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1

Where are the 2 places to obtain blood for hematology?

1. Periferal blood via venipuncture. 2. Bone marrow via bone marrow aspiration.

2

Bone marrow is aka?

Myeloid, myelogenous or intramedullary tissue.

3

What is the most common type of hematologic test?

Complete blood count CBC.

4

In a CBC which cells are biggest and smallest?

Biggest---> smallest; WBC, RBC, HGB, HCT, MCV, MCH, MCHC, RDW, Platelets.

5

List WBC from largest to smallest?

Neutrophils, Band, Lymphocytes, Monocytes, Eosinophils, Basophils.

6

What is hematopoiesis?

The formation and development of all types of blood cells from their parental precursors.

7

Where will a fetus's hematopoiesis happen at?

Starts with yolk sack then moves to liver and spleen, then axial skeleton.

8

Where will an adult's hematopoiesis happen at?

For the first few decades in the distal long bones and axial skeleton, and then later in life mainly the axial skeleton.

9

What is erythropoiesis?

Production of RBC and it is a type of hematopoiesis.

10

What will the cytoplasm color be like from beginning to the end of erythropoiesis?

It will start blue and eventually turn to orange.

11

During erythropoiesis it starts with a stem cell---> progenitor cell ----> ?

Rubriblast.

12

1 Rubriblast will eventually make how many RBC?

Many.

13

How long will erythropoiesis take?

5-6 days for bone marrow development.

14

What is the nucleus like during erythropoiesis?

It is present at the beginning and will disappear after 2-3 days.

15

What is the name of the first cell during erythropoiesis that will not have a nucleus?

Reticulocyte.

16

What part of erythropoiesis will cells enter the circulating blood?

Very promptly, even before the last maturational events have occurred as reticulocytes.

17

How long will a RBC last in circulation and what will happen to it?

120 days, senescence and destruction.

18

What is the last stage of RBC maturation that occurs after the nucleus is extruded in the bone marrow?

Reticulocyte.

19

Why are reticulocytes slightly larger than Mature RBC?

Because they are still maturing and contain residual fragments of cytoplasmic RNA and mitochondria.

20

Why will reticulocytes have a different color than mature RBC's and what is the color?

Polychromatic from fragments of mitochondria.

21

When will reticulocytes finish maturing?

1-2 days after entering the peripheral circulation.

22

What % of circulating Red cells are reticulocytes?

0.5-2.5 %.

23

What are reticulocytes counts commonly used for?

Diagnosis of various anemia and in monitoring the recovery in factor deficiency anemias.

24

Will a CBC have a reticulocyte count?

No.

25

Where will erythropoietin be made at?

Peritubular interstitial cells of the kidenys.

26

When will erythropoietin be made?

With blood loss the kidneys sense a loss of O2 and make EPO. This can also happen with chronic obstructive pulmonary disease since O2 levels will be low.

27

What will EPO do?

Increases the number of stem cells that commit to rubriblasts, and speeds up the maturation time by 20-30%. EPO also allows for early release of immature cells into peripheral circulation.

28

Where is hemoglobin synthesized at?

Within the maturing nucleated red cell within the bone marrow via a series of biochemical enzymatically driven reactions intimately involving the mitochondria.

29

How is heme produced?

when iron is enzymatically inserted into protoporphyrin.

30

How is globin produced?

Polyribosomes produce globin chains in pairs (alpha, gamma, beta, delta).

31

Each globin chain provides what?

a site for insertion of one heme molecule.

32

What will go into making 1 hemoglobin?

four globin chains (2 pairs) and four heme molecules.

33

How can different types of hemoglobin be made?

Various combinations of pairings of globin chains produce different types of hemoglobin.

34

What type of hemoglobin will fetuses make?

F= 2 alpha, 2 gamma globulins.

35

What type of hemoglobin will infants make?

95-97% is A1- 2 alpha, 2 beta globulins. And 2-3% will be A2- 2 alpha, 2 delta globulins.

36

What test can be done to determine what types of hemoglobin are present?

Hemoglobin electrophoresis.

37

How will iron be transported in the body?

By transferrin.

38

Iron is essential for what?

Erythropoiesis.

39

What % of dietary iron is absorbed and where?

10% is absorbed via proximal small intestine.

40

What happens to dietary iron not absorbed?

Excreted in feces, and small amounts in urine.

41

Where will transferrin take iron once in the plasma, and what will the iron do in these places?

Bone marrow- hemoglobin synthesis. Muscles- myoglobin synthesis. Liver- storage.

42

Name 4 tests that reflect the status of iron metabolism?

1. Serum iron concentration (SI). 2. Total iron binding capacity (TIBC). 3. % saturation of iron (% sat or TSAT). 4. Serum ferritin concentration.

43

What is the serum iron concentration (SI) test?

the concentration of circulating iron that is bound to transferrin.

44

Is SI a good test for iron metabloism why or why not?

No there are physiological causes of altered concentrations.

45

What is total iron binding capacity (TIBC)?

An indirect assay of transferrin concentration performed by measuring the amount of iron (added in vitro) needed to totally saturate the unbound iron-binding sites on the transferrin molecules.

46

Normally how many of the transferrin binding sites are bound with iron?

only 1/3.

47

TIBC should not be ordered as what type of test?

An individual test it should be ordered in combination with the SI.

48

% saturation of iron test?

Calculated value estimating the % of binding sites on transferrin that are bound with iron.

49

What is needed to measure the % saturation of iron test?

SI and TIBC.

50

% saturation of iron test is much more sensitive indicator of what?

Iron deficiency or iron overload than is SI.

51

How is iron stored in the body?

Ferritin is the body's major iron storage compound.

52

Where is ferritin found at?

In nearly every cell, but the major sites of storage are hepatocytes, spleen, and bone marrow.

53

Each ferritin molecule contains how much iron?

as many as 4,000 iron molecules.

54

Ferritin that is in circulation is in direct proportion to what?

The amount of ferritin stored in the tissues.

55

OF all the tests what is the gold standard to evaluate iron storage?

Serum ferritin.

56

What type(s) of test(s) should be done to investigate iron related abnormalities?

SI< TIBC, % sat, and serum ferritin.

57

Name 3 groups of white blood cells?

Granulocytes, lymphocytes, and monocytes.

58

What are granulocytes?

Maturation of leukocytes that contain granules so they are Neurtophils, eosinophils and basophils.

59

Production and maturation of granulocytes is under what influence?

Humoral growth factors.

60

What is the difference between erythropoisis and granulopoiesis?

With granulopoiesis stem cells commit, differentiate and accumulate into different compartments or pools both within and outside of the bone marrow.

61

Where will granulocytes pool?

about 50% are available mature granulocytes circulating.

62

What else besides humoral growth factors can influence leukocyte production?

Chemical mediators (cytokines and chemokines) released during inflammatory and immune reactions.

63

Granulocytes have how long of a life span and are in circulation how long?

They live for 9-15 days and are in circulation 7-24 hours.

64

What is a band neutrophil?

An immature form of neutrophil which is observed both within and outside of the bone marrow.

65

What is a PMN?

a mature neurtophil.

66

What is shift to the left?

Any increase in numbers of immature neurotphils in peripheral circulation.

67

Shift to the left is indicative of what?

acute infection or other cause of neutrophila.

68

What is lymphopoiesis?

Growth and maturation of lymphocytes.

69

Where will lymphocytes mature at?

within bone marrow and is mediated by a poorly understood control mechanism.

70

What do lymphocytes do in circulation?

repopulate lymph nodes and lymphatic tissue.

71

Lymphocytes are conditioned by what?

Thymus- T-lymphocytes. Bone marrow- B lymphocytes.

72

T-lymphocytes and B-lymphocytes are for what?

T- cellular immunity. B- humoral immunity.

73

What are atypical lymphocytes?

Abnormal appearing T-lymphocytes usually observed in peripheral blood of an immunologically stimulated patient, most often viral infections.

74

Atypical lymphocytes are classically seen with what and are aka?

Mononucleosis and may be known as Downey cells or reactive lymphocytes.

75

What is the name of WBC when they are elevated and decreased?

Elevated; neutrophilia, lymphocytosis, moncytosis, eosinophilia, basophilia. Decreased; neutropenia, lymphocytopenia, moncytopenia, eosinopenia, basopenia.

76

What can cause neutophilia?

physical or emotional stress, acute suppurative infeciton, myelocytic leukemia, inflammatory disorders.

77

What can cause lymphocytosis?

Chronic bacterial infections, viral infections, lymphocytic leukemias.

78

What can cause moncytosis?

Chronic inflammatory disorders, tuberculosis.

79

What can cause eosinophilia?

Parsitic infections, allergic reactions, hodgkin lymphoma.

80

What can cause basophilia?

Myeloproliferative diseases.

81

What can cause neutropenia?

dietary deficiencies (B12 and folate), some overwhelming bacterial infections, viral infections, radiation and chemotherapy.

82

What can casue lymphocytopenia?

Immunodeficiency diseases, radiation therapy.

83

What can cause moncytopenia?

Very uncommon.

84

What can cause eosinopenia?

Very uncommon.

85

What can cause basopenia?

Very uncommon.

86

Is platelet count part of the CBC?

Yes.

87

What is megakaryopoiesis?

Production of thrombocytes (platelets).

88

Maturation and growth of thrombocytes is influenced by what?

Thrombopoietin TPO, megakaryocyte growth and development factor MGDF, and same cytokines and chemokines as granulocytes.

89

Name 3 tests to evaluate hematopoeiesis?

CBC, reticulocyte count, bone marrow aspiration and biopsy.

90

Are there any special times of collection or patient preparation needed for a CBC?

No.

91

What is a RBC count?

Absolute quantification of RBCs in a unit volume of blood.

92

What are the units for conventional and international for a red blood count?

Conventional- mm^3. International- L

93

How often is a Red blood cell count used alone?

Not often not even to determine if a blood transfusion is needed.

94

What is the most widely used single test used to evaluate a patient for anemia?

Hemoglobin concentration.

95

What is a hemoglobin concentration test testing?

Direct measurment of the weight of hemoglobin in a unit volume of blood.

96

What are the conventional and international units used for hemoglobin concentration tests?

Conventional- gm/dL. International- gm/L

97

What is the hematocrit test testing?

The ratio of the volume of the RBCs after centrifugation to that of whole blood.

98

Hematocrit is aka?

crit, and packed cell volume PCV.

99

What are the conventional and international units used for the hematocrit test?

Conv- %. Internat- L/L

100

How can the PCV aka hematocrit(HCT) aka crit approximate the hemoglobin (HGB)?

Divide the HCT by 3.

101

What are the RBC, HGB, HCT tests used to determine?

Anemia, erythrocytosis, and polycythemia.

102

What are the 3 types of polycythemia and what are they?

Polycythemia vera- myeloproliferative disorder. Secondary polycythemia- hypoxia= not getting enough oxygen. Relative polycythemia- dehydration.

103

Name the RBC indicies?

mean corpuscular volume MCV, Mean corpuscluar hemoglobin MCH, Mean corpuscular hemoglobin concentration MCHC.

104

What is MCV?

Measure of the intracellular volume of the average circulating RBC. So this is the size of the average circulating RBC.

105

What are the units used for MCV?

fenta Liter.

106

Name 3 types of anemias?

microcytic, macrocytic, normocytic.

107

What will the MCV test be like for the 3 types of anemia?

Microcytic- decreased MCV. Macrocytic- Increased MCV. Normocytic- normal MCV.

108

What is the MCH used for?

Measure of the weight of hemoglobin within the average circulating RBC. It will relate to the intensity of the coloration of the RBCs when stained.

109

What are the types of MCH?

Hypochromic, normochromic, hyperchromic

110

Of the 3 types of MCH which one is very uncommon?

Hyperchromic.

111

What is the MCHC?

% of the intracellular volume of the average circulating RBC that is hemoglobin. This is essentially the same info as the MCH.

112

What are the clinical applications of RBC indicies?

To determine what type of anemia is present.

113

What type of anemia is present with decreased RBC, HGB, HCT and decreased MCV, MCH, MCHC?

microcytic and hypochromic anemia (iron deficiency).

114

What would the blood tests be like for macrocytic anemia and how is this caused?

decreased RBC, HGB, HCT and increased MCV, normal MCH and normal MCHC. This is caused by B12 and folate deficiencies.

115

What would the blood tests be like for normocytic anemia and how is this caused?

Decreased RBC, HGB, HCT and normal RBC indicies and this is caused by chronic illness.

116

What is the Red cell distribution width RDW test?

index of RBC size difference or the variability in RBC size populations.

117

what type of variation in RBC is normal?

Minimal.

118

Increased RDW correlates with what?

increased anisocytosis- variability in cell size populations done by a person looking through a microscope.

119

When will a decreased RDW be given?

It wont only increased variation.

120

What tests will be used to define the presence or absence of anemia?

RBC count, Hemoglobin concentration HGB, hematocrit HCT.

121

What tests wil help to initially categorize the type of anemia?

MCV, MCH, MCHC aka the RBC indicies.

122

What is the RDW test used for clinically?

as an early sign of developing anemia.

123

What type of stain is used to look at a blood smear?

Wright.

124

Can machines report morphological variations in RBC?

Yes with limited capability.

125

What is polychromatophilia, poikilocytosis?

Polychromatophilia a RBC that is a little bluer. Poikilocytosis is abnormal shapes of RBC.

126

How will the lab report poikilocytosis?

They shape should be given like teardrop, sickle, etc.

127

When doing a vena puncture what vein should you never try to shift the needle to the side if you did not draw blood?

Bascilic vein.

128

What should you do if you are drawing blood and you notice a mound is starting to build under the skin?

Finish the blood draw and then add lots of pressure after to avoid brusing.

129

What are the different ways the lab will report microcytes?

Few microcytes, slight microcytes, and a scale of 1-4+ microcytes.

130

What is anioscytosis?

Variable size of RBC.

131

What test will be increased with anisocytosis?

RDW.

132

What test will be increased with macrocytosis?

MCV.

133

What test will be decreased with microcytosis?

MCV

134

What test will be decreased with hypochromia?

MCH and or MCHC.

135

What is a WBC count?

The absolute quantification of the total number of circulating WBC.

136

What are the conventional and international units for the WBC count?

Convent- mm^3. Intern- L.

137

What info is important about WBC's?

The proportion of each, not the total leukocyte count.

138

What are the 2 types of WBC differential counts and how are they done?

Relative- performed by microscopic evaluation, and counting 100 WBC. Absolute- more accurate and is done by modern hematology instuments.

139

How can absolute differential be calculated if only relative WBC differential count is given?

Relative % X total WBC = absolute count.

140

What would the diagnosis be given; WBC- 3.5 x10^3/ mm^3 (reference 4-11 x 10^3/ mm^3), neutrophils- 30% (reference 50-70% or 4.7x10^3), lymphocytes 70% (reference 20-40% 2.4x10^3).

Neutropenia.

141

What will the RBC morphology tests help to determine?

Correlates with changes in indices and RDW, may provide specific evidence of certain hematologic abnormalities.

142

WBC Count is used to determine what?

Leukopenia or leukocytosis.

143

What is the WBC differential count used for?

Provides more specific info about underlying pathology causing altered WBC count.

144

What type of test is a platelet count?

Absolute quantification of the number of circulating thrombocytes and this test is considered a hemostatic test.

145

What is the correlation of platlet function and platelet count?

There is none.

146

What are the conventional units and international units for the platelet count?

Convet- mm^3. Inter- L

147

Spontaneous bleeding can occur at what platelet count?

40-50 X 10^3/mm^3.

148

How serious is gaining platelets?

Not very the serious part is droping down.

149

What is the reference range for normal platelet count?

150-450.

150

What is the mean platelet volume (MPV)?

This calculates the internal volume of the average circulating platelet, therefore it is the size of the average platelet.

151

What may correlate with an abnormal MPV?

Autoimmune disorders and some hematologic malignancies.

152

Will the MPV be inculded in the CBC?

Maybe but many labs do not report the MPV.

153

Is a reticulocyte count part of a CBC, and what is a reiculocyte count used for?

No. This is used to determine if the bone marrow is responding to therapy in factor deficiency anemias such as iron, folate, and vitamin B12 deficiencies.

154

How is a reticulocyte count calculated?

Count 1000 RBC and determine the # of them that are reticulocytes. Take the total amount of reticulocytes and multiply this by 100 and then divide by 1000.

155

What is essential for redering a definitive diagnosis about reticulocyte count?

Aspiration and biopsy of marrow. This would be needed for lymphoproliferative disorders such as leukemia and others.

156

How is aspirated marrow studied?

Histologicaly and cytochemically by a MD clinical pathologist.

157

What happens to Hemoglobin when RBC undergo senescence?

Heme is converted to unconjugated-bilirubin in the blood, and globin will go to the AA pool to be recyled.

158

What happens to unconjugated-bilirubin?

It is transferred to the liver and then it is converted to conjugated-bilirubin.

159

What are the paths that conjugated-bilirubin can take?

Leave the liver as bile or become part of urine and be excreted (however there is only the smallest of amounts of conjugated-bilirubin in urine).

160

What happens to bile as it leaves the liver?

It is concentrated in the gallbladder and then gets converted to urobilinogen in the intestines.

161

What are the options for urogilinogen?

It can be converted to stercobilin and be excreted in the feces. It can be recycled into the liver. It can be sent to the kidney and excreted in urine (urobilinogen is the major part of urine that comes from heme).

162

What part of the heme is converted into unconjugated-bilirubin?

The porphyrin component.

163

How is unconjugated-bilirubin transported to the liver?

By the protein albumin.

164

How will the RBC count be different for pediatrics?

It will be high 0-1 months after birth and then be low 2months-1year.

165

how will the Hematocrit be different for pediatrics?

High for the first 2 months and then low until 1 year old.

166

How will the hemoglobin be different for pediatrics?

High for the first 2 months and then low until 1 year old.

167

How will the MCV be different for pediatrics?

High for the first 6 months and then low until 1 year.

168

How will the white cell count be different for pediatrics?

High for the first 4 years.

169

How will the neutrophils be different for pediatrics?

High for the first 3 months and then normal.

170

How will the lymphocytes be different for pediatrics?

normal from 0-1 month and then high until 4 years.

171

Urinalysis is a poor mans ____.

Renal biopsy.

172

What does it mean that the importance of a urinalysis is often undersold?

It will lead to mistakes especially regarding collection and handling which can lead to errors.

173

What is the pH of glomerular filtrate vs urine?

GF-7.4. Urine- 6.0.

174

What is the difference in specific gravity of glomerular filtrate vs urine?

GF- 1.005. Urine- 1.020.

175

How much glomerular filtrate is produced a day?

180 Liters.

176

How much urine is produced a day?

1-2 liters.

177

What is anuria?

No urine output.

178

What is oliguria?

Less than 500 ml of urine produced a day.

179

What is nocturia?

more than 500 ml of urine produced a night this is not nocturnal frequency.

180

What is nocturnal frequency?

Waking up often to pee and this will not be more than 500 ml of urine all together at night unless there is also a nocturia.

181

What is polyuria?

More than 2 liters a urine produced a day.

182

Who will create more urine volume an adult or child per kilogram of body weight?

Children by 3-4 times as much.

183

How often should one urinate?

should be around 2 hours inbetween.

184

What is urgency and dysuria?

Urgency- instantly needing to pee. Dysuria- painful urination.

185

Will urine odor be performed in labs?

No.

186

What is the normal description of urine odor?

Faintly aromatic.

187

Name 5 things that can cause abnormal urine odors?

vitamins, drugs, foods (like asparagus), bacterial contamination, metabolic disorders (like diabetics).

188

What is CCMS?

Clean catch midstream specimen.

189

What is the first step in a CCMS?

Wash hands with soap and water.

190

What is the second step in a CCMS?

Clean urinary opening with a towlelette 3 times for females and once for males.

191

When is the best time to take a urine sample?

First thing in the morning due to most concentrated and bladder incubated.

192

What type of urine sample is most often taken?

Random specimen.

193

Name three things that a 24 hour urinary collection might be needed for?

protein, calcium, and hormone and their metabolites.

194

How long between sample and test should there be for urine?

within 1 hour, or refrigerate or add a perservative.

195

What is used to test urine and what are the results like?

Reagent strip and results are semi-quantitative at best.

196

Name 10 things that can be determined by using a reagent strip testing urine?

pH, specific gravity, protein, glucose, ketones, urobilinogen, bilirubin, leukocyte esterase, nitrate, blood (hemoglobin).

197

With capillary tubes what is the difference between blue and red tipped?

Blue- no preservative. Red- has heparin to keep blood from clotting.

198

What is the normal color of urine?

colorless to amber yellow.

199

Dark yellow urine can be caused by what?

Concentrated urine or bilirubin which can come from dehydration or hepatobiliary.

200

What can cause red urine?

Blood, hemoglobin, food dyes, beets.

201

What can cause brown urine?

Acid hematin bilirubin.

202

What can cause green urine?

Pseudomonas from a urinary tract infection.

203

Anything that makes urine hazy will come from ______.

formed elements.

204

What things will be seen with urinary infections?

back pain, cloudy urine from hematuria, inability to urinate, frequent urinate or painful urination, malaise (general discomfort).

205

What is the normal pH of urine?

4-8 pH.

206

What 3 things can cause an acidic urine?

Western diet, ketosis, systemic acidosis.

207

What are 4 things that can cause an alkaline urine?

vegetarian/ vegan or diet high in citrus fruits, postparandial specimen (alkaline tide- kidneys getting rid of the extra bicarbonate from the pancrease after a meal.), stale unrefrigerated specimen, urinary tract infection.

208

What is the specific gravity of urine used to evaluate?

the concentration and excretory power of the kidneys.

209

How is a true kidney funciton test done?

water depravation for 16 hours prior to testing since it is easily altered by consumption.

210

When would a urine sample be more concentrated?

With decreased fluid intake, first morning specimen, with other solutes like with diabetics increased glucose, ketones and proteins.

211

When would a urine sample be dilute?

Increased fluid intake, random specimens, renal disease.

212

What is the normal amount of protein in urine?

None.

213

What would protiens in the urine help us diagnose?

Protein in the urine is the easiest and earliest way to find a kidney disease.

214

What is the most common and significant protein that is found in urine?

Albumin.

215

What are the 2 types of proteinuria?

Functional and organic.

216

What is a functional proteinuria?

Benign. Associated with fever, exposure to extremes of heat or cold, excessive exercise, or emotional stress. It tends to be a minimal amount of protein lost.

217

What is organic proteinuria?

Proteinuria associated with demonstrabale systemic disease or renal damage and most often resulting in more than 500 mg/day.

218

What are the 3 areas of origin for protein being lost?

pre-renal, renal, post-renal.

219

What would a trace, or 1+ measure of protein in urine likely mean?

Functional problem not organic.

220

What are the 3 categories of quantity of protein lost per day?

minmal- less than .5 gm/24 hours. Moderate- 0.5-4.0 gm/ 24 hour. Marked- more than 4.0 gm/24 hours.

221

What will likely cause the minimal protein loss in urine?

exercise, stress, postural/ orthostatic, pregnancy, early effects of kidney disfunction, lower UTI.

222

What will likely cause the moderate protein loss in urine?

chronic glomerlonephritis, pyelonephritis, diabetic nephropathy, mutliple myeloma, pre-eclampsia.

223

What will likely cause the marked protein loss in urine?

Acute and chronic glomerulonephritis, diabetic nephropathy, nephrotic syndrome and nephrosis, lupus nephritis.

224

What is the normal amount of glucose in the urine?

none.

225

What are the 2 types of glucosuria?

With hyperglycemia and without hyperglycemia.

226

What can cause glucosuria with hyperglycemia?

DM, cushings syndrome, thyrotoxicosis (hyperthyroidism), exocrine pancreatic disease, drugs.

227

What can cause glucosuria without hyperglycemia?

Renal tubular disease, late (normal) pregnancy.

228

What is the normal amount of ketones aka ketone bodies in the urine?

none.

229

What are the 3 types of ketones and where do they come from?

acetoacetic acid, acetone, betahydroxybutyric acid. They are byproducts of fatty acid catabolism which is often due to impaired glucose metabolism.

230

Name 5 things that can cause ketonuria?

Inadequate carbohydrates in the diet, malnutrition, defect in carbohydrate metabolism, DM, Defect in carbohydrate absorption.

231

What are the normal amounts of bilirubin and urobilinogen in the urine?

Bilirubin- none. Urobilinogen- 0.1-1 ehrlich unit.

232

What 2 things will cause bilirubinuria?

Intrahepatic obstructive disorder and extrahepatic obstructive disorder.

233

What is the type of bilirubin that can be excreted by the kidneys?

Conjugated bilirubin.

234

Since urobilinogen is found in urine what can make the levels go up or down?

Up- hemolytic diseases, hepatic diseases. Down- Biliary obstruction.

235

What is leukocyte esterase and what are the normal urine levels?

White blood cells in urine and there is normaly none found in urine.

236

Reagent strip turns positive in the presence of what for leukocyte esterase?

WBC's either lysed or intact.

237

Leukocyte esterase is a sensitive test for what?

UTI.

238

What can give a false positive for leukocyte esterase tests?

vaginal contamination, conditions causing heavy mucus discharge and irritation.

239

What is pyuria and what causes it?

Pyuria is white blood cells/ pus in urine and it is caused by 3 things; 1. Inflammation within the urinary tract. 2. Infection within the urinary tract. 3. Sterile pyuria.

240

What are the catagories for things that cause sterile pyuria?

Infective and non-infective.

241

What would be under the infective and non-infective sterile pyuria?

infective- virus, fungi, atypical organims. Non-infective- systemic and localized diseases, structural and physiologicla abnormalities, drugs, recent antibiotic use.

242

What is the normal amount of nitrite in urine?

none.

243

What will cause nitrite in the urine?

Dietary urinary nitrAte is reduced to nitrite by many urinary tract pathogens.

244

Can there be urinary pathogens without nitrite in the urine?

Yes because they require adequate time for incubation.

245

How powerful is the nitrite test of urine?

Very specific indicator of UTI, but lacks sensitivity.

246

What will blood in the urine mean?

RBC's only.

247

How much blood should be in the urine?

none.

248

What is the difference between hemoglobinuria vs. hematuria?

hemoglobinuria- presence of hemoglobin in the urine coming from the circulation. Hematuria- presence of RBC's in the urine which are leaking into the urinary tract.

249

What can or cant be seen of a microscopic examinatino of the urine sediments when blood is in the urine?

No RBC's can be seen.

250

Can the terms hemoglobinuria and hematuria be interchanged?

No, but they often are.

251

What will the presence of blood in the urine require?

Always warrents investigation into the site and cause of the bleeding.

252

Where are casts formed at?

Only in the kidneys.

253

What can cause hematuria with casts and proteinuria?

Kidney based; acute or chronic glomerulonephritis, rheumatoid disease.

254

What can cause hematuria without casts?

may or may not be kidney involvment. Vigorous exercise, urinary tract trauma, Lower urinary tract infection, hypertension, bleeding disorders, kidney stones, kidney tumors.

255

How will EDTA and Hepparin prevent coagulation?

EDTA- binds Ca2+. Hepparin- binds thrombin.

256

What can the presence of ascorbic acid do to a urinalysis?

Reduce positive or false negatives for blood, glucose, nitrite and bilirubin.

257

What is the normal amount of RBC's seen in High power field (HPF)?

0-4 per HPF.

258

What can often be mistaken for RBC's while doing a microscopic evaluation of urine crystals?

yeaste.

259

What is the normal amount of WBC's seen while doing a microscopic evaluation of urine?

0-4 per hpf.

260

What will the significance be of WBC's clumping together?

It will increase the probability that problems are coming from the kidney or bladder.

261

What are the 3 types of epithelial cells found in microscopic analysis of urine? What is the normal amount seen?

Squamous, transitional- and renal. The normal amounts for all 3 are occasional per lpf.

262

Where are squamous epithelial cells derived from in the urine?

Distal urethra and female vulva.

263

What is the index of contamination for squamous epithelial cells?

Indicates urine not collected via CCMS technique especially in women.

264

Where are transitional epithelial cells derived from that are found in the urine?

Renal pelvis to the proximal urethra.

265

When would transitional epithelial cells found in the urine be significant?

When large numbers exhibiting unusual morphology are found.

266

What should be done if there are unsual morpholgy found in transitional epithelial cells?

They should be sent for cytologic examination for malignancy.

267

Where are the renal epithelial cells derived from that are seen in the urine?

Nephron to the collecting tubules.

268

What will an increased number of renal epithelial cells in the urine indicate?

Tubular necrosis or tubular damage in a variety of renal tubular disorders.

269

Of the 3 types of epithelial cells found in the urine which one is the most significant?

Renal epithelial cells.