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Urinalysis > Exam 4 (Body Fluids) > Flashcards

Exam 4 (Body Fluids) Flashcards

1
Q

What diluents can be used for WBC ONLY? Why?

A

Hypotonic saline, Dilute acetic acid, and Turk’s solution.
These all lyse RBCs

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2
Q

What diluents can be used for both WBCs and RBCs?

A

Cellpack (commercial isotonic diluent), Isotonic saline, and Hyaluronidase

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3
Q

What is the purpose of hyaluronidase in body fluid analysis?

A

Eliminates viscosity of specimen by depolymerizing hyaluronic acid
Prevents mucin clot formation

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4
Q

What is the formula for manual RBC/WBC counts?

A

cells/uL (mm^3) = (# cells counted)(dilution factor)/(area counted)(0.1)

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5
Q

What is the area for the small (R) squares for manual cell counts?

A

0.04 mm^2

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6
Q

What is the area for the large (W) squares for manual cell counts?

A

1 mm^2

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7
Q

What is the preferred technique for slide preparation?

A

Cytocentrifugation

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8
Q

What are the benefits of cytocentrifugation?

A
  • optimizes cell recovery
  • concentrates cells in a small area on the slide
  • creates a monolayer that optimizes microscopic viewing
  • fast and easy to perform
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9
Q

Describe cytocentrifugation

A

Cells adhere to glass, liquid absorbed by filter paper, cell button is formed

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10
Q

List the 3 meninges

A

Dura mater, Arachnoid, Pia mater

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11
Q

Where does CSF flow?

A

In the subarachnoid space which is located between the arachnoid and the pia mater

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12
Q

What is the function of CSF?

A

protects and supports the brain and spinal cord, provides a means of transport for nutrients and waste

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13
Q

How does CSF enter the bloodstream?

A

via arachnoid granulations

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14
Q

What is the total volume of CSF in neonates? adults?

A

Neonates: 10-60 mL
Adults: 85-150 mL

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15
Q

What is the blood brain barrier? Function?

A

The region between the blood and CSF
- Reduces the passage of substances from the blood plasma into the CSF

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16
Q

What accounts for the concentration differences of electrolytes, proteins, and other solutes?

A

Blood Brain Barrier

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17
Q

What is the procedure for collecting spinal fluid?

A

Lumbar puncture: needle goes into lumbar interspace and a pop can be heard, physician takes the opening pressure and closing pressure of CSF

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18
Q

How many mL of CSF can be removed safely if the pressure is in the normal range (50-180mmHg)?

A

up to 20 mL

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19
Q

List the order of sterile tubes that CSF is collected in

A

chemical and immunological testing (1), microbial testing (2), hematology and cytologic studies (3)

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20
Q

What happens with testing if only a small amount of CSF can be collected?

A

One tube is collected and microbiology always receives the specimen first so it can be done using sterile technique

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21
Q

T/F: CSF specimens are considered STAT.

A

True

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22
Q

Normal CSF appearance

A

clear, colorless, viscosity similar to water

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23
Q

What is pleocytosis?

A

Increased number of cells in CSF that causes a cloudy appearance

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24
Q

Why might there be a clot formation in CSF specimen?

A

Most often caused by a traumatic puncture (hit vessel during collection) but can also be due to increased FBG in CSF due to compromised BBB

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25
Q

What is xanthochromia?

A

A yellow discoloration or a spectrum of CSF discolorations

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26
Q

How can you tell the difference between a traumatic tap vs a hemorrhage?

A

Traumatic taps have no xanthochromia, and no hemosiderin while hemorrhages have hemosiderin and xanthochromia.

Traumatic taps there will be a decrease in amount of blood from first to last collection tube while hemorrhages will have the same amount of blood in all collection tubes.

There will be streaking of blood in CSF during collection with a traumatic tap, but with a hemorrhage, there will be evenly dispersed blood during collection.

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27
Q

What WBCs normally predominate the CSF?

A

Lymphocytes and monocytes

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28
Q

What does a high neutrophil count in CSF indicate?

A

Bacterial meningitis

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29
Q

What does increased lymphocytes in the CSF indicate?

A

later stages of viral, tuberculosis, fungal, and syphilitic meningitis

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30
Q

What does eosinophilia in the CSF indicate?

A

parasitic and fungal infections or allergic reactions

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31
Q

Are plasma cells normally present in CSF?

A

No; presence should always be noted

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32
Q

Are macrophage normally present in CSF? Why?

A

No; they are frequently found after hemorrhage, though.

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33
Q

Siderophage

A

Macrophage containing hemosiderin

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34
Q

How do proteins cross the blood brain barrier?

A

Pinocytosis

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35
Q

Which 4 protein bands are present in a normal CSF pattern? Which one helps us identify a body fluid specifically as CSF because it is not found in other specimens?

A
  1. Transthyretin (TTR)
  2. Albumin
  3. Transferrin
  4. Tau transferrin <—- helps us identify CSF
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36
Q

What is the purpose of electrophoresis of CSF?

A

detection of oligoclonal bands in the gamma region

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37
Q

What is the importance of detecting oligoclonal bands in CSF?

A

If there are oligoclonal bands in CSF but NOT in serum, it is highly indicative of multiple sclerosis

If there are oligoclonal bands in both CSF AND SERUM, it indicates lymphoproliferative disorder (CLL leukemia)

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38
Q

What will oligoclonal bands look like on an electrophoresis pattern?

A

Many abnormal peaks seen in the gamma region; normally should not be anything there

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39
Q

What is the normal range for CSF glucose? What are increased levels associated with? Decreased?

A

50-80 mg/dL
Increased = hyperglycemia and traumatic punctures (not significant)
Decreased = Meningitis, tumor in meninges, hypoglycemic states

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40
Q

What is the normal CSF IgG index? What is increased levels associated with? Decreased?

A

0.30-0.70
Increased levels = multiple sclerosis
Decreased levels = compromised BBB

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41
Q

What is the normal CSF/Serum Albumin index? What are abnormal results associated with?

A

Normal is <9. Increased values are associated with impairments of the blood brain barrier (>100 assumes complete breakdown of barrier)

42
Q

Over 50% of meningitis cases have a decreased _________ level.

A

CSF glucose

43
Q

What is normal CSF lactate range? What are increased lactate levels associated with?

A

10-22 mg/dL.
Increased lactate levels can indicate tissue hypoxia or meningitis

44
Q

What do the lactate levels look like in viral meningitis vs other forms of meningitis?

A

Lactate <30 = viral meningitis
Lactate >35 = other causes of meningitis (bacterial)

45
Q

Increased CSF lactate levels are closely associated with _______ _______ levels.

A

low glucose

46
Q

Primary amebic meningoencephalitis

A

rare/deadly disease caused by amoeba Naegleria fowleri

47
Q

3 organisms that cause meningitis

A

Haemophilus influenzae
Neisseria meningitidis
Streptococcus pneumoniae

48
Q

What is the normal CSF total protein? What can increased/decreased results be caused by?

A

15-45 mg/dL or 150-450 mg/L
Increased: traumatic taps, meningitis, hemorrhage
Decreased: loss of fluid, increased intracranial pressure, or invasive procedures

49
Q

What is the normal CSF WBC count?

A

0-5 WBCs/uL in adults and higher in children

50
Q

What is the function of the Sertoli cells?

A

regulate sperm production

51
Q

What is the function of the Interstitial cells of Leydig?

A

responsible for production and secretion of testosterone

52
Q

What is the function of the testes?

A

Exocrine function: secretion of sperm
Endocrine function: secretion of testosterone

53
Q

What is the function of seminal fluid (semen)?

A

Body fluid used to transport sperm

54
Q

List the path of semen in the reproductive tract starting with the testes:

A

Testes (Sertoli cells) –> Epididymis –> Vas deferens –> Ejaculatory ducts –> Prostate gland –> Urethra

55
Q

Seminal vesicle fluid vs Prostatic fluid?

A

Seminal vesicle fluid: accounts for 70% of ejaculate and is high in flavin and contains fructose

Prostatic fluid: accounts for 25% of ejaculate and contains proteins, enzymes, citric acid, and zinc

56
Q

What enzyme does semen have a high concentration of?

A

Acid phosphatase

57
Q

What are the rules for sperm collection? (time, temp, etc.)

A

Must be received in the lab within 1 hour of collection and maintained at 20-40 degrees celsius (room temp or body temp)

58
Q

Briefly describe a sperm motility test.
What is normal sperm motility results?

A

Sperm motility graded 0-4 under a microscope, with 0 being immotile and 4 being motile with strong forward progression. Normal sperm motility results are 50% or more of the sperm showing moderate to strong forward progression (3 or 4)

59
Q

Sperm count vs Sperm concentration (normal value)

A

Sperm concentration is the number of sperm per mL (normal is 20-250 million/mL)
Sperm count is the total number of sperm present in the entire ejaculate

60
Q

How to calculate sperm count

A

(Sperm concentration)x(volume of ejaculate)

61
Q

Describe sperm morphology test

A

Sperm head, midpiece, and tail are measured and/or looked at and sperm as a whole is identified as normal or abnormal

62
Q

Describe a sperm vitality test. Which sperm take up the stain vs do not?

A

Allows for the differentiation of live and dead sperm.
Dead sperm will take up the stain, live sperm will not

63
Q

How many sperm are alive in normal semen?

A

50% or more

64
Q

What is the normal pH of semen? What does an increased vs decreased seminal fluid pH mean?

A

7.2-7.8.
Decreased pH indicates abnormal epididymis, vas deferens, or seminal vesicles
Increased pH indicates infection of reproductive tract

65
Q

What is the major anion in semen?

A

Citric acid

66
Q

Why might acid phosphatase be a test performed on semen?

A

Acid phosphatase has a uniquely high concentration in semen and is often used to determine whether semen is present in specimens after alleged sexual assault, such as vaginal fluids or stained clothing

67
Q

What is the most commonly performed fecal test?

A

Presence for occult blood

68
Q

What does the presence of occult blood indicate?

A

Earliest and most frequent initial symptom of colorectal cancer

69
Q

Steatorrhea

A

Increased fecal lipids >7g/day

70
Q

Major function of the small intestine

A

Digestion and absorption of foodstuffs

71
Q

Major function of the large intestine

A

Absorption of water, sodium, and chloride

72
Q

Diarrhea

A

increase in volume, liquidity, and frequency of bowel movements

73
Q

Scybala

A

small, hard, spherical masses of feces

74
Q

Secretory diarrhea

A

Due to increased solute secretions (could be from infestation with enterotoxin-producing organisms or damage to mucosa caused by drugs)

75
Q

Osmotic diarrhea

A

Due to increased quantities of osmotically active solutes remaining in the intestinal lumen (malabsorption and maldigestion)

76
Q

Intestinal hypermotility

A

Due to an increase in intestinal motility

77
Q

Maldigestion vs Malabsorption

A

Maldigestion is inability to convert food into absorbable materials
Malabsorption is normal digestion but unable to absorb processed food

78
Q

Acute diarrhea vs Chronic diarrhea

A

Acute: sudden onset usually due to toxin ingestion or pathogen infection; resolves in 1-2 weeks
Chronic: diarrhea lasting for longer than 4 weeks

79
Q

Chronic bloody diarrhea vs Chronic watery diarrhea

A

Bloody: inflammatory bowel disease like ulcerative colitis or Crohn’s disease
Watery: celiac disease, tropical sprue, microscopic colitis

80
Q

What is indicated if diarrhea ceases upon fasting? What if it persists despite fasting?

A

Ceases upon fasting –> malabsorption or maldigestion (osmotic diarrhea)
Persists despite fasting –> secretory diarrhea

81
Q

What might a steatorrheal specimen look like?

A

pale, greasy, bulky, spongy, pasty (…..I cant believe im making a flash card for this….)

82
Q

What test could be performed to differentiate steatorrhea from diarrhea?

A

Fecal Fat determination

83
Q

What gives stool its color?

A

Normal brown color results from bile pigments and urobilins give feces orange-brown color

84
Q

What is acholic stool?

A

Pale or clay-colored stools due to inhibited bile secretion into small intestine

85
Q

Noninflammatory diarrhea vs inflammatory diarrhea

A

Inflammatory diarrhea has WBCs in it; non-inflammatory diarrhea does not

86
Q

Describe Fecal WBC test

A

Used to determine if WBCs present in feces (inflammatory diarrhea).
Detects lactoferrin in feces; lactoferrin is present in activated neutrophils, so increased lactoferrin = increased neutrophils = intestinal inflammation

87
Q

Creatorrhea

A

Increased numbers of fecal meat fibers which correlates with impaired digestion and the rapid transit of intestinal contents

88
Q

Describe qualitative fecal fat test

A

2 slides made:
Slide 1 is a wet prep observed for the presence of neutral fats (triglycerides) that will stain red

Slide 2 is an aliquot of the fecal suspension acidified with acetic acid and heated to provide an estimation of the total fecal fat content (neutral fats + fatty acids + fatty acid salts)

89
Q

Describe what the results mean during qualitative fecal fat test

A

Normal fecal neutral fat (1st slide), but increased total fat (2nd slide) = malabsorption

Increased amount of neutral fat (1st slide) = maldigestion

90
Q

What color will stool blood be if bleeding in upper GI tract? Lower?

A

Upper GI tract bleed = dark/mahogany red colored stool (BAD)
Lower GI tract bleed = bright red blood coating surface of stool (OK)

91
Q

Melena

A

dark or black stools resulting from presence of large amounts of fecal blood (degradation of hemoglobin)

92
Q

What is gFOBT? What is the principle behind it? Positive result?

A

Guaic-Based Fecal occult blood test - based on the pseudoperoxidase activity of the heme moiety of hemoglobin. Positive result will be a blue color.

93
Q

What foods can create a false positive gFOBT?

A

rare cooked meats, turnips, horseradish, cantaloupe, bananas, pears, drugs such as aspirin

94
Q

what can cause a false negative gFOBT?

A

antacids, vitamin C

95
Q

What is an iFOBT?

A

immunochemical based test for fecal occult blood (Hemosure) - more specific than gFOBT especially for lower GI tract bleed and does not require any food restrictions

96
Q

What is the Porphyrin-Based Fecal Occult blood test?

A

HemoQuant test - chemical conversion of heme to intensely fluorescent porphyrins (increased porphyrins found with upper GI bleeds)

97
Q

What is the Apt test? What do results mean?

A

Allows for blood found in stool/vomit/gastric aspirate to be differentiated whether it was from the neonate or from maternal blood ingested during delivery

Yellow brown color = maternal hemoglobin
Pink color remains (no color change) = fetal hemoglobin

98
Q

Quantitative fecal fat test

A

Patient collects feces excreted for 2-3 days and specimen is weighed and homogenized and a portion is removed for chemical analysis of lipid content

99
Q

Normal fecal fat excretion

A

2-7 g/day

100
Q

Normal percent fat retention? What does this value mean?

A

95%; It means that a person is retaining 95% fat and excreting 5% fat which is normal.

101
Q

What is the oral tolerance test used for? What do results mean?

A

Used to diagnose an intestinal enzyme deficiency.
Person ingests disaccharide and blood glucose is measured.
>30 mg/dL blood glucose = adequate enzyme
<20 mg/dL blood glucose = deficiency of enzyme

Urinalysis (4 decks)

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