Michelle Moy, MAd Ed, MT(ASCP)SC Program Director Clinical Laboratory Science Program Loyola University Chicago, Illinois

Transcription

1 Reviewers Lorraine Doucette, MS, MLS(ASCP)CM Associate Professor and Medical Laboratory Technician Program Coordinator Anne Arundel Community College Arnold, Maryland Pamela B. Lonergan, MS, MT(ASCP)SC Medical Technology Program Director Department of Nursing and Allied Health Norfolk State University Norfolk, Virginia Jessica Loontjer, MLS(ASCP)CM, LS(ASCP)CM Clinical Instructor, Special Chemistry and Urinalysis/Body Fluids Nebraska Methodist Hospital Laboratory Omaha, Nebraska Michelle Moy, MAd Ed, MT(ASCP)SC Program Director Clinical Laboratory Science Program Loyola University Chicago, Illinois C. Thomas Somma, PhD Associate Professor School of Medical Diagnostics and Translational Sciences College of Health Sciences Old Dominion University Norfolk, Virginia vii

2 PART ONE: Background CHAPTER 1 Safety and Quality Assessment 3 SAFETY 4 Biologic Hazards 4 Personal Protective Equipment 7 Hand Hygiene 7 Biologic Waste Disposal 9 Sharp Hazards 9 Chemical Hazards 10 Chemical Spills and Exposure 10 Chemical Handling 10 Chemical Hygiene Plan 10 Chemical Labeling 10 Material Safety Data Sheets 10 Radioactive Hazards 11 Electrical Hazards 11 Fire/Explosive Hazards 12 Physical Hazards 13 QUALITY ASSESSMENT 13 Urinalysis Procedure Manual 14 Preexamination Variables 14 Examination Variables 16 Postexamination Variables 20 CHAPTER 2 Introduction to Urinalysis 27 History and Importance 28 Urine Formation 29 Urine Composition 29 Urine Volume 29 Specimen Collection 30 Containers 30 Labels 30 Requisitions 31 Specimen Rejection 31 Specimen Handling 31 Specimen Integrity 31 Specimen Preservation 31 Types of Specimens 32 Random Specimen 32 First Morning Specimen Hour (or Timed) Specimen 33 Catheterized Specimen 34 Midstream Clean-Catch Specimen 34 Suprapubic Aspiration 34 Prostatitis Specimen 34 Pediatric Specimens 34 Drug Specimen Collection 35 CHAPTER 3 Renal Function 39 Renal Physiology 40 Renal Blood Flow 40 Glomerular Filtration 41 Tubular Reabsorption 43 Tubular Secretion 45 Renal Function Tests 46 Glomerular Filtration Tests 47 Cystatin C 49 Tubular Reabsorption Tests 50 Tubular Secretion and Renal Blood Flow Tests 52 PART TWO: Urinalysis CHAPTER 4 Physical Examination of Urine 59 Color 60 Normal Urine Color 60 Abnormal Urine Color 61 Clarity 62 Normal Clarity 62 Nonpathologic Turbidity 63 Pathologic Turbidity 63 Specific Gravity 63 Refractometer 64 Osmolality 65 Reagent Strip Specific Gravity 66 Odor 66 CHAPTER 5 Chemical Examination of Urine 71 Reagent Strips 72 Reagent Strip Technique 72 Handling and Storing Reagent Strips 73 Quality Control of Reagent Strips 73 Confirmatory Testing 73 ph 73 Clinical Significance 73 Reagent Strip Reactions 75 Protein 75 Clinical Significance 75 Prerenal Proteinuria 75 xi

3 xii Renal Proteinuria 76 Postrenal Proteinuria 76 Reagent Strip Reactions 77 Reaction Interference 77 Glucose 79 Clinical Significance 79 Reagent Strip (Glucose Oxidase) Reaction 81 Reaction Interference 81 Copper Reduction Test (Clinitest) 81 Clinical Significance of Clinitest 82 Ketones 82 Clinical Significance 82 Reagent Strip Reactions 83 Reaction Interference 83 Blood 83 Clinical Significance 84 Hematuria 84 Hemoglobinuria 84 Myoglobinuria 84 Reagent Strip Reactions 84 Reaction Interference 85 Bilirubin 85 Bilirubin Production 85 Clinical Significance 86 Reagent Strip (Diazo) Reactions 87 Reaction Interference 87 Urobilinogen 87 Clinical Significance 88 Reagent Strip Reactions and Interference 88 Reaction Interference 88 Nitrite 88 Clinical Significance 88 Reagent Strip Reactions 89 Reaction Interference 89 Leukocyte Esterase 90 Clinical Significance 90 Reagent Strip Reaction 90 Reaction Interference 91 Specific Gravity 91 Reagent Strip Reaction 91 Reaction Interference 92 CHAPTER 6 Microscopic Examination of Urine 99 Macroscopic Screening 100 Specimen Preparation 100 Specimen Volume 100 Centrifugation 100 Sediment Preparation 101 Volume of Sediment Examined 101 Commercial Systems 101 Examining the Sediment 101 Reporting the Microscopic Examination 101 Correlating Results 102 Sediment Examination Techniques 102 Sediment Stains 103 Cytodiagnostic Urine Testing 105 Microscopy 105 Types of Microscopy 107 Urine Sediment Constituents 110 Red Blood Cells 110 White Blood Cells 112 Epithelial Cells 113 Bacteria 118 Yeast 119 Parasites 119 Spermatozoa 120 Mucus 120 Casts 121 Urinary Crystals 128 Urinary Sediment Artifacts 138 CHAPTER 7 Renal Disease 147 Glomerular Disorders 148 Glomerulonephritis 148 Nephrotic Syndrome 149 Tubular Disorders 150 Acute Tubular Necrosis 150 Hereditary and Metabolic Tubular Disorders 153 Interstitial Disorders 154 Acute Pyelonephritis 155 Chronic Pyelonephritis 155 Acute Interstitial Nephritis 155 Renal Failure 155 Renal Lithiasis 157 CHAPTER 8 Urine Screening for Metabolic Disorders 163 Overflow Versus Renal Disorders 164 Newborn Screening Tests 164 Amino Acid Disorders 165 Phenylalanine-Tyrosine Disorders 165 Branched-Chain Amino Acid Disorders 167 Tryptophan Disorders 168 Cystine Disorders 169 Porphyrin Disorders 170 Mucopolysaccharide Disorders 172 Purine Disorders 174 Carbohydrate Disorders 174 PART THREE: Other Body Fluids CHAPTER 9 Cerebrospinal Fluid 181 Formation and Physiology 182 Specimen Collection and Handling 182

4 xiii Appearance 183 Traumatic Collection (Tap) 184 Uneven Blood Distribution 184 Clot Formation 184 Xanthochromic Supernatant 185 Cell Count 185 Methodology 185 Total Cell Count 186 WBC Count 186 Quality Control of CSF and Other Body Fluid Cell Counts 186 Differential Count on a CSF Specimen 186 Cytocentrifugation 186 CSF Cellular Constituents 187 Chemistry Tests 193 Cerebrospinal Protein 193 CSF Glucose 196 CSF Lactate 195 CSF Glutamine 195 Microbiology Tests 195 Gram Stain 196 Serologic Testing 197 CHAPTER 10 Semen 203 Physiology 204 Specimen Collection 205 Specimen Handling 205 Semen Analysis 205 Appearance 205 Liquefaction 206 Volume 206 Viscosity 206 ph 207 Sperm Concentration and Sperm Count 207 Sperm Motility 208 Sperm Morphology 209 Additional Testing 210 Sperm Vitality 211 Seminal Fluid Fructose 211 Antisperm Antibodies 212 Microbial and Chemical Testing 212 Postvasectomy Semen Analysis 213 Sperm Function Tests 213 Semen Analysis Quality Control 213 CHAPTER 11 Synovial Fluid 217 Physiology 218 Specimen Collection and Handling 218 Color and Clarity 219 Viscosity 219 Cell Counts 220 Differential Count 220 Crystal Identification 221 Types of Crystals 221 Slide Preparation 222 Crystal Polarization 222 Chemistry Tests 224 Microbiologic Tests 224 Serologic Tests 224 CHAPTER 12 Serous Fluid 229 Formation 230 Specimen Collection and Handling 230 Transudates and Exudates 231 General Laboratory Procedures 231 Pleural Fluid 232 Appearance 232 Hematology Tests 232 Chemistry Tests 235 Microbiologic and Serologic Tests 236 Pericardial Fluid 236 Appearance 237 Laboratory Tests 237 Peritoneal Fluid 237 Transudates Versus Exudates 237 Appearance 238 Laboratory Tests 238 CHAPTER 13 Amniotic Fluid 243 Physiology 244 Function 244 Volume 244 Chemical Composition 244 Differentiating Maternal Urine From Amniotic Fluid 245 Specimen Collection 245 Indications for Amniocentesis 245 Collection 246 Specimen Handling and Processing 246 Color and Appearance 246 Tests for Fetal Distress 246 Hemolytic Disease of the Newborn 246 Neural Tube Defects 247 Tests for Fetal Maturity 248 Fetal Lung Maturity 248 Lecithin-Sphingomyelin Ratio 248 Phosphatidyl Glycerol 249 Foam Stability Index 249 Lamellar Bodies 249

5 xiv CHAPTER 14 Fecal Analysis 255 Physiology 256 Diarrhea and Steatorrhea 257 Diarrhea 257 Steatorrhea 258 Specimen Collection 258 Macroscopic Screening 258 Color 258 Appearance 259 Microscopic Examination of Feces 259 Fecal Leukocytes 259 Muscle Fibers 259 Qualitative Fecal Fats 260 Chemical Testing of Feces 261 Occult Blood 261 Quantitative Fecal Fat Testing 262 APT Test (Fetal Hemoglobin) 263 Fecal Enzymes 264 Carbohydrates 264 CHAPTER 15 Vaginal Secretions 269 Specimen Collection and Handling 270 Color and Appearance 271 Diagnostic Tests 271 ph 271 Microscopic Procedures 272 Vaginal Disorders 277 Bacterial Vaginosis 277 Trichomoniasis 278 Candidiasis 278 Desquamative Inflammatory Vaginitis 279 Atrophic Vaginitis 279 Additional Vaginal Secretion Procedures 279 Fetal Fibronectin Test 279 AmniSure Test 279 APPENDIX A Urine and Body Fluid Analysis Automation 283 APPENDIX B Bronchoalveolar Lavage 293 Answers to Study Questions and Case Studies and Clinical Situations 297 Abbreviations 305 Glossary 307 Index 315