value is per milliliter (mL) So you have to take the results and multiply X 1000. 17

18. Body Fluids other than Urine • What seminal fluid substances can be used for forensic and rape evaluations?

19. Body Fluids other than Urine What seminal fluid substances can be used for forensic and rape evaluations? Acid phosphatase enzyme DNA UV light ABO /HLA 19

20. Body Fluids other than Urine • Amniotic Fluid • Of what is it composed? • What is the name of the collection procedure? • What purpose does it serve? • Why is it sometimes analyzed?

21. Body Fluids other than Urine • Amniotic Fluid • Indications for analysis • Chromosomal abnormalities, such as Down’s syndrome • Metabolic disorders, such as Tay Sachs • Neural tube defects – such as spinal bifida or an encephalic • Determination of extent of HDN • Others - gestational age, fetal maturity, etc.

22. Body Fluids other than Urine • Why do we sometimes analyze sweat? • What is the name of that procedure? • What are normal values?

23. Body Fluids other than Urine • Why do we analyze gastric fluids? • How are the specimens collected? • What lab procedures are performed?

24. Body Fluids other than Urine • Indications for testing • Drug analysis • Peptic ulcer evaluation • Specimen collection • Nasal or oral intubation • Fasting and avoid swallowing saliva • Laboratory procedures • Gastric acidy (acid <7.0) • Peptic ulcers, diagnosis and treatment • Zollinger-Ellison Syndrome – tumor of pancreas causing gastric over-secretion • Decreased gastric secretion • Anacidity – inability to produce acid • Drug screening

25. Body Fluids other than Urine • Feces • What is it and why do we care? • What is the significance of different stool colors?

26. Body Fluids other than Urine • What test is performed as a screen for colorectal cancer?

27. Body Fluids other than Urine • What patient preparation is needed for this test to be most useful?

28. Body Fluids other than Urine • What other tests are done on fecal samples?

29. Cells of the Body Fluids • What cells can be found in body fluids? • Cells seen in the peripheral blood, but they sure don’t look so good in the BFs.

30. More often they look like these: Lymphocytes and monocytes Cerebrospinal Fluid (CSF) Cells of the Body Fluids (other than Urine)

31. Lymphocytes and eosinophils – CSF Patient had shunt Cells of the Body Fluids (other than Urine)

32. Lymphocytes, macrophages and basophil Cells of the Body Fluids

33. Other cells Ependymal cells - on left Mesothelial cells - on right Cells of the Body

34. Cells of the Body FluidsThen there are the inclusions, and the ‘new’ names

35. And the ‘other’ cells, ‘unclassified’ – those referred to the cytologist / pathologist. Cells of the Body Fluids

36. Intracellular inclusions: The yeast Cells of the Body Fluids

37. The yeast - Cryptococcus in CSF Cells of the Body Fluids

38. Bacteria Cells of the Body Fluids

39. For synovial fluid Crystals Calcium pyrophosphate Monosodium urate Cells of the Body Fluids

40. LE cells – Serous and Synovial Fluids

41. Clinical Urinalysis and Body Fluids Review, part 2 Austin Community College Medical Laboratory Technology Clinical II Spring 09

42. Chemical Exam of Urine

43. Chemical Exam of Urine

44. Chemical Exam of Urine Reagent strip manufactures Bayer Corporation- Diagnostics Division (formerly Ames) produces Multistix Boehringer-Mannheim Corporation which produces Chemstrip Behring Diagnostics which produces Rapignost

45. Chemical Exam of Urine Recall normal dipstick procedure What are sources of error?

46. Chemical Exam of Urine Sources of error (and preventions) Testing cold specimens would result in a slowing down of reactions; test specimens when fresh or bring them to RT before testing Inadequate mixing of specimen could result in false reduced or negative reactions to blood and leukocyte tests mix specimens well before dipping Over-dipping of reagent strip will result in leaching of reagents out of pads; briefly, but completely dip the reagent strip into the urine

47. Chemical Exam of Urine Inadequate blotting and Failure to keep strip horizontal will result in over-run or mixing of reagents between the different reaction pads; blot excess urine off the strip and keep strip horizontal. If dipping from the tube, can run the side of the strip along the rim to remove excess urine. Improper timing of tests over development of reagent pad colors leading to falsely increased results; follow manufacturer’s recommendations

48. Chemical Exam of Urine Inadequate light misinterpretation of results; use good lighting Mis-using color chart misinterpretation of results; hold strip just over color chart and match colors as close as possible, consider use of back-up tests, if needed, especially if urine’s color masks reaction colors.

49. Chemical Exam of Urine Handling and Storage Keep strips in original container, stored at RT Protect from moisture and volatile fumes Use before expiration date Do not touch reagent pad areas

50. Chemical Exam of Urine Quality Control - use appropriate, commercially prepared positive and negative controls. Use commercially prepared pos and neg controls, at least once per 24 hours, and anytime a new bottle is opened, or question of validity of results. Readings should agree with published results ± one color block.