CLINICAL MICROSCOPY SECTION Flashcards by Isha Ashi

The performance of scientific analysis on body fluids other than blood: seminal fluid, spinal fluid, serous fluids, synovial fluid, amniotic fluid, and URINE.

Clinical microscopy

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Is considered as the most readily available and easily collected indicator of the body’s many metabolic functions.

Clinical microscopy

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Defines urinalysis as “the testing of urine with procedures commonly performed in an expeditious, reliable, accurate, safe,and cost-effective manner.”

The Clinical and Laboratory Standards Institute (CLSI)

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The main reasons for performing urinalysis

diagnosis of disease, screening asymptomatic populations for undetected disorders, and monitoring the progress of disease and the effectiveness of therapy

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Wrote a book in “uroscopy”

Hippocrates (5th 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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Considered as one of the founders of the origins of nephrology

Isaac Judaeus (900 AD)

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Detailed the concepts of urine formation, urinary sediments, and urine characteristics in relation to diseases.

Book Kitab al Baul (Book of Urine)

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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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described the significance of 20 different colors

Color charts

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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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Involved “ant testing” and “taste testing” for glucose

Chemical testing of urine

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

Thomas Bryant (1627)

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Revelations uncovered in his book inspired the passing of the first medical licensure laws in England

Thomas Bryant (1627)

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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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Discovered albuminuria by boiling urine; Observed that proteins in the urine precipitated when boiled with acetic acid

Frederik Dekker (1694)

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First attempt to standardize the quantitation of formed elements in urine microscopic analysis

Thomas Addis (1926)

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used a hemocytometer to count the number of RBCs, WBCs, casts and epithelial cells

Addis count

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a hemocytometer to count the number of RBCs, WBCs, casts and epithelial cells present in_________ hours.

12 hours

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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)

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

1930s

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Rescued routine urinalysis by making chemical and physical examination of urine samples easier

Reagent Strips (Urine Test Strip)

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were first made on industrial scale and offered commercially

Urine test strips(1950)

Launched its first Combur test strips

The company Boehringer Mannheim (today Roche)

Accurate urinary results greatly depend on the quality of_________

specimen collected

laboratories routinely request patients to collect urine samples using

Midstream Clean-Catch Method.

are less contaminated by epithelial cells and bacteria.

midstream clean-catch method

To examine urine color, examine the specimen under a good light source, looking down through the container against a white Background

Color

Normal urine color

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

Responsible for the YELLOW color of urine

Urochrome

a PINK pigment most evident in REFRIGERATED SPECIMENS as a result of amorphous urates precipitation

Uroerythrin

Imparts an ORANGE-BROWN color to urine samples that are not fresh

Urobilin

Refers to the TRANSPARENCY / TURBIDITY of a urine specimen

Clarity

Reporting:No visible particulates, transparent

Clear

Reporting:Few particulates, print easily seen through urine

Hazy

Reporting:Many particulates, print blurred through urine

Cloudy

Reporting:May precipitate or be clotted

Milky

Reporting: Print cannot be seen through urine

Turbid

INDICATOR OF CONCENTRATION OF DISSOLVED MATERIAL IN THE URINE and Affected by both NUMBER AND SIZE of particles in the solution

Specific Gravity

Normal urine specific gravity: Random:

1.003 to 1.035

24-hour urine sample

1.015-1.025

Normal urine specific gravity:<1.003

Probably not a urine sample

using urinometers (hydrometer)

Direct measurement

using refractometer which measures refractive index of the urine sample

Indirect measurement

Not part of routine urinalysis, only an incidental observation

Odor

Normal urine specific gravity:>1.035

Radiographic contrast media

Bacterial decomposition, UTI

FOUL, AMMONIA-LIKE

FRUITY, SWEET

Ketones (Diabetes mellitus, starvation, and vomiting)

MAPLE SYRUP

Maple syrup urine disease

MOUSY

Phenylketonuria

RANCID

Tyrosinemia

SWEATY FEET

Isovaleric acidemia

CABBAGE

Methionine malabsorption

ROTTING FISH

Trimethylaminuria

BLEACH

Contamination

UNUSUAL OR PUNGENT

Ingestion of onions, garlic, and asparagus

Chemical parameters (and specific gravity) of urine samples are routinely assessed using reagent strips (urine strips)

Chemical Examination of Urine

Consist of chemical-impregnated absorbent pads attached to a plastic strip

Reagent Strips (Urine Strips)

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

urine

Normal Urine pH:Random

4.5 to 8.0

Normal Urine pH:First Morning urine samples

5.0 to 6.0

Normal Urine pH:With normal protein diet

4.5 to 6.5

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

Cellular elements

Only elements found in the urinary sediment that are unique to the Kidney and Formed within the kidney (lumens of the distal convoluted tubule and collecting ducts)

Casts

Miscellaneous elements:

Yeast cells, parasites, spermatozoa

deals with processing and preparation of tissue and cell samples for microscopic examination by the pathologist.

Histopathology

enable the pathologist to make a proper interpretation and diagnosis of a disease.

well-preserved and adequately processed tissue sections

“Father of Histopathology” / “Father of Histologic Pathology”

Johannes Muller

became the leading textbook in physiology for much of the nineteenth century

“Elements of Physiology”

“Founder of Pathology”/ “Father of Modern Anatomic Pathology”

Marcello Malphigi

Became renowned for his exploration of embryology and physiology of the glands and the viscera

Marcello Malphigi

to preserve tissues and other samples

heat fixation

“Father of microscopic pathology”

Rudolf Virchow

established the world’s first pathology laboratory

Rudolf Virchow

the first scientist/ physician of the time who emphasized the study of the manifestation of diseases and infections, which are visible at the cellular level by means of a microscope

Rudolf Virchow

Discovered the fixative effects of formaldehyde

Ferdinand Blum

A machine used for cutting tissue blocks into thin slices called ribbons/ sections

Microtome

Sliding Microtome

George Adams Jr.

Rocking/ Cambridge Microtome

Paldwell Trefall

Minot / Rotary Microtome

Minot

Freezing Microtome

Queckett

Preserving the tissue specimen in as life-like a manner as possible

Fixation(1)

Routine fixative:

10% formalin

Process of removing water from the Specimen and Utilizes increasing concentrations of ethyl alcohol

Dehydration(2)

Removing dehydrating agents from the sample and replacing it with a fluid miscible with wax which produces a translucent appearance of the sample

Clearing (De-alcoholization) (3)

Routine clearing agent:

Xylene

Routine infiltration medium

Paraffin

Process where the clearing agent is Removed and clearing agent is replaced with a fluid that will cover the cavities resulting in a firmer consistency of the sample

Infiltration (Impregnation)(4)

The process of arranging the infiltrated tissue inside a mold containing a medium which is then allowed to solidify

Embedding (Casting/ Blocking)(5)

Routine embedding medium

Paraffin

Process of removing excess paraffin wax from the block

Trimming(6)

A tissue block is cut into thin slices called ribbons/ sections

Sectioning (Microtomy)(7)

Application of dyes on the sections for studying the architectural pattern of the tissue and physical characteristics of the cell

Staining(8)

Process of placing a cover slip on the stained tissue using a mounting medium

Mounting(9)

Routine mounting medium

Canada Balsam