Handling and Processing of Non Blood Specimen for Laboratory Testing Flashcards
- 95% water and 5% solutes
Urine
• Factors that influence urine volume includes:
fluid intake,
variations in the secretion of antidiuretic hormone,
and need to excrete increased amount of dissolved solids (glucose and salts)
Normal daily urine output:
1200-1500 mL
*Range of 600-2000 mL is considered normal
9 urine components
urea
creatinine
uric acid
chloride
sodium
potassium
phosphate
ammonium
calcium
Specimen Collection
Recommended capacity of the container is
50mL
Reasons for Rejecting Specimen
• specimens in unlabeled containers • nonmatching labels and requisition forms
• specimens contaminated with feces or toilet paper
• containers with contaminated exteriors
• specimens of insufficient quantity • specimens that have been improperly transported
Non blood Specimen Handling
• Specimen Integrity
specimens should be delivered to the laboratory promptly and tested within ______
2 hours
Non blood Specimen Handling
• Specimen Integrity
a specimen that cannot be delivered and tested within 2 hours should be
refrigerated or have an appropriate chemical preservative added.
Non blood Specimen Handling
• Specimen Preservation
The most routinely used method of preservation is refrigeration at _________(temperature)
2°C to 8°C
Specimen Handling
• Specimen Preservation
When a specimen must be transported over a long distance and refrigeration is impossible, ___________________ may be added
chemical preservatives
Specimen Handling
• Specimen Preservatives
• Refrigeration
• Boric acid
• Formalin (Formaldehyde)
• Sodium fluoride
7 Types of Non Blood Specimens
- Random Specimen
- First Morning Specimen
- 24 hour Specimen (Timed specimens)
- Catheterized Specimen
- Midstream Clean
- Suprapubic Aspiration
- Three Glass Collection
Type of Specimen
- most commonly received specimen - useful for routine screening tests to detect obvious abnormalities
Random Specimen
Type of Specimen (Non Blood)
- ideal screening specimen
- also essential for preventing false-negative pregnancy tests and for evaluating orthostatic proteinuria - concentrated specimen
First Morning Specimen
Type of Specimen (Non Blood)
carefully timed specimen must be used to produce accurate quantitative results
24 hour Specimen (Timed specimens)
Type of Specimen
- for bacterial culture
- specimen is collected under sterile conditions by passing a hollow tube (catheter) through the urethra into the bladder
Catheterized Specimen
Type of Specimen
-Catch Specimen
- provides a safer, less traumatic method for obtaining urine for bacterial culture and routine urinalysis
- urine is less contaminated from vaginal bacteria and other cells
Midstream Clean
Type of Specimen
- provides a sample for bacterial culture that is completely free of extraneous contamination.
- the specimen can also be used for cytologic examination
- urine may be collected by external introduction of a needle through the abdomen into the bladder
Suprapubic Aspiration
Type of Specimen collection
- detect the presence of prostatitis.
Three Glass Collection
Physical Examination of Urine
Normal colors
pale yellow, yellow, dark yellow and amber
Abnormal Urine Color
• Dark Yellow or amber - presence of the abnormal pigment bilirubin.
• Yellow-orange
• Red
• Brown or black
• Blue/green
Physical Examination of Urine
CLARITY - refers to the transparency or turbidity of a urine specimen
5 Common terminology used to report clarity includes
clear, hazy, cloudy, turbid, and milky
Physical Examination of Urine
CLARITY
no visible particulates, transparent
Clear
Physical Examination of Urine
CLARITY
few particulates, print easily seen through urine
hazy
Physical Examination of Urine
CLARITY
many particulates, print blurred through urine
cloudy
Physical Examination of Urine
CLARITY
print cannot be seen through urine
turbid
Physical Examination of Urine
CLARITY
may precipitate or be clotted
milky
Physical Examination of Urine
ODOR
Freshly voided urine
faint aromatic odor
Chemical Examination of Urine
- consist of chemical-impregnated absorbent pads attached to a plastic strip.
- color-producing chemical reaction takes place when the absorbent pad comes in contact with urine.
- the reactions are interpreted by comparing the color produced on the pad with a chart supplied by the manufacturer.
Reagent Strips
- chemical analysis of urine includes
KPPBBLUNGS
ketones
pH
protein
blood
bilirubin
leukocytes
urobilinogen
nitrite
glucose
specific gravity
Chemical Examination of Urine
- Store with desiccant in an opaque, tightly closed container.
- Store below 30 degrees Celcius; do not freeze.
- Do not expose to volatile fumes.
- Do not use past the expiration date.
- Do not use if chemical pads become discolored.
- Remove strips immediately prior to use.
*Reagent strips must be checked with both positive and negative controls a minimum of once every 24 hours.
Care of Reagent Strips
Sediment Preparation of Urine
Specimen Volume - 10 and 15 mL is centrifuged in a
conical tube
Sediment Preparation of Urine
Centrifugation
__ minutes at a relative centrifugal force (RCF) of 400.
all specimens must be centrifuged in capped tubes.
5
Sediment Preparation of Urine
Sediment Preparation
- sediment should remain in the tube after ___________
- sediment must be thoroughly resuspended by gentle agitation
decantation
normal fecal specimen contains:
bacteria,
cellulose,
undigested foodstuffs,
GI secretions,
bile pigments,
cells from the intestinal walls, electrolytes,
and water
Approximately _________ of feces is excreted in a 24-hour period
100 to 200 g
Feces Specimen Collection
Special containers with _________ are available for ova and parasite collection
preservative
Feces Specimen Collection
Preserved specimens can usually be kept at ________________.
room temperature
Feces Specimen Collection
- used for 24-, 48-, and 72-hour stool collections for fecal fat and urobilinogen (these specimens must normally be refrigerated throughout the collection period)
Large gallon containers
Feces Macroscopic Screening
• Color and Appearance
Appearance: watery consistency present in diarrhea;
small, hard stools seen with constipation; and
__________________ stools, which suggest obstruction of the normal passage of material through the intestine.
slender, ribbon-like
Feces Chemical Testing of Feces
Occult Blood - Annual testing for occult blood has a high positive predictive value for detecting
colorectal cancer in the early stages
- most frequently used screening test for fecal blood
- based on detecting the pseudoperoxidase activity of hemoglobin
Guaiac-Based Fecal Occult Blood Tests
Feces
requires the collection of at least a 3-day specimen. The patient must maintain a regulated intake of fat (100 g/d) before and during the collection period. The specimen is collected in a large, pre-weighed container. Before analysis, the specimen is weighed and homogenized. Refrigerating the specimen prevents any bacterial degradation.
- confirmatory test for steatorrhea
Quantitative Fecal Fat Testing
Feces
Absence of bile salts that assist pancreatic lipase in the breakdown and subsequent reabsorption of dietary fat (triglycerides) produces an increase in stool fat
Steatorrhea (fecal fat)
- major fluid in the body
- provides a physiologic system to supply nutrients to the nervous tissue, remove metabolic wastes, and produce a mechanical barrier to cushion the brain and spinal cord against trauma
Cerebrospinal Fluid
• Specimen Collection
routinely collected by lumbar puncture between the third, fourth, or fifth lumbar vertebra
- Specimens are obtained by a physician; most often through lumbar puncture (spinal tap)
Cerebrospinal Fluid
Cerebrospinal Fluid
Collection order of draw
• Tube No. 1: Chemistry and Immunology
• Tube No. 2: Microbiology
• Tube No. 3: Hematology (Cell counts)
• *A Fourth tube may be drawn for the microbiology lab
Cerebrospinal Fluid Appearance
Normal CSF
Clear, Crystal-clear and Colorless
Cerebrospinal Fluid Appearance
• The major terminology used to describe CSF appearance includes
crystal-clear,
cloudy or turbid,
milky,
xanthocromic,
and hemolyzed/bloody
Cerebrospinal Fluid Appearance
- used to describe CSF supernatant that is pink, orange, or yellow.
Xanthochromia
Cerebrospinal Fluid
• Reason for collection:
- to diagnose meningitis, subdural hemorrhage, and other neurological disorders.
Routine tests performed on CSF:
- cell counts, chloride, glucose, and total protein.
Semen is composed of four fractions that are contributed by the
testes, epididymis, seminal vesicles, prostate gland, and bulbourethral glands
Semen Composition:
• Spermatozoa 5% • Seminal fluid 60% to 70% • Prostate fluid 20% to 30% • Bulbourethral glands 5%
Semen Specimen Collection - collected and tested to evaluate
fertility and postvasectomy.
When a part of the ____ portion of the ejaculate is missing, the sperm count will be decreased, the pH falsely increased, and the specimen will not liquefy
first
- When part of the ____ portion of ejaculate is missing, the semen volume is decreased, the sperm count is falsely increased, the pH is falsely decreased, and the specimen will not clot.
last
Semen Specimen Collection
- Specimens are collected following a period of sexual abstinence of at least
2 days to not more than 7 days
Semen Specimen Collection
- If the sample is collected at home, it must be kept warm and delivered to the laboratory within
1 hour
Semen Specimen Collection
Specimens should be collected by masturbation; only _________________________________ should also be used to collect the specimen
nonlubricant-containing rubber or polyurethane condoms
Semen Specimen Collection
Sample should be kept at ____(temperature)
37°C
- A fresh semen specimen is clotted and should liquefy within ________ minutes after collection
30 to 60
Semen ph
pH 7.2 to 8.0
Normal Semen Appearance
has a gray-white color,
appears translucent,
and has a characteristic musty odor
Semen analysis for fertility evaluation consists of both macroscopic and microscopic examination.
Parameters reported include
appearance,
volume,
viscosity,
pH,
sperm concentration and count, motility
and morphology
- joint fluid
- is a viscous liquid found in the cavities of the movable joints (diarthroses) or synovial joints
- hyaluronic acid: contribute the noticeable viscosity
- clear, pale-yellow, viscous fluid that lubricates and decreases friction in movable joints
- normally occurs in small amounts but increases when inflammation is present
Synovial Fluid
- to identify or differentiate arthritis, gout, and other inflammatory conditions.
Synovial Fluid Reason for collection
Synovial Fluid Specimen Collection
- Synovial fluid is collected by needle aspiration called
arthrocentesis
Normal synovial fluid does not
clot
Synovial Fluid
Specimen Collection
Turbidity is frequently associated with the presence of
WBC
Normal viscous synovial fluid resembles
egg white
Synovial Fluid Specimen Collection
Collected in tubes:
• EDTA or heparin tube for cell counts, identification of crystals, and Smear preparation;
• Sterile tube for culture and sensitivity;
• Nonadditive tube for macroscopic appearance, and immunology tests and to observe clot formation.
- it provides lubrication between the parietal and visceral membranes
Serous Fluid
3 types of Serous fluids
• Pleural fluid
• Peritoneal fluid
• Pericardial fluid
Serous Fluid
aspirated from the pleural space, or cavity, surrounding the lungs
Pleural fluid
Serous Fluid
aspirated from the abdominal cavity
Peritoneal fluid
Serous Fluid
aspirated from the abdominal cavity
Peritoneal fluid
Serous Fluid
aspirated from the pericardial cavity surrounding the heart
Pericardial fluid
-pale-yellow, watery, serum-like fluid found between the double-layered membranes enclosing the pleural, pericardial, and peritoneal cavities
- lubricates the membranes and allows them to slide past one another with minimal friction.
- normally present in small amounts, but volumes increase when inflammation or infection is present or when serum protein levels decrease.
Serous Fluid
Serous Fluid - aspiration procedures are referred to as
thoracentesis (pleural), pericardiocentesis (pericardial), and paracentesis (peritoneal)
Serous Fluid
Collected in:
• EDTA tube is used for cell counts and the differential.
• Sterile heparinized or sodium polyanethol sulfonate (SPS) evacuated tubes are used for microbiology and cytology.
• Chemistry tests can be run on clotted specimens in plain tubes or in heparin tubes
present in the amnion, a membranous sac that surrounds the fetus
- provides a protective cushion for the fetus, allow fetal movement, stabilize the temperature to protect the fetus from extreme temperature changes, and permit proper lung development.
- amount increases in quantity throughout pregnancy, reaching a peak of approximately 800 to 1200 mL during the third trimester, and then gradually decreases prior to delivery.
Amniotic Fluid
- can be analyzed to detect genetic disorders such as Down’s syndrome, identify hemolytic disease resulting from blood incompatibility between the mother and fetus, and determine gestational age
• *most common reasons: to detect problems in fetal development and assess fetal lung maturity.
Amniotic Fluid
Amniotic Fluid
preferably collected after __ weeks of gestation (pregnancy) and is obtained by a physician
15
Amniotic Fluid Collection:
- Amniotic fluid is obtained by needle aspiration into the amniotic sac, a procedure called
amniocentesis
Amniotic Fluid
the first 2 or 3 mL collected can be contaminated by maternal blood, tissue fluid, and cells and are _________
discarded
Normal amniotic fluid is ________ and may exhibit slight to moderate turbidity from cellular debris, particularly in later stages of fetal development
colorless
Amniotic Fluid Specimen Handling
• The specimen should be protected from light to prevent _________________ and delivered to the laboratory ASAP.
breakdown of bilirubin
Amniotic Fluid Specimen Handling
• Specimens for chromosome analysis (cytology) must be kept at ____ temperature.
room
Amniotic Fluid Specimen Handling
• Specimens for some chemistry tests (gases) must be kept on ___.
ice
• mucus or phlegm that is ejected from the trachea, bronchi, and lungs through deep coughing
• For the diagnosis or monitoring of lower respiratory tract infections such as tuberculosis (TB), caused by Mycobacterium tuberculosis.
• FYI: The microbe that causes TB is called an acid-fast bacillus (AFB), and the sputum test for TB is often called an AFB culture.
Sputum
• Preferred specimen: First morning
• Atleast 1 hour after meal
Sputum
Methods of Tissue Examination
Fresh Tissue Examination Preserved/Fixed Tissue Examination
4 Methods of Fresh Tissue Examination
Teasing or Dissociation
Squash Preparation (Crushing) Smear Preparation
Frozen Section
Fresh Tissue Examination method
A selected tissue specimen is immersed in a watch glass containing NSS, carefully dissected or separated and examined
Teasing/Dissociation
Fresh Tissue Examination method
Small pieces of tissues are placed in a microscopic slide and forcibly compressed with another slide or coverslip
squash preparation
Fresh Tissue Examination method
Methods of Smear Preparation:
1.streaking
2.spreading
3.pull apart
4.touch or impression smear
Fresh Tissue Examination method
Smear Preparation
used for preparing mucoid secretions vaginal secretions, sputum and gastric content) use a spatula, dissecting needle or applicator stick and streak in a zigzag fashion
STREAKING
Fresh Tissue Examination method
Smear Preparation
used for thick mucoid secretions (smears of fresh sputum and bronchial aspirates)
SPREADING
Fresh Tissue Examination method
Smear Preparation
for serous fluids, concentrated sputum, and enzymatic lavage form the GIT, smears of urinary sediment, vaginal pool and breast secretions
PULL - APART
Fresh Tissue Examination method
Smear Preparation
for preparation of direct impression from the cut surface of tissue like the lymph nodes and other surgical or autopsy secretions.
TOUCH OR IMPRESSION SMEAR
TISSUES
is a pathological laboratory to perform rapid microscopic analysis of a specimen. The technical name for this procedure is Cryo section.
The frozen section procedure
designed to remove all extractable water from the tissue, replacing it with a support medium that provides sufficient rigidity to enable sectioning of the tissue without parenchymal damage or distortion.
Fixed tissue examination
Fixed Tissue Histopathologic Techniques/Steps
• Numbering
• Fixation
• Dehydration
• Clearing
• Impregnation
• Embedding
• Blocking
• Trimming
• Sectioning
• Staining
• Mounting
• Labelling
Fixed Tissue
Gross Examination of Specimen
• Surgical cut –up
• Specimen Dissection
• Grossing Medtech will assist pathologist in doing the gross examination, he/she will write down __________________________________
descriptions of the specimen received.
