Section 7 Flashcards
(172 cards)
1
Q
Describe random urine specimen
A
- use = routine urinalysis (UA)
- collection = anytime
- not ideal since urine may be dilute and contaminated
2
Q
Describe first morning urine specimen
A
- use = routine UA
- collection = upon waking
- best for screening
- most concentrated
3
Q
Describe 2 hour postprandial urine specimen
A
- use = diabetes mellitus monitoring
- collection = 2 hour after eating
- best for detecting glycosuria
4
Q
Describe 24 hour urine specimen
A
- use = quantitative chemical tests
- collection = discard 1st void on day 1 and note time
- collect uri ne for next 24 hours, including first void at same time on day 2
5
Q
Describe clean catch urine specimen?
A
- use = routine, culture
- collection = cleanse external genitalia and collect midstream in sterile container
- less contamination
- setup culture before UA
6
Q
Describe Catherized urine specimen
A
- use = culture
- collection = catheter inserted into urethra
- avoids contamination
7
Q
Describe suprapubic aspiration urine specimen
A
- use = culture
- collection = needle inserted through abdomen into bladder
- avoids contamination
8
Q
What is the normal daily volume of urine?
A
- 600-2000 mL
- average = 2:1 - 3:1
9
Q
What is diuresis?
A
- increased urine production
10
Q
What is polyuria?
A
- marked increased in urine flow
- adult: 2,500 mL/day
- children: 2.5-3 mL/kg/day
11
Q
What is oliguria?
A
- marked decreased in urine flow
- adult: <400 mL/day
- children: <0.5 mL/kg/hr
- infants: <1 mL/kg/hr
12
Q
What is anuria?
A
- no urine production
13
Q
What is the color of normal urine?
A
- yellow due to urochrome
14
Q
What is the color of dilute urine?
A
- colorless, pale yellow
15
Q
What is the color of concentrated urine?
A
- dark yellow, amber
16
Q
What is the color of bilirubin urine?
A
- amber, orange, yellow-green
- yellow foam when shaken
17
Q
What is the color of urobilin urine?
A
- amber, orange, no yellow foam upon shaking
18
Q
What is the color of homogenistic acid urine?
A
- normal on voiding; brown or black on standing
19
Q
What is the color of melanin urine?
A
- brown or black on standing
20
Q
What is the color of myoglobin urine?
A
- red; brown on standing
21
Q
What is the color of blood/hgb urine?
A
- pink or red when fresh
- brown on standing
22
Q
What is the color of methemoglobin urine?
A
- brown or black
23
Q
What is the color of drugs, medication, food?
A
- green, blue, red, orange
24
Q
What is the color of psuedomonas infection urine?
A
- green, blue-green
25
What is the change in turbidity at RT for more than 2 hours?
- increased
- caused by multiplication of bacteria, precipitation of amorphous crystals
26
What is the change of pH in urine sitting at RT for more than 2 hours?
- increased
- caused by conversion of urea to ammonia by bacteria
27
What is the change in glucose in urine sitting at RT for more than 2 hours?
- decreased
- caused by metabolism by bacteria
28
What is the change of ketones sitting at RT for more than 2 hours?
- decreased
- votalization of acetone, breakdown of acetoacetate by bacteria
29
What is the change bilirubin in urine sitting at RT for more than 2 hours?
- decreased
- oxidation to biliverdin
30
What is the change of urobilinogen in urine sitting at RT for more than 2 hours?
- decreased oxidation to urobilin
31
What is the change in WBCS/RBCS/casts in urine sitting at RT for more than 2 hours?
- decreased
- lysis in dilute or alkaline urine
32
Describe pH on reagent strip
- normal
— first AM = 5-6
— random = 4.5-8
- principle = double indicator system
- significance = acid-base balance, management or UTI/renal calculi
- acid with protein/meat diet; alkaline with vegetarian diet
- pH 9 indicates improperly preserved
33
Describe glucose of the reagent strip
- normal = NEG
- principle = glucose oxidase/ peroxidase
- significance = possible diabetes mellitus
- specific for glucose
- normal renal threshold = 160-180 mg/dL
34
Describe protein for the reagent strip
- normal = NEG to trace
- principle = protein error in indicator
- significance = possible renal disease
- buffered to pH 3
- most sensitive to albumin
- orthostatic protein is NEG in 1st AM and POS afterr standing
35
Describe the ketones of the reagent strip
- Normal = NEG
- principle = sodium nitroprusside rxn
- significance = increases fat metabolism (uncontrolled diabetes mellitus, vomiting, starvation, low carb diet, strenuous exercise)
- most sensitive to acetoacetic acid
- less sensitive to acetone
- doesn’t react with beta-hydroxybutric acid
36
Describe blood of the reagent strip
- normal = NEG
- principle = pseudoperoxidase activity of hgb
- significance = hematuria, hemoglobinuria, myoglobinuria
- uniform color = Hgb or myoglobin
- speckled = RBCs
37
Describe bilirubin of the reagent strip
- normal = NEG
- principle = Diazo reaction
- significance = liver disease, biliary obstruction
- only conjugated bilirubin is excreted in urine
38
Describe nitrite of the reagent strip
- normal = NEG
- principle = Greiss rxn
- significance = UTI
- some bacteria reduce nitrates to nitrites
- 1st am specimen best
- increased sensitivity urine i n bladder at least 4 hours
39
Describe Leukocyte esterase (LE) of the reagent strip
- normal = NEG
- principle = LE rxn
- significance = UTI
- longest rxn time (2 minutes)
- detects intact and lysed granulocytes and monocytes, not lymphocytes
- can be used with nitrite to screen urines for culture
40
Describe specific gravity of the reagent strip
- normal = 1.003-1.030
- principle = pKa change of polyelectrolyte
- significance = indication of kidneys concentrating ability and state of hydration
- increased in diabetes mellitus due to glucose
- decreased in diabetes insipidus due to decreased ADH
- only measures ionic solute
- not affected by urea, glucose, radiographic contrast media, plasma expanders
- not always same as SG by refractometer
41
Describe urobilinogen of the reagent strip
- normal = 1 Ehrlich unit or 1 mg/dL
- principle = Ehrlich aldehyde rxn or diazo rxn
- significance = liver disease, hemolytic disorders
- reagent strips don’t detect absence or urobilinogen, only increased
42
Discuss errors associated with failure to test within 2 hour of collection or to preserve correctly
- changes in chemical composition
43
Discuss error associated with failure to bring refrigerated specimens to RT before testing
- false-NEG enzymatic rxns
44
Discuss the error associated with failure to mix specimen well
- false-NEG leukocyte and RBC
- WBCs and RBCs settle out
45
Discuss the error associated with failure to perform QC
- erroneous results
- run POS and NEG control every 24 hours and when opening new container
46
Discuss the error associated with prolonged dipping of the reagent strip
- false-NEG rxn
- reagents may leach from pads
47
Discuss the error associated with failure to dip all test pads in urine
- false-NEG rxns
48
Discuss the error associated with failure to remove excess urine for strip
- remover of chemicals to adjacent pads, distortion of colors
49
Discuss the error associated with failure to read art recommended time
- erroneous results
50
Discuss error associated with highly pigmented urine
- atypical colors, false POS rxns
- pigment masks for true rxns
- test by alternate method
51
Discuss the error associated with failure to store strips properly
- erroneous results
- stored in capped original container at RT
52
What could cause an increase or false POS of pH on reagent srtrip
- improperly preserved specimen
53
What could cause a decrease or false NEG for pH?
- acid run over from protein square
54
What could cause an increase or false POS for protein?
- highly buffered alkaline urine, prolonged dipping, contaminated container, increase SG
55
What could cause a decrease or false NEG for protein
- proteins other than albumin
56
What could cause an increase or false POS for glucose?
- contamination with peroxide or bleach
57
What cool cause a decrease or false NEG for glucose?
- unreserved specimen
- increased ascorbic acid
- increased SG
- decreased temp
58
What could cause an increase or false POS for ketones?
- red pigments, dyes, some meds
59
What could cause a decrease or false NEG for ketones?
- improper storage
- acetone is volatile
- bacteria break down acetoacetic acid
60
What could cause an increase or false POS for blood in urine?
- menstruation
- oxidizing agents
- bacterial peroxidase
61
What could cause a decrease or false NEG for blood in urine?
- increased ascorbic acid
- increased nitrite
- increased SG (crenated RBCs)
- unmixed specimen
62
What could cause an increase or false POS of bilirubin in urine?
- highly pigmented urine
63
What could cause a decrease or false NEG for bilirubin in the urine?
- exposure to light
- increased ascorbic acid
- increased nitrite
64
What could cause an increase or false POS for urobilinogen in urine?
- highly pigmented urine
65
What could cause a decrease or false NEG for urobilinogen in urine?
- improperly preserved specimen (oxidation to urobilin), formalin
66
What could cause an increase or false POS for NItrite in urine?
- highly pigmented urine
- improperly preserved specimen (contaminating bacteria produce nitrites)
67
What could cause a decrease or false NEG for nitrite in urine?
- Non nitrate-reducing bacteria, inadequate time in bladder, reduction of nitrites to N2
- decreased dietary nitrate, antibiotics, increased ascorbic acid
- increased SG
68
What could cause a increase or false POS for Leukocytes esterase (LE)
- high pigmented urine
- oxidizing agents
- formalin
- nitrofurantion
- vaginal discharge
69
What could cause a decrease or false NEG for LE in urine?
- increased glucose
- increased protein
- increased ascorbic acid
- increased SG
- antibiotics
- reading too soon
70
What could cause a increase or false POS for Specific Gravity
- increased protein
71
What could cause a decrease or false NEG for Specific gravity?
- alkaline urine
72
Describe the microalbumin test for urine
- detects = albumin in low/moderate concentration
- method = immunoassay on on 24 hour urine or albumin-to-creatinine ratio (ACR) on random sample
- dipsticks available for ACR
- not detected by moe urine dipsticks
- 50-200 mg/24 hour or ACR >/= 2.8 for males and >/= 2.0 for females predictive of diabetic nephroparthy
- strict control of glucose and blood pressure can prevent progression to end-stage renal disease
73
Describe the icotest performed on urine
- detects bilirubin
- method is diazo reaction
- false POS: urine pigments
- false NEG: exposure to light, improperly stored specimen, increased ascorbic acid, and increased nitrite
- more sensitive then reagent strip
- less affected by interfering substances
74
What are the sediment stains for urine?
- Sternheimer-Malbin
- Oil Red O and Sudan III
- Hansel Stain
75
Describe Sternheimer-Malbin Stain
- action = delineates cell structure and contrasting colors of nucleus vs. cytoplasm
- function = ID WBC, epithelial cells, and casts
76
Describe Oil Red and Sudan III stain
- action = stains triglycerides and neutral fatal, cholesterol will not stain
- function = ID free fat droplets and lipid-containing cells or casts
77
Describe Hansel Stain
- action = methylene blue and eosin Y stain eosinophilic granules
- function = ID eosinophils in urine
78
Describe squamous epithelial cells found in urine
- 40-50 um, flat. Prominent round nucleus
- origin = lower urethra and vagina
- significance = usually none
- increased # usually seen in urine from females
- may obscure RBCs and WBCs
- reduced by collecting midstream clean catch specimen
79
Describe transitional epithelial cell
- 20-30 um. Spherical pear-shaped or polyhedral. Round central nucleus
- origin = renal pelvis, ureters, bladder, upper urethra
- significance = seldom
- may form synctia (clumps)
80
Describe the renal tubular epithelial cell in urine
- slightly larger than WBC (12 um). Round. Eccentric round nucleus
- origin = renal tubules
- significance = tubular necrosis, toxins, viral infections, renal rejection
- differentiate WBCs
81
Describe oval fat body in urine
- renal tubular epithelial cell containing fat droplets
- origin = renal tubules
- significance = tubular necrosis, toxins, viral infections, renal rejection
- Maltese cross with polarized light
82
Describe WBC in urine
- usually polys. About 12 um. Granular appearance
- origin = kidney, bladder, or urethra
- significance = cystitis, pyelonephritis, tumors, Renal calculi
- normal: 0-8/hpf
- clumps of WBCs is associated with acute infection
83
Describe glitter cells found in the urine
- WBC with Brownian movement of granules. Stain faintly or not at all
- origin = kidney, bladder, or urethra
- significance = cystitis, pyelonephritis, tumors, Renal calculi
- observed in hypotonic urine
84
Describe RBCs found in urine
- bioconcave disk, about 7 um. Smooth. Nonnucleated
- origin = kidney, bladder or urethra
- significance = infection, trauma, tumors, renal calculi. Dysmorphic RBCs indicate glomerular bleeding
- normal: 0-3/hpf
- crenate in hypertonic urine
- lyse in hypotonic urine and with 2% acetic acid
85
What are the normal crystals found in acid or neutral urine?
- Amophous urate
- uric acid
- calcium oxalate
86
Describe amorphous urate crystal found in urine
- irregular granules
- form pink precipitate in bottom of tube
- may obscure significant sediment
- dissolve by warming to 60C
87
Describe uric acid crystals found in urine
- pleomorphic. 4 sided, 6 sided, star-shaped, rosettes, spears, plates. Colorless, red-brown, or yellow
- birefringement
- polarizes light
88
Describe calcium oxalate crystals found in urine
- octahedral (8-sided) envelope form is most common. Also dumbbell and ovoid forms
- occasionally found in slightly alk urine
- monohydrate form may be mistaken for RBCs
- most common constituent of renal calculi
- from oxalate-rich foods
89
What are the normal crystals found in alkaline urine?
- amorphous phosphates
- triple phosphate
- ammonium biurate
- calcium phosphate
- calcium carbonate
90
Describe amorphous phosphatase crystals found in urine
- irregular granules
- form white precipitate in bottom of tube
- dissolve with 2% acetic acid
91
Describe triple phosphate crystals found in urine
= coffin-lid shaped
92
Describe ammonium biurate crystal found in urine
- yellow-brown “thorny-apples” and spheres
- seen in old specimens
93
Describe calcium phosphate crystal found in urine
- needles, rosettes, “pointing-finger”
- only needle form seen in alkaline urine
94
Describe calcium carbonate crystals found in urine
- colorless dumbbells or aggregates
95
What are abnormal crystals found in urine?
- leucine
- tyrosine
- cystine
- cholesterol
- bilirubin
96
Describe Leucine crystals found in urine
- yellow, oily-looking sphere. Radial and concentrics striations
- significance = severe liver disease
- often seen with tyrosine
97
Describe tyrosine crystals found in urine
- fine yellow needles in sheaves or rosettes
- severe liver disease
- often seen with leucine
98
Describe cystine crystals found in urine
- hexagonal (6-sided)
- significance = cystinuria
- must differentiate from uric acid
- does not Polarize light
99
Describe cholesterol crystals found in urine
- flat plates, notched out corners, “stair-steps”
- significance = nephrotic syndrome
- berefringent
100
Describe bilirubin crystals found in urine
- yellowish brown needles, plates, granules
- significance = liver disease
- chemical tests for bilirubin should be POS
101
Describe hyaline casts found in urine
- homogenous with parallel sides, rounded ends
- significance = Normal: 0-2/lpf. Increase with stress, fever, trauma, exercise, renal disease
- most common type
- least significant
- Tamm-Horsfall protein only
- dissolve in alkaline urine
- same refractive index as urine; may be overlooked with bright light
102
Describe granular casts found in urine
- Homogenous with parallel sides, rounded ends. Has granules
- significance = normal: 0-1/lpf. Increased with stress, exercise, glomerulonephritis, pyleonephritis
- from disintergration of cellularc casts
103
Describe RBC casts found in urine
- RBCs in cast martrix. Yellowish to orange color
- significance = acute glomerulonephritis, strenuous exercise
- IDs kidneys as source of bleeding
- most fragile cast
- often in fragments
104
Describe blood casts found in urine
- contain hgb. Yellowish-orange color
- significance - acute glomerulonephritis, strenuous exercise
- from disintegration of RBC casts
105
Describe WBC casts found in urine -
- WBCs in cast matrix. Irregular in shape
- significance = pyelonephritis
- IDs kidney as site of infection
106
Describe epithelial cell casts found in urine
- renal tubular epithelial cells in cast matrix
- significance = renal tubular damage
- transitional and squamous epithelial cell are not seen in casts
- distal to renal tubules and collecting ducts where casts are formed
107
Describe ways casts found in urine
- homogenous, opaque, notched edges, broken ends
- urinary stasis
- from degradation of cellular and granular casts
-unfavorable sign
108
Describe fatty cast found in urine
- casts containing lipid
- significance = nephrotic syndrome
- Maltese crosses with polarized light if lipid is cholesterol
- Sudan III and oil red O stain triglycerides and neutral fats
109
Describe broad casts found in urine -
- wide, may be cellular, granular, or waxy
- significance = advanced renal disease
- formed in dilated distal tubules and collecting ducts.
- “Renal failure casts”
110
Describe bacteria found in urine
- rods, cocci
- significance = UTI or contaminants
- if clinically significant, WBCs present (unless patient is neutropenia
111
Describe yeast found in urine
- 5-7 um, ovoid, colorless, smooth, refractile. May bud and form pseudohyphae
- significance = usually due to vaginal or fecal contamination. May be due to kidney infection. Often in urine of diabetic
- Add 2% acetic acid to differentiate from RBCs lyse; yeast don’t
- pseudohyphae indicate severe infection
- WBCs are present in true yeast infections
112
Describe sperm found in urine
- 4-6 um head, 40-60 um tail
- usually not significant in adult unless seen in child
113
Describe trichomonas found in urine
- resembles WBC. Flagella and undulating membrane. Rapid, jerky, nondirectional motility
- significance = parasitic infection of genital tract
- more common in females
- do not report unless motile
114
Describe mucus found in urine
- transparent long, thin, ribbon-like structure with tapering ends
- no significance
- may be mistaken for hyaline casts
115
What are the renal disorders?
- acute glomerulonephritis
- nephrotic syndrome
- pyelonephritis
- cystitis
- acute intestitial nephritis
- fanconi syndrome
116
Describe acute glomerulonephritis
- cause = inflammation and damage to glomeruli
- reagent strip = protein and blood POS
- sediment = RBCs (some dysmorphic), WBCs, hgb casts
- frequently follows untreated group A strep infection
117
Describe nephrotic syndrome -
- cause = increased glomerular permeability
- reagent strip = large amount of protein
- sediment = casts (all kinds), free fat and oval fat bodies
- hypoproteinemia, hyperlipidemia
118
Describe pyelonephritis
- Cause = kidney infection
- reagent strip = protein, LE, nitrite POS
- sediment = WBCs, WBC casts, RBC casts, no bacteria
119
Describe fanconi syndrome
- cause = failure of trouble reabsorption, can bone hereditary or exposure to drugs, multiple myeloma
- reagent strip = glucose and protein POS, low pH
- normal plasma glucose
120
Describe cystitis
- cause = bladder infection
- reagent strip = LE, nitrite POS
- sediment = WBCs, bacteria, possibly RBCs. No casts
121
Describe acute intestinal nephritis
- cause = allergic reaction to medication
- reagent strip = LE, blood, protein POS
- sediment = WBCs, WBC casts, RBC casts, no bacteria
- frequently presents with rash
122
Describe correlartion between pH and microscopic of UA
- check pH when ID crystals
- RBCs, WBCs, and casts lyse at alkaline pH
123
Describe the correlation between pH, nitrite, LE, and microscopic of UA-
- with bacterial UTI, usually have POS nitrite, POS LE
- check for bacteria and WBCs
- bacteria converts urea to ammonia
- increased pH
124
Describe the correlation between protein and microscopic UA
- protein may indicate renal disease
- check for casts
125
Describe the correlation between protein, blood and microscopic UA
- large amounts of blood and myoglobin an cause POS protein
- checks for RBCs
- present with hematuria, not with hemoglobinuria or myoglobinuria
126
Describe the correlation between protein and SG
- increased SG can cause false POS trace protein
- trace protein more significant in dilute urine
127
Describe the correlation between glucose and ketones of UA
- ketones present with uncontrolled diabetes mellitus
128
Describe correlation between glucose and microscopic of UA-
- yeast thrives in increased glucose
- WBCs should be present if true yeast infection
129
Describe correlation between glucose, protein and microscopic of UA
- renal disease is common complication of diabetes Mellitus
- check for casts
130
Describe correlation of blood and microscopic of UA
- POS blood, no RBCs rxn could be due to hgb or myoglobin, or false POS due to bacterial peroxidase
— check for bacteria
- NEG blood, RBCs seen: could be false-NEG blood due to increased ascorbic acid
— yeast or monhydrate calcium oxalate crystals could be mis-ID as RBCs
131
Describe the correlation between bilirubin and urobilinogen of UA
- liver disease: bili POS or NEG, urobili increased
- biliary obstructions: bili POS, urobili normal
- hemolytic disorder: bili NEG, urobili increased
132
Describe the correlation between LE and microscopic of UA
- can have POS LE without WBC (WBCs lysed)
- can have POS LE WBCs without bacteria (trichomonas)
133
Describe the correlation between Nitrite, LE, and microscopic of UA
- with POS nitrite, usually have POS LE, WBCs, and bacteria
- can have POS LE, WBCs, bacteria and NEG nitrite (non-nitrate-reducing bacteria)
134
Describe the correlation between SG and microscopic of UA
- RBCs and WBCs lyse in dilute urine
- with increased SG, RBCs and WBCs may crenate, cause false NEG blood and LE
135
Describe the color of CSF
- normal = colorless
- abnormalities
—xanthochromia = slight pink, orange, or yellow due to oxyhemoglobin or bilirubin. Seen with subarachnoid hemorrhage
— traumatic tap = red or pink, decreasing from 1-3
- examine within 1 hour of collection to avoid false POS from lysis of RBCs
- centrifuge and examine against white background
136
Describe clarity of CSF
- Normal = clear
- abnormalties = cloudy with infection or bleeding
137
Describe WBCs of CSF -
- normal
— adult: 0-5/uL
— newborn: 0-30/uL
- abnormalities = increase in meningitis
- cells begin to lyse within 1 hour-
- perform cell count within 30 minutes of collection
- traditionally performed in hemacytometer, following lysis of RBCs with # glacial acetic acid
- can be performed on automated analyzers of sufficient sensitivity
- differential on stained smear following concentration (cytocentrifugation)
138
Describe RBCs of CSF
- normal = 0
- abnormalties = increased with subarachnoid hemorrhage, traumatic tap
- limited diagnostic value
139
Describe glucose found in CSF
- 60-70% of blood glucose
- decreased in bacterial meningitis
- blood glucose method
140
Describe protien found in CSF
- Normal = 15-45 mg/dL
- abnormalties = increased meningitis and with traumatic tap
- biuret method not sensitive enough, use alternative method
141
Describe cells found in CSF
- normal = WBCs, monos, ependymal cells, choroid plexus cells
- abnormalities = siderophages with subarachnoid hemorrhage. Blast with leukemia
- nRBCs may be seen due to bone marrow contamination.
- cartilage cells may be seen `
142
What are the expected results for a patients with bacterial meningitis?
- increased WBC, protein, and lactate
- decreased = glucose
- differential = neutrophils
- other= POS gram stain, bacterial antigen
143
What are the expected results of a patient with viral meningitis?
- increased = WBC, and protein
- normal = glucose and lactate
- differential = lymphs
-
144
What are the expected results of a patient with mycobacteria meningitis?
- increased = WBCs, protein, and lactate
- decreased = glucose
- differential = lymphs and mons
- weblike clot or pellicle
145
What are the expected results for patient with fungal meningitis
- increased = WBCS, protein, and lactate
- normal or decreased = glucose
- POS India ink and/or cryptococcus neoformans antigen tests
146
What is effusion?
- abnormal accumulation of fluid in body cavity
- classified as transduate or exudate
147
What is serous fluid?
- fluid contained in pericardial, peritoneal, and pleural cavities
148
What is pericardial fluid?
- fluid surrounding the heart
149
What is peritonea fluid? -
Fluid in abnominal cavity
150
What is pleural fluid?
- fluid surrounding lungs
151
What is synovial fluid?
- fluid in joints
152
What are the characteristics of transudate?
- etiology - systemic disorder affecting fluid filtration and reabsorption (congestive heart failure, hypoalbuminemiam, cirrhosis); problem orginating outside body cavity
- noninflammtory process
- colorless
- clear
- SG is <1.015
- <3 g/dL protein
- fluid to serum protein ratio = <0.5
- glucose = equal to serum level
- does not spontaneously clot
- LD = <60% of serum
- WBC = 1,000/uL
- differential = mostly mononuclear
153
What are the characteristics of exudates?
- etiology = condtion involving membranes within body cavity (infection, malignancy, inflammation, hemorrhage
- inflammatory process
- color = yellow, brown, red, green
- clarity = cloudy
- SG is >1.015
- >3 g/dL protein
- fluid to serum protein ratio = >0.5
- glucose = 30 mg or more than serum level
- spontaneously clots
- LD = >60%
- >1,000/uL
- mostly neutrophils
154
Describe characteristics of normal synovial fluid
- color = pale yellow to colorless
- clarity
- clear
- good viscosity
- <200 WBCs
- <25% polys
155
Describe the characteristics of a noninflammatory synovial fluid
- etiology = degenerative joint disease
- yellow
- clear
- good viscosity
- <2,000 WBCs
- <30% polys
156
describe the characteristics of inflammatory synovial fluid
- etiology = RA, SLE, gout, pseudogout
- yellow
- cloudy, turid
- poor viscosity
- 2,000-100,000 WBCs
- >50% polys
157
describe characteristics of infectious synovial fluids
- etiology = bacterial infection
- yellow-green
- cloudy, turbid
- poor viscosity
- 50,000-200,000 WBCs
- >90% polys
- POS culture (S. aureus, N. gonorrhea most common)
158
describe the characteristics of crystal induced synovial fluid -
- etiology = gout, pseudogout
- yellow, white
- cloudy, milky
- poor viscosity
- 500-200,000 WBC
- <90% polys
- crystals present
159
describe the characteristics of a hemorrhagic synovial fluid
- etiology = trauma, coagulation abnormality
- pink, red, red-brown
- cloudy
- poor viscosity
- 50-10,000 WBCs
- <50% polys
160
what are crystals found in synovial fluid?
- monosodium urate (MSU)
- calcium pyrophosphate
- cholesterol
161
describe monosodium urate (MSU() found in synovial fluid -=
- 1-30 u long needles
- intra or extracellular (strongly birefringent)
- yellow when long axis of crystals is paralleled to slow wave of red compensator; blue when perpendicular
- significance = gout
162
describe calcium pyrophosphate crystal found in synovial fluid
- 1-20 um long, 4 um wide
- rod-shaped, rectangular or rhomboid
- intracellular
- weakly birefringent
- blue when long axis of crystal is parallel to slow wave of red compensator; yellow when perpendicular
- significance = pseudogout
163
describe cholesterol crystal found in synovial fluid
- large rectangule witrh notched-out corner
- extracellular
- significance = extracellular
164
describe fertility testing on semen
- collection = collect in sterile container, without condom, after 3-day abstinence. keep at RT. Deliver to lab within 1 hour of collection
- liquefaction = dont analyze until specimen is liquified (normally within 30 minute of collection
- normal volume = 2-5 mL
- motility = observe within 3 hours of collection. 50-60% of sperm should show at least fair motility
- cell count = dilute and count in Neubauer hemacytometer. Normal: >20 million per mL
- morphology = stain and examine at least 200 cells. Normal: oval head with long tapering tails
— abnormalties = double heads, giant heads, amorphous heads, pinheads, tapering heads, constricted heads, double tails, coiled tails, large #of spermatoid (immature form)
— normal
165
describe post-vasectomy semen analysis
- specimen collection = condom can be used. time and temp nor critical. test monthly beggining 2 months after vasectomy. continue until 2 consecutive specimens are without sperm
- liquefaction = dont analyze until specimen is liquified
- cell count = examine undiluted and following centrifugation. even 1 sperm is significant
166
what are the tests for amniotic fluid?
- L/S ratio
- PG
- Shake test
- lamellar body count
- amniotic fluid bilirubin
- AFP
167
describe the Lecithin-to-sphingomyelin (LS) ratio test
assessment/diagnosis = fetal lung maturity
- method = thin layer chromatography
- reference method
- L/S ratio >/= 2.0 signifies maturity
- false increase with blood or meconium contamination
168
describe phosphatidyglycerol (PG) test
- assessment/diagnosis = fetal lung maturity
- method = immunologic agglutination
- last surfactant to rise
- not affected by presence of blood or meconium
169
describe foam stability index (shake test)
-
assessment/diagnosis = fetal lung maturity
- method = shake with increasing amounts of 95% ethanol
- index is highest concentrartion of ethanal that supports rings of foam after shaking
- indx of 0.48 is comparable to L/S ratio of 2.0
- blood and meconium
170
Describe lamellar body count test-
- assessment/diagnosis = fetal lung maturity
- method = count in platelet channel of hematology analyzers
- # of correlates with amount of phospholipid present in fetal lungs
- sample must be free of blood or meconium
171
describe amniotic fluid bilirubin test
- assessment/diagnosis = hemolytic disease of the newborn/fetus
- method = direct spectrophotometric scan from 365-550 nm
- bilirubin has peak absorbance at 450 nm
- specimen must be protected from light
- blood and meconium interfere
172
describe alpha-fetoprotein (AFP)
- assessment/diagnosis = neural tube defects
- method = immunologic method
- high levels with anencephaly, spina bifida,
- ultrasound needed to confirm
