HARR 7.5 Urinalysis and Body Fluids Problem Solving

Given the following dry reagent strip urinalysis results, select the most appropriate course of action: pH = 8.0 Protein = 1+ Glucose = Neg Blood = Neg Ketone = Neg Nitrite = Neg Bilirubin = Neg

A. Report the results, assuming acceptable quality control

B. Check pH with a pH meter before reporting

C. Perform a turbidimetric protein test and report instead of the dipstick protein

D. Request a new specimen

C. Perform a turbidimetric protein test and report instead of the dipstick protein

Given the following urinalysis results, select the most appropriate course of action: pH = 8.0 Protein = Trace Glucose = Neg Ketone = Small Blood = Neg Nitrite = Neg Microscopic findings: RBCs = 0-2/HPF WBCs = 20-50/HPF Bacteria = Large Crystals = Small, CaCO3

A. Call for a new specimen because urine was contaminated in vitro

B. Recheck pH because calcium carbonate (CaCO3) does not occur at alkaline pH

C. No indication of error is present; results indicate a UTI

D. Report all results except bacteria because the nitrite test was negative

C. No indication of error is present; results indicate a UTI

SITUATION: A 6-mL pediatric urine sample is processed for routine urinalysis in the usual manner. The sediment is prepared by centrifuging all of the urine remaining after performing the biochemical tests. The following results are obtained: SG = 1.015 Protein = 2+ Blood = Large RBCs: 5-10/HPF WBCs: 5-10/HPF Select the most appropriate course of action.

A. Report these results; blood and protein correlate with microscopic results B. Report biochemical results only; request a new sample for the microscopic examination

C. Request a new sample and report as quantity not sufficient (QNS)

D. Recentrifuge the supernatant and repeat the microscopic examination

B. Report biochemical results only; request a new sample for the microscopic examination

Given the following urinalysis results, select the most appropriate course of action: pH = 6.5 Protein = Neg Glucose = Neg Ketone = Trace Blood = Neg Bilirubin = Neg Microscopic findings: Mucus = Small Ammonium urate = Large

A. Recheck urine pH

B. Report these results, assuming acceptable quality control

C. Repeat the dry reagent strip tests to confirm the ketone result

D. Request a new sample and repeat the urinalysis

A. Recheck urine pH

Given the following urinalysis results, select the most appropriate course of action: pH = 6.0 Protein = Neg Glucose = Neg Ketone = Neg Blood = Neg Bilirubin = Neg Other findings: Color: Amber Transparency: Microscopic: Crystals Clear Bilirubin granules = Small

A. Perform a tablet test for bilirubin before reporting

B. Request a new sample

C. Recheck the pH

D. Perform a test for urinary urobilinogen

A. Perform a tablet test for bilirubin before reporting

A biochemical profile gives the following results: Creatinine = 1.4 mg/dL BUN = 35 mg/dL K = 5.5 mmol/L All other results are normal and all tests are in control. Urine from the patient has an osmolality of 975 mOsm/kg. Select the most appropriate course of action.

A. Check for hemolysis

B. Repeat the BUN and report only if normal

C. Repeat the serum creatinine and report only if elevated

D. Report these results

D. Report these results

A 2 p.m. urinalysis has a trace glucose by the dry reagent strip test. A fasting blood glucose drawn 8 hours earlier is 100 mg/dL. No other results are abnormal. Select the most appropriate course of action.

A. Repeat the urine glucose and report if positive

B. Perform a test for reducing sugars and report the result

C. Perform a quantitative urine glucose; report as trace if greater than 100 mg/dL

D. Request a new urine specimen

A. Repeat the urine glucose and report if positive

Following a transfusion reaction, urine from a patient gives positive tests for blood and protein. The SG is 1.015. No RBCs or WBCs are seen in the microscopic examination. These results:

A. Indicate renal injury induced by transfusion reaction

B. Support the finding of an extravascular transfusion reaction

C. Support the finding of an intravascular transfusion reaction

D. Rule out a transfusion reaction caused by RBC incompatibility

C. Support the finding of an intravascular transfusion reaction

A urine sample taken after a suspected transfusion reaction has a positive test for blood, but intact RBCs are not seen on microscopic examination. Which one test result would rule out an intravascular hemolytic transfusion reaction?

A. Negative urine urobilinogen

B. Serum unconjugated bilirubin below 1.0 mg/dL

C. Serum potassium below 6.0 mmol/L

D. Normal plasma haptoglobin

D. Normal plasma haptoglobin

Given the following urinalysis results, select the most appropriate course of action: pH = 5.0 Protein = Neg Glucose = 1,000 mg/dL Blood = Neg Bilirubin = Neg Ketone = Moderate SSA protein = 1+

A. Report the SSA protein result instead of the dry reagent strip result

B. Call for a list of medications administered to the patient

C. Perform a quantitative urinary albumin

D. Perform a test for microalbuminuria

B. Call for a list of medications administered to the patient

Urinalysis results from a 35-year-old woman are: SG = 1.015 pH = 7.5 Protein = Trace Glucose = Small Ketone = Neg Blood = Neg Leukocytes = Moderate Microscopic findings: RBCs: 5-10/HPF WBCs: 25-50/HPF Select the most appropriate course of action.

A. Recheck the blood reaction; if negative, look for budding yeast

B. Repeat the WBC count

C. Report all results except blood

D. Request a list of medications

A. Recheck the blood reaction; if negative, look for budding yeast

A routine urinalysis gives the following results: pH =6.5 Protein = Neg Blood = Neg Glucose= Trace Ketone = Neg Microscopic findings: Blood casts: Mucus: Crystals: 5-10/LFP Small Large, Amorphous These results are most likely explained by:

A. False-negative blood reaction

B. False-negative protein reaction

C. Pseudocasts of urate mistaken for true casts

D. Mucus mistaken for casts

C. Pseudocasts of urate mistaken for true casts

SITUATION: When examining a urinary sediment under 400× magnification, the technologist noted many red blood cells to have cytoplasmic blebs and an irregular distribution of the hemoglobin. This phenomenon is most often caused by:

A. Intravascular hemolytic anemia

B. Glomerular disease

C. Hypotonic or alkaline urine

D. Severe dehydration

B. Glomerular disease

SITUATION: A urine specimen is dark orange and turns brown after storage in the refrigerator overnight. The technologist requests a new specimen. The second specimen is bright orange and is tested immediately. Which test result would differ between the two specimens?

A. Ketone

B. Leukocyte esterase

C. Urobilinogen

D. Nitrite

C. Urobilinogen

A patient's random urine consistently contains a trace of protein but no casts, cells, or other biochemical abnormality. The first voided morning sample is consistently negative for protein. These findings can be explained by:

A. Normal diurnal variation in protein loss

B. Early glomerulonephritis

C. Orthostatic or postural albuminuria

D. Microalbuminuria

C. Orthostatic or postural albuminuria

A urine sample with a pH of 8.0 and a specific gravity of 1.005 had a small positive blood reaction, but is negative for protein and no RBCs are present in the microscopic examination of urinary sediment. What best explains these findings?

A. High pH and low SG caused a false-positive blood reaction

B. The blood reaction and protein reaction are discrepant

C. Hemoglobin is present without intact RBCs due to hemolysis

D. An error was made in the microscopic examination

C. Hemoglobin is present without intact RBCs due to hemolysis

A urine sample has a negative blood reaction and 5-10 cells per high-power field that resemble red blood cells. What is the best course of action?

A. Mix a drop of sediment with 1 drop of WBC counting fluid and reexamine

B. Report the results without further testing

C. Repeat the blood test and if negative report the results

D. If the leukocyte esterase test is positive, report the cells as WBCs

A. Mix a drop of sediment with 1 drop of WBC counting fluid and reexamine

A pleural fluid submitted to the laboratory is milky in appearance. Which test would be most useful in differentiating between a chylous and pseudochylous effusion?

A. Fluid to serum triglyceride ratio

B. Fluid WBC count

C. Fluid total protein

D. Fluid to serum LD ratio

A. Fluid to serum triglyceride ratio

A cerebrospinal fluid sample from an 8-year-old child with a fever of unknown origin was tested for glucose, total protein, lactate, and IgG index. The glucose was 180 mg/dL but all other results were within the reference range. The CSF WBC count was 9 × 106/L and the RBC count was 10 × 106/L. The differential showed 50% lymphocytes, 35% monocytes, 10% macrophages, 3% neutrophils, and 2% neuroectodermal cells. What is the most likely cause of these results?

A. Aseptic meningitis

B. Traumatic tap

C. Subarachnoid hemorrhage

D. Hyperglycemia

D. Hyperglycemia

A WBC count and differential performed on ascites fluid gave a WBC count of 20,000μL with 90% macrophages. The gross appearance of the fluid was described by the technologist as "thick and bloody." It was noted on the report that several clusters of these cells were observed and that the majority of the cells contained many vacuoles resembling paper-punch holes. What do the observations above suggest?

A. Malignant mesothelial cells were counted as macrophages

B. Adenocarcinoma from a metastatic site

C. Lymphoma infiltrating the peritoneal cavity

D. Nodular sclerosing type Hodgkin's disease

A. Malignant mesothelial cells were counted as macrophages

Given the following data for creatinine clearance, select the most appropriate course of action. Volume = 2.8 L/day; surface area = 1.73 m2; urine creatinine = 100 mg/dL; serum creatinine = 1.2 mg/dL

A. Report a creatinine clearance of 162 mL/min

B. Repeat the urine creatinine; results point to a dilution error

C. Request a new 24-hour urine sample

D. Request the patient's age and sex

C. Request a new 24-hour urine sample

An elevated amylase is obtained on a stat serum collected at 8 p.m. An amylase performed at 8 a.m. that morning was within normal limits. The technologist also noted that a urine amylase was measured at 6 p.m. Select the most appropriate course of action.

A. Repeat the stat amylase; report only if within normal limits

B. Repeat both the a.m. and p.m. serum amylase and report only if they agree

C. Request a new specimen; do not report results of the stat sample

D. Review the amylase result on the 6 p.m. urine sample; if elevated, report the stat amylase

D. Review the amylase result on the 6 p.m. urine sample; if elevated, report the stat amylase

Results of a fetal lung maturity (FLM) study from a patient with diabetes mellitus are as follows: L/S ratio = 2.0; Phosphatidyl glycerol = Pos; Creatinine = 2.5 mg/dL Given these results, the technologist should:

A. Report the result and recommend repeating the L/S ratio in 24 hours

B. Perform scanning spectrophotometry on the fluid to determine if blood is present

C. Repeat the L/S ratio after 4 hours and report those results

D. Report results as invalid

A. Report the result and recommend repeating the L/S ratio in 24 hours

A 24-hour urine sample from an adult submitted for catecholamines gives a result of 140 μg/day (upper reference limit 150 μg/day). The 24-hour urine creatinine level is 0.6 g/day. Select the best course of action.

A. Check the urine pH to verify that it is less than 2.0

B. Report the result in μg catecholamines per mg creatinine

C. Request a new 24-hour urine sample

D. Measure the VMA and report the catecholamine result only if elevated

C. Request a new 24-hour urine sample

A 5-hour urinary D-xylose test on a 7-year-old boy who was given 0.5 g of D-xylose per pound is 15%. The 2-hour timed blood D-xylose is 15 mg/dL (lower reference limit 30 mg/dL). Select the most appropriate action.

A. Request that a β carotene absorption test be performed

B. Repeat the urinary result because it is borderline

C. Request a retest using a 25-g dose of D-xylose

D. Request a retest using only a 1-hour timed blood sample

D. Request a retest using only a 1-hour timed blood sample

A quantitative serum hCG is ordered on a male patient. The technologist should:

A. Perform the test and report the result

B. Request that the order be cancelled

C. Perform the test and report the result if negative

D. Perform the test and report the result only if greater than 25 IU/L

A. Perform the test and report the result

SITUATION: A lamellar body count (LBC) was performed on an amniotic fluid sample that was slightly pink in color within 1 hour of specimen collection. The sample was stored at 4°C prior to analysis. The result was 25,000/μL, classified as intermediate risk of respiratory distress syndrome. The physician waited 24 hours and collected a new sample that was counted within 2 hours of collection on the same instrument. The LCB count of the new sample was 14,000/ μL and the patient was reclassified as high risk. Which statement best explains these results?

A. Loss of lamellar bodies occurred in the second sample because of storage

B. Blood caused a falsely elevated result for the first sample

C. The fetal status changed in 24 hours owing to respiratory illness

D. The difference in counts is the result of day-to-day physiological and instrument variance

B. Blood caused a falsely elevated result for the first sample

When testing for drugs of abuse in urine, which of the following test results indicate dilution and would be cause for rejecting the sample?

A. Temperature upon sample submission 92°F

B. Specific gravity 1.002; Creatinine 15 mg/dL,

C. pH 5.8; temperature 94°C

D. Specific gravity 1.012, creatinine 25 mg/dL

B. Specific gravity 1.002; Creatinine 15 mg/dL,

SITUATION: A urine specimen has a specific gravity of 1.025 and is strongly positive for nitrite. All other dry reagent strip test results are normal, and the microscopic exam was unremarkable, showing no WBCs or bacteria. The urine sample was submitted as part of a preemployment physical exam that also includes drug testing. Which most likely caused these results?

A. A viral infection of the kidney

B. A urinary tract infection in an immunosuppressed person

C. An adulterated urine specimen

D. Error in reading the nitrite pad caused by poor reflectometer calibration

C. An adulterated urine specimen

A CSF sample submitted for cell counts has a visible clot. What is the best course of action?

A. Count RBCs and WBCs manually after diluting the fluid with normal saline

B. Tease the cells out of the clot before counting, then dilute with WBC counting fluid

C. Request a new sample

D. Perform a WBC count without correction

C. Request a new sample

Total hemolytic complement and glucose are ordered on a synovial fluid sample that is too viscous to pipet. What is the best course of action?

A. Dilute the sample in saline

B. Add 1 mg/mL hyaluronidase to the sample and incubate at room temperature for 30 minutes

C. Warm the sample to 65°C for 10 minutes

D. Request a new specimen

B. Add 1 mg/mL hyaluronidase to the sample and incubate at room temperature for 30 minutes

A CSF CytoPrep smear shows many smudge cells and macrophages with torn cell membranes. What most likely caused this problem?

A. Failure to add albumin to the cytospin cup

B. Failure to collect the CSF in EDTA

C. Centrifuge speed too low

D. Improper alignment

A. Failure to add albumin to the cytospin cup

An automated electronic blood cell counter was used to count RBCs and WBCs in a turbid pleural fluid sample. The WBC count was 5 × 1010/L (50,000/μL) and the RBC count was 5.5 × 1010/L (55,000/ μL). What is the significance of the RBC count?

A. The RBC count is not significant and should be reported as 5,000/μL

B. The RBC count should be reported as determined by the analyzer

C. A manual RBC count should be performed

D. A manual RBC and WBC count should be performed and reported instead

A. The RBC count is not significant and should be reported as 5,000/μL

A sperm motility test was performed and 200 sperm were evaluated in each of two

duplicates. The first sample showed progressive movement in 50% and nonprogressive

movement in 35%, and 15% were immotile. The second showed progressive movement

in 35% and nonprogressive movement in 35%, and 30% were immotile. What is the

best course of action?

A. Report the average of the two values for progressive movement

B. Report the higher of the two values

C. Repeat the motility test

D. Call for a new specimen

D

A toluidine blue chamber count on CSF gives the following values:

CSF Counts Peripheral Blood Counts

WBCs 10 × 106/L WBCs 5 × 109/L

RBCs 1,000 × 106/L RBCs 5 × 1012/L

After correcting the WBC count in CSF, the MLS should next:

A. Report the WBC count as 9 × 106/L without additional testing

B. Report the WBC count and number of PMNs identified by the chamber count

C. Perform a differential on a direct smear of the CSF

D. Concentrate CSF using a cytocentrifuge and perform a differential

D

A blood-tainted pleural fluid is submitted for culture. Which test result would be most

conclusive in classifying the fluid as an exudate?

Test Result

A. LD fluid/serum 0.65

B. Total protein 3.2 g/dL

C. RBC count 10,000/µL

D. WBC count 1500/µL

A