urianalysis & body fluids exam

Which department would tube 1 of CSF collection go to if there are THREE tubes collected?

Chemistry and serology

Which department would tube 2 of CSF collection go to if there are THREE tubes collected?

Microbiology

Which department would tube 3 of CSF collection go to if there are THREE tubes collected?

Hematology

Which department would tube 1 of CSF collection go to first if there is ONE tube collected?

Microbiology (to avoid contamination)

What tests can be used to diagnose multiple sclerosis?

CSF IgG Index >0.70, CSF protein electrophoresis and Myelin Basic Protein

What disorder is indicated by the presence of oligoclonal bands present in CSF but absent in serum?

Multiple Sclerosis, >90 patients have these bands

What disorder is indicated by the presence of oligoclonal bands present in CSF and serum?

Lymphoproliferative conditions

Reference range for CSF Glucose

Reference for total protein

Reference range for WBC

What type of WBCs are present in bacterial meningitis?

Mainly Neutrophils

What type of WBCs are present in viral meningitis?

lymphocytes

What type of WBCs are present in fungal or tubercular meningitis?

lymphocytes and monocytes

What are some characteristics of a traumatic tap?

No xanthochromia, clotting present, negative CSF D-dimer, heavy blood in tube 1 only, no erythrocytes/siderophages/macrophages, colorless supernatant

What type of analytical error is patient misidentification, transcription errors and inability to identify interfering substances?

post analytical error

Collection and transportation issues are considered what type of analytical error?

Pre-analytical error

Test analysis issues are considered what type of analytical error?

Analytical error

Reporting issues are considered what type of analytical error?

Post analytical error

Why do the kidneys form urine?

As an ultrafiltrate of plasma

What does urine consist of?

95% water and 5% solutes

Creatinine and uric acid are examples of what type of substance?

Organic substance

What 3 elements are inorganic substances of urea?

chloride, sodium and potassium

What is oliguria?

decreased urine output

What is anuria?

no urine production

What is nocturia?

excessive urination at night

What is polyuria?

excessive urination

What can oliguria be associated with?

dehydration due to vomiting, diarrhea, sweating or burns

What can polyuria be associated with?

diabetes inspidus and mellitus

What can anuria be associated with?

serious kidney damage or reduced renal blood flow

What medical condition is associated with polydipsia, polyuria and DECREASED specific gravity?

diabetes inspidus

What medical condition is associated with polydipsia, polyuria and INCREASED specific gravity?

diabetes mellitus

What is occurring during diabetes insipidus?

ADH is not functioning properly as it is not telling kidneys to reabsorb water, leading to very dilute urine

In which condition can you most commonly observe rice bodies?

Rheumatoid arthritis

What does it mean if a crystal has a strong birefringence under direct microscopy?

bright against a dark background

What does it mean if a crystal has a weak birefringence under direct microscopy?

dim against a dark background

What does is mean if a crystal has positive birefringence under compensated microscopy?

Blue color when parallel

What does is mean if a crystal has negative birefringence under compensated microscopy?

Yellow when parallel

Describe monosodium urates and their significance

Needle like crystals that are seen in gout (purine metabolism), negative strong birefringence, yellow when parallel

What P-SF glucose difference is considered normal?

< 10 mg/dL

What P-SF glucose difference is considered non-inflammatory/hemorrhagic?

<20 mg/dL

What P-SF glucose difference signifies an inflammatory joint disorder?

>20 mg/dL

What P-SF glucose difference signifies a septic joint disorder?

>40 mg/dL

What color of synovial fluid may indicate a non-inflammatory/inflammatory disorder?

Yellow

What color of synovial fluid may indicate a septic joint disorder?

yellow-green

What color of synovial fluid may indicate a hemorrhagic disorder?

red-brown

Describe calcium pyrophosphate crystals and their significance

Short stubby rods seen in pseudo-gout, weak birefringence and blue when parallel

What is used in the ropes (mucin clot) test?

Synovial fluid added to 2-5% acetic acid, normal will form a clot surrounded by clear fluid (means high viscosity)

what can an abnormal result in the ropes test look like and what does it indicate?

theres decreased viscosity, which can indicate inflammatory, septic and hemorrhagic joint disorders

What is the purpose of a peritoneal lavage and how is it performed?

saline is injected into the peritoneal cavity and an RBC count is performed, detects early intra-abdominal bleeding from more than 100,000 RBCs/uL

Thoracentesis

pleural cavity (lung)

Pericardiocentesis

heart cavity

Paracentesis

peritoneal cavity (stomach)

In serous fluids, what type of results would a transudate effusion show?

Clear, everything decreased, <500 WBCs

In serous fluids, what type of results would an exudate effusion show?

Cloudy, >30 g/L fluid TP, >500 WBCs, >0.5 fluid:serum ratio, >0.67 fluid LD and ratio

What are the conditions seen in transudate effusions?

increasing hydrostatic pressure and decreasing oncotic pressure

What are the conditions seen in exudate effusions?

increase capillary permeability and cause lymphatic obstruction

What are some characteristics of chylous effusion?

lymphatic obstruction/duct leakage, mostly lymphs, absent cholesterol crystals, chylomicrons present

What are some characteristics of pseudochylous effusion?

chronic inflammatory disorders, mixed cells, cholesterol crystals present, no chylomicrons

Where is the volume of amniotic fluid derived from in the 1ST trimester?

maternal circulation

Where is the volume of amniotic fluid derived from AFTER 1ST trimester?

fetal urine production

Where is the volume of amniotic fluid derived from in the 3RD trimester?

fetus secretes lung liquid

How do we differentiate material urine from amniotic fluid?

amniotic fluid has LESS creatine and urea and MORE glucose and protein

If change in A450 is in zone 3 of Liley graph, what test would we do next?

assess fetal lung maturity, fetus severely affected and intervention required

In the tests for neural tube defects, we would start with the ____ test. If positive, we would follow up with the ___ test.

1. Alpha-1 fetoprotein (AFP)

2. Acetylcholinesterase (AChE) confirmatory**

What is the purpose of the LS (Lecithin:Spingomyelin) ratio? How can it be interpreted?

used to assess fetal lung maturity AFTER 35 weeks, ratio >2.0, premature delivery is safe

If the first portion of ejaculate is missing, what values will be affected?

Concentration DECREASED, pH INCREASED

If last portion of ejaculate is missing, which values are affected?

Volume and pH DECREASED, Concentration INCREASED

Concentration reference range in semen

>20 million

Motility reference range for semen

>50% within an hour

Volume reference range for semen

2-5 mL

Viability reference range for semen

50% living semen

What should a scientist look for in a post vasectomy analysis and should it be reported?

Looking for sperm and should be reported if found.

When should a seminal fructose level be conducted?

decreased sperm concentration, low fructose levels

Which test should be conducted when there is a normal concentration but DECREASED motility?

Eosin-negrosin stain

What test should be conducted when decreased sperm motility with clumping is present?

male antisperm antibodies

What test should be conducted when analysis is normal but there is infertility?

female antisperm antibodies

Which structure contributes the largest volume of seminal fluid?

seminal vesicles

What are the (3) fecal OCCULT blood tests?

Guaiac, immunochemical and porphyrin

What does the Guaiac occult blood test look for?

upper and lower GI bleeding

What does the immunochemical occult blood test look for?

Lower GI bleeding

what does the porphyrin occult blood test look for?

upper GI bleeding

What does a red fecal sample indicate about site of infection?

lower GI bleed

What does a black fecal sample indicate about site of infection?

upper GI bleed

What does a green fecal sample indicate about site of infection?

choleastasis

What sample is required for a quantitative fecal test?

3 day (72 hours)

What are the causes of steatorrhea?

Maldigestion (pancreatic enzyme and bile deficiency) and malabsorption (intestinal disease)

How should a urine specimen be handled?

If stored at room temp, delivered and tested within 2 hours

How should a urine specimen be handled if it has been refrigerated?

Refrigerated for up to 24 hours, and returned to room temperature before testing

What is important to know about the refrigeration of urine specimens?

Refrigeration can cause amorphous urate and phosphate crystals

What are the acid preservatives used for?

urine culture tubes, preventing bacterial growth

What is the sodium fluoride preservative used for?

drug tests, inhibits reagent strip glucose, blood and leukocytes

What are commercial preservative tablets used for?

when you cannot refrigerate, has controlled concentration

What is the LIGHT GRAY top tune used for?

contains boric acid, useful for bacterial cultures, stable at room temp for 48 hours

What is the yellow UA plus tube used for?

automation, must refrigerate within 2 hours due to no preservatives

What is the cherry red/yellow preservative tube used for?

automation, stable for 72 hours at room temperature

What is a random specimen?

most common received in lab, collected at any time but time must be recorded, used in routine screening

What may affect results from random urine sample?

diet and physical activity

what is the first morning specimen?

most concentrated specimen, prevents false negative pregnancy tests

What is a catheterized specimen?

a specimen collected under sterile conditions by passing catheter through urethra into bladder

What is a midstream clean catch specimen?

safe, less traumatic method, less contaminated than random specimen and is performed by patient