Lab Practical 1 Flashcards
Specimen Containment
and labeling
Leak proof, dry, clear
Label the container not the lid because of mix ups
- Name
- Pt ID
- Date and time of collection
Specimen Processing
Time, storage, what changes
Time: deliver within 2 hours
Fridge: amorph crystals will form
- Reheat to room temp before analyzing
- Preservatives may be used
Purpose For Random Collection
Routine screening
Purpose For First Morning Collection
Purpose For Routine
Purpose For Midstream Clean Catch
Routine screening, bacterial culture
Purpose For Catheterized
Bacterial culture
Purpose For Suprapubic Aspirate
Bacterial culture
Cytology
Purpose For Drug Specimen Collection
Drug Testing
- Requires chain of custody
Preservatives: Refrigeration
Pros, cons, commennts
Pros: no interference with chemical tests
Cons: raises specific gravity, precips more amorph crystals
Comments: prevents bacterial growth 24 hours
Preservatives: Boric Acid
Pros, cons, comments
Pros: preserves protein, formed elements
Cons: inhibits bacterial growth
Comments: keeps pH at 6.00
Preservatives: Formalin
pros, cons
Pros: sediment
Cons: interferes with copper reduction; glucose, blood, leuk esterase on reagent strip
Preservatives: Sodium Fluoride
pros, cons
Pros: prevents glycolysis, good for drug analysis
Cons: inhibits glucose, blood, leuk esterase on reagent strip
Changes at Room Temp For >2 Hours: pH and Glucose
pH: increases
- breakdown of urea to ammonia if bacteria are present
Glucose: decreases
- GLycolysis if bacteria utilize glucose
Changes at Room Temp For >2 Hours: Nitrite
Increases
- if bacteria reduces nitrite
Changes at Room Temp For >2 Hours: Urobilinogen and Bacteria
Urobilinogen: decrease because of oxidization to urobilin
Bacteria: increase due to multiplying
Changes at Room Temp For >2 Hours: Ketones and Bilirubin
Ketones: decrease, evaporation
Bilirubin: Decrease, oxidation to biliverdin when exposed to light
Changes at Room Temp For >2 Hours: Turbidity and Color
Turbidity: increase due to amorph
Color: can change
Changes at Room Temp For >2 Hours: Cells and Casts
Cells and casts: decrease/disintegrate in dilute alkaline urine
Normal Crystals
7 and basic description, ph
Calcium oxalate: square with x, dumbell, ovoid, long, octahedral, acidic
Triple phosphate: long, alkaline
Ammonium biurate: brown fuzzy round, thorny apple, old urine alkaline
Uric acid: brown cylinder or lemon, acidic
Hippuric acid: very long, pointed ends, acidic
Calcium phosphate: prisms in a cluster, alkaline
Ca carbonate: dumbell, alkaline
Amorph
Two types, ph
Normal
Amorph urate: acidic
Amorph phosphate: alkaline
Abnormal Crystals
7, descrip, ph
Bilirubin: brown fine needles, acidic
Cholesterol: clear plates, notched edges, acidic
Cystine: clear hexagon, acidic
Leucine: dark tree trunk, acidic
Tyrosine: large needle cluster sheaves, acidic
Sulfa: drug, brown dumbell needles, acidic
Drug crystals: most are big needles, can be clustered
Correlations: Leukocytes
Infection
- Kidneys
- UTI
- Bacteria most common
Correlations: Nitrite
UTI
- Bacteria
- Bladder
Correlations: Urobilinogen
Liver cell damage, or increased bilirubin excretion to intestines
Correlations: Protein
Kidney disease (glomerular)
Correlations: PH
Acidic can be caused by kidney disease or diet
Correlations: Blood
Infection or disease in kidney or bladder
Correlations: Specific Gravity
radiographic dye?
High specific gravity: kidney’s ability to concentrate urine in relation to plasma
> 1.035: radiographic dye
Correlations: Ketones
Diabetes, low carb, starvation
Correlations: Bilirubin
Liver damage
Correlations: Glucose
Diabetes mellitus
Tubular
How many CSF tubes to be collected and how much
4 tubes, 10-20 mls
CSF tubes and where they’re sent in order, and storage if STAT tests cant be performed
- Chem - fridge or freeze
- Micro - room temp
- Heme - fridge
When should cell counts be performed for a CSF specimen and why?
ASAP, cells deteriorate within 2 hours of collection
Why are CSF cell counts done manually
Automated instruments have a minimum range and sometimes CSF has too few cells to register an accurate count
Normal CSF appearance, cell count, and diff count
- Clear/colorless
- 0-5 wbc/ul
- Lymphs and monos, mononuclear cells
Causes for clear but bloody CSF
RBCs
- hemorrhage or traumatic tap
- 200-400 RBC/ul might appear clear
Milky or cloudy CSF
Bacteria, WBCs, protein
Clotted CSF
Protein, usually from traumatic tap
Xanthochromic CSF
Hgb, bilirubin
Pleural fluid location and specimen collection
- Lungs, chest wall
- Thoracentesis
Peritoneal, ascitic fluid location and collection
- Abdominal wall/pelvic cavity
- Paracentesis, peritoneocentesis
Pericardial fluid location and collection
- Around the heart
- Paracardiocentesis
Synovial fluid composition
Similar to plasma, ultrafiltrate of plasma
What makes synovial fluid viscous
Hyaluronic acid
Synovial fluid tubes for department tests
- Heme: EDTA
- Micro: heparin
- Chem/immuno: not anticoagulant tube
MSU crystals
Needle
Negative birefringence
- Gout
- parallel: yellow
- perp: blue
CCPD crystals
Blunt, positive birefringence
- Pseudogout
- Parallel: blue
- Perp: yellow
Liquefaction in semen
Fresh semen clotted then liquifies again between 15-30 minutes
How does viscosity of semen affect sperm quality
Too viscous (>2 cm thread test) and incomplete liquefaction impedes sperm motility
Semen pH
7.2-7.8 slightly alkaline
How to calculate sperm concentration
number of sperm heads x dilution x 1,000,000 = sperm concentration /ml
How to calculate sperm count
number of sperm heads x dilution x 1,000,000 x specimen volume
Normal sperm concentration and count
Concentration: >20 mil per ml
Count: >40 mil per ml
How long to eval sperm motility
Within 1 hour or else motility decreases
- 50% or more sperm should be motile in categories a,b,c or 25% in a/b
Sperm motility categories
4 (a): rapid, straight line motility
3 (b): slower, some lateral movement
2 (b): slow forward, lateral movement
1 (c): no forward progression
0 (d): no movement
What are lining cells in CSF called
Choroid plexus cells
- dont count in the diff
What are lining cells in synovial fluid called
Synoviocytes
Lining cells in amniotic fluid
SECs
Lining cells in serous fluid
Mesothelial cells
Troubleshooting: crypto vs poor slide
poorly spun lymphs can look smashed and like cryptococcus, remake the slide or other clues like pt history
