Clinical Microscopy Flashcards by Steven Rei Roque

Performance of physical, chemical, and microscopic analysis on non-blood body fluids such as urine, semen, serous fluids, and synovial fluid

Clinical Microscopy

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Clinical Microscopy is a performance of __________, __________, and __________________ on non-blood body fluids such as _______, _______, _____________, and _______________

physical

chemical

microscopic analysis

urine

semen

serous fluids

synovial fluid

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Brief historical background of urinalysis (11)

a. Hippocrates

b. Rufus of Ephesus

c. Isaac Judaeus

d. Middle Ages

e. Thomas Bryant

f. Jean Baptiste van Helmont

g. Frederik Dekker

h. Thomas Addis

i. Richard Bright

j. 1930’s

k. Reagent Strips (Urine Test Strip)

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Wrote a book on “uroscopy”

Hippocrates (15th century)

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Made the first description of hematuria as the presence of blood in the urine

Rufus of Ephesus (50 AD)

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Rufus of Ephesus made the first description of ____________ as the presence of blood in the urine

Hematuria

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Considered one of the founders of the origins of nephrology

Isaac Judaeus (900 AD)

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Isaac Judaeus wrote ________________, which detailed the concepts of urine formation, urinary sediments, and urine characteristics in relation to diseases.

Kitab al Baul (Book of Urine)

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Isaac Judaeus wrote Kitab al Baul (Book of Urine), which detailed the concepts of _________, _________, ________, in relation to diseases

urine formation
urinary sediments
urine characteristics

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Physicians concentrated their efforts very intensively on the art of uroscopy, receiving instruction in urine examination as part of their training

Middle Ages

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When do the color charts had been developed that described the significance of ____ different colors

1140; 20

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In the middle ages, chemical testing of urine involved _________, and ________ for glucose

“ant testing” “taste testing”

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Charlatans without medical credentials began offering health-related predictions of patients using their urine samples

Pisse prophets

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He published a book that exposed the scam offered by the “pisse prophets”

Thomas Bryant (1627)

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Thomas Bryant’s revelations uncovered in his book inspired the passing of the first ___________ in England

medical licensure laws

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Introduced the gravimetric analysis of urine by weighing a number of 24-hour urine specimens. No significant conclusions were derived from his measurements

Jean Baptiste van Helmont

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Helmont introduced the ________________ of urine by weighing a number of _________ urine specimens.

gravimetric analysis

24-hour

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True or False: Helmont’s analysis brought significant conclusions derived from his measurements

False

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He discovered albuminuria by boiling urine; observed that proteins in the urine precipitated when boiled with acetic acid

Frederik Dekker

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What did Dekker discover by boiling urine?

Albuminuria

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He first attempted to standardize the quantitation of formed elements in urine microscopic analysis

Thomas Addis

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It used a hemocytometer to count the number of RBCs, WBCs, casts, and epithelial cells present in a 12-hour urine sample

Addis count

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Introduced the concept of urinalysis as part of a doctor’s routine patient examination

Richard Bright (1827)

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Revealed the presence of albumin in heated urine samples

Richard Bright (1827)

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Studied renal diseases and clearly established the overall correlation of edema, albumin in urine, and diseased kidneys observed after death

Richard Bright (1827)

Bright

Bright studied renal diseases and clearly established the overall correlation of ________, ________, and ___________ observed after death

edema, albumin in urine, diseased kidneys

1930s

The number and complexity of the tests performed in a urinalysis had reached a point of impracticality, and urinalysis began to disappear from routine examinations

- Rescued routine urinalysis by making chemical and physical examination of urine samples easier - 1950s: Urine test strips were first made on industrial scale and offered commercially - 1964: The company Boehringer Mannheim (today Roche) launched its first Combur test strips

Reagent Strips (Urine Test Strip)

When did urine test strips were first made on industrial scale and offered commercially

1950s

What company in 1964 launched its first Combur test strips

Boehringer Mannheim (today Roche)

Routine work in the Clinical Microscopy Section

Midstream Clean-Catch Method

Common Collection Method: a. Patients must be provided instructions for cleansing. Mild antiseptic towelettes are recommended as cleansing materials * Patients are instructed to wash their hands before beginning the collection * Male patients should clean the glans penis. For uncircumcised patients, they should withdraw the foreskin * Female patients should separate the labia and clean the urinary meatus and surrounding area b. After cleansing, patients are to void first into the toilet, then collect an adequate amount of urine in a sterile container, and finish voiding into the toilet

Midstream Clean-Catch Method

What are the recommended as cleansing materials?

Mild antiseptic towelettes

Patients are instructed to ___________ before beginning the collection

wash their hands

Method for male patients are required to clean the ___________

glans penis

For uncircumcised patients, they should withdraw the ________

foreskin

Method for female patients should separate the _________ and clean the ____________ and the surrounding area

labia, urinary meatus

ii. What are the factors to consider in the physical examination of urine

Color, Clarity, Specific Gravity, Odor

To examine urine color, examine the specimen under a ___________, looking down against what background?

good light source white

5 normal urine colors

straw, pale yellow, yellow, dark yellow, & amber (relatively dehydrated states)

Pigments that are responsible for urine coloration

Urochrome, Uroerythin, Urobilin

Responsible for the yellow color of urine

Urochrome

A pink pigment that is most evident in refrigerated specimens as a result of amorphous urates precipitation

Uroerythrin

Uroerythrin is a pink pigment due to?

amorphous urates precipitation

An orange-brown color to urine samples that is an indication of not fresh

Urobilin

Refers to the transparency/turbidity of a urine specimen

clarity

True or False: The amount of turbidity will correspond to the amount of material observed during microscopic examination

True

True or False: Clarity is examined in a clear container while holding it in front of a light source

True

Clarity Reporting: No visible particulates

Clear

Considered normal for a turbidity in midstream clean-catch urine

Clear

Clarity Reporting: Transparent

Clear

Clarity Reporting: Few particulates

Hazy

Clarity Reporting: print easily seen in urine

Hazy

Clarity Reporting: Few particulates, print easily in urine

Hazy

Clarity Reporting: Many particulates

Cloudy

Clarity Reporting: print blurred through urine

Turbid

Clarity Reporting: Many particulates, print blurred through urine

Cloudy

Clarity Reporting: Print cannot be seen through urine

Turbid

Clarity Reporting: May precipitate or be clotted

Milky

Different reportings in the clarity of urine

Clear, Hazy, Cloudy, Turbid, Milky

An indicator of concentration of dissolved material in the urine

Specific Gravity

Specific gravity is affected by both _____ & _____ of particles in the solution

number & size

It is affected by both number & size of particles in a solution

Specific Gravity

Normal urine specific gravity (random)

Random 1.003 to 1.035

Normal urine specific gravity (24-hour sample)

24-hour urine sample: 1.015-1.025

<1.003

Probably not a urine sample

Range of sample that is probably not a urine

<1.003

>1.035

Radiographic contrast media

Range of sample that is a radiographic contrast media

>1.035

2 methods of measuring specific gravity

Direct measurement using urinometers (hydrometer) Indirect measurement using refractometer which measures refractive index of the urine sample

A direct method that measures urine using?

Urinometer (hydrometer)

An indirect method that measures urine using?

refractometer - measures refractive index

An incidental observation

Odor

It is not a part of a routine urinalysis

Odor

Odor: Aromatic

Cause: Normal

Odor: Foul

Cause: Bacterial decomposition, UTI

Odor: Ammonia-like

Cause: Bacterial decomposition, UTI

Odor: Foul, ammonia-like

Cause: Bacterial decomposition, UTI

Odor: Fruity

Cause: Ketones (diabetes mellitus, starvation, vomiting)

Odor: Sweet

Cause: Ketones (diabetes mellitus, starvation, vomiting)

Odor: Fruity, Sweet

Cause: Ketones (diabetes mellitus, starvation, vomiting)

Odor: Maple syrup

Cause: Maple syrup urine disease

Odor: Mousy

Cause: Phenylketonuria

Odor: Rancid

Cause: Tyrosinemia

Odor: Sweaty feet

Cause: Isovaleric acidemia

Odor: Cabbage

Cause: Methionine malabsorption

Odor: Rotting fish

Cause: Trimethylaminuria

Odor: Bleach

Cause: Contamination

Odor: Unusual

Cause: Ingestion of onions, garlic, and asparagus

Odor: Pungent

Cause: Ingestion of onions, garlic, and asparagus

Odor: Unusual or Pungent

Cause: Ingestion of onions, garlic, and asparagus

Cause: Normal odor

Odor: Aromatic

Cause: Bacterial decomposition, UTI

Odor: Foul, ammonia-like

Cause: Ketones (Diabetes mellitus, starvation, vomiting)

Odor: Fruity, Sweet

Cause: Maple syrup urine disease

Odor: Maple Syrup

Cause: Phenylketonuria

Odor: Mousy

Cause: Tyrosinemia

Odor: Rancid

Cause: Isovaleric acidemia

Odor: Sweaty feet

Cause: Methionine malabsorption

Odor: Cabbage

Cause: Trimethylaminuria

Odor: Rotting fish

Cause: Contamination

Odor: Bleach

Cause: Ingestion of onions, garlic, asparagus

Odor: Unusual or Pungent

True or False: Genetically precipitated people can smell the odor which is produced by asparagus in urine samples

False. *Studies have shown that although everyone who eats asparagus produces urine samples with an odor, only genetically PREDISPOSED people can smell the odor

Commonly assessed in the Chemical Examination of Urine

Specific Gravity, pH, Protein, Glucose Others: Ketones Blood Bilirubin Urobilinogen Nitrite Leukocyte esterase

Chemical parameters of urine samples are assessed using what?

Reagent strips

It is consists of chemical-impregnated absorbent pads attached to a plastic strip

Reagent Strips

A color-producing chemical reaction takes place when the absorbent pad comes in contact with urine

Reagent Strips

True or False: Reactions are interpreted by comparing the color produced on the pad with a chart supplied by the manufacturer

True

2 major types of reagent strips

Multistix (Siemens Medical Solutions Diagnostics) Chemstrip (Roche Diagnostics)

Reagent strip made by Siemens Medical Solutions Diagnostics

Multistix

Reagent strip by Roche Diagnostics

Chemstrip

What is tested in the chemical parameters of urine when specific gravity is involved

its physical property

Normal Urine pH (random, first morning, normal protein diet)

Random: 4.5 to 8.0 First Morning urine samples: 5.0 to 6.0 With normal protein diet: 4.5 to 6.5

Normal Urine pH (Random)

Random: 4.5 to 8.0

Normal Urine pH (First morning urine samples)

First Morning urine samples: 5.0 to 6.0

Normal Urine pH (Normal protein diet)

With normal protein diet: 4.5 to 6.5

Normal Urine protein

<10 mg/dL OR <100 mg/24 hours Henry: 150 mg/24 hours

Normal Urine glucose

15 mg/dL Fasting: 2 to 20 mg/dL per 100 mL urine

Normal Urine glucose (fasting)

Fasting: 2 to 20 mg/dL per 100 mL urine

How many urine sediments from a centrifuged urine sample is placed on a glass slide?

20 µL (some labs use one or two drops)

True or False: After the urine sample is placed, a cover slip is then placed on top of the slide after observing the sample

False A cover slip is then placed on top of the slide BEFORE observing the sample

What objectives are used in the microscopic examination of urine samples

Low power objective High power objective

What are the assessed elements seen in the microscopic examination of urine

Cellular elements Urinary crystals Casts Mucus threads Bacteria Other miscellaneous elements

Cellular elements seen in microscopic examination of urine

Cellular elements: Red blood cells, white blood cells, epithelial cells (normal and pathologic variations)

It is an element found only in the urinary sediment that are unique to the kidney

Casts

It is formed within the kidney at the lumens of the distal convoluted tubule and collecting ducts

Casts

Casts are formed within the kidney at the?

Lumens of the distal convoluted tubule and collecting ducts

Examples of other miscellaneous elements found on a microscopic examination of urine

Yeast cells, parasites, spermatozoa