CLINICAL MICROSCOPY
1. Explain the principle behind the fully automated urinalysis. How does this differ from the
manual method?
- Manual method still depend on an operator for specimen mixing, test strip dipping,
and microscopic results input. In a fully automated chemistry analyzer, the tubes of
urine are placed on a rack or a carousel and moved automatically through the
instrument. Automated urine cell analyzers mix, aspirate, dilute, and stain urine to
classify urine sediment particles. Automated urine systems perform a complete
urinalysis that includes the physical, chemical, and microscopic parts of a routine
urinalysis.
Reflectance photometry uses the principle that light reflection from the test pads
decreases in proportion to the intensity of color produced by the concentration of the test
substance. In reflectance photometry, a monochromatic light source is directed toward
the reagent pads by placing a filter between the light source and the reflective surface of
the pad or by using a light-emitting diode (LED) to provide the specific wavelength
needed for each test pad color reaction.
SOURCE: Strasinger (2014) Urinalysis and Body Fluids 6th edition by Davis pg. 283
2. What are the tests performed in the lab for the following specimen and how do we
store this samples?
a. CSF
DIFFERENTIAL COUNT - Identifying the type or types of cells present in
the CSF is a valuable diagnostic aid. The differential count should be
performed on a stained smear and not from the cells in the counting chamber.
CELL COUNT – It is routinely performed on CSF specimens is the leukocyte
(white blood cell count. the presence and significance of RBCs can usually be
ascertained from the appearance of the specimen. Therefore, RBC counts are
usually determined only when a traumatic tap has occurred and a correction
for leukocytes or protein is desired.
CSF GLUCOSE - Glucose enters the CSF by selective transport across the
blood– brain barrier, which results in a reference value that is approximately
60% to 70% that of the plasma glucose.
CEREBROSPINAL PROTEIN (Chemical Test) - The most frequently
performed chemical test on CSF is the protein determination. Normal CSF
contains a very small amount of protein. Reference values for total CSF
protein are usually listed as 15 to 45 mg/dL.
CSF LACTATE - CSF lactate levels can be a valuable aid in diagnosing and
managing meningitis cases. In bacterial, tubercular, and fungal meningitis,
CSF lactate levels greater than 25 mg/dL occurs much more consistently than
does decreased glucose and provides more reliable information when the
initial diagnosis is difficult.
CSF GLUTAMINE - Glutamine is produced from ammonia and α
-ketoglutarate by the brain cells. This process serves to remove the toxic
metabolic waste product ammonia from the CNS.
b. Seminal fluid
SPERM CONCENTRATION & SPERM COUNT - Even though
fertilization is accomplished by one spermatozoon, the actual number of
sperm present in a semen specimen is a valid measurement of fertility.
SPERM VITALITY - Decreased sperm vitality may be suspected when a
specimen has a normal sperm concentration with markedly decreased
motility.
SEMINAL FLUID FRUCTOSE - Low sperm concentration may be
caused by lack of the support medium produced in the seminal vesicles,
which can be indicated by a low to absent fructose level in the semen
ANTISPERM ANTIBODIES - Antisperm antibodies can be present in
both men and women. They may be detected in semen, cervical mucosa,
or serum, and are considered a possible cause of infertility.
SPERM FUNCTION TEST - Advances in assisted reproduction and IVF
have resulted in a need for more sophisticated semen analysis to assess not
only the characteristics of sperm but also the functional ability.
c. Synovial fluid
CELL COUNT - The total leukocyte count is the most frequently performed cell
count on synovial fluid. Red blood cell (RBC) counts are seldom requested. To
prevent cellular disintegration, counts should be performed as soon as possible or
the specimen should be refrigerated.
DIFFERENTIAL COUNT - Differential counts should be performed on
cytocentrifuged preparations or on thinly smeared slides. Fluid should be
incubated with hyaluronidase prior to slide preparation.
CRYSTAL IDENTIFICATION - Microscopic examination of synovial fluid for
the presence of crystals is an important diagnostic test in evaluating arthritis.
MICROBIOLOGIC TESTS - An infection may occur as a secondary
complication of inflammation caused by trauma or through dissemination of a
systemic infection; therefore, Gram stains and cultures are two of the most
important tests performed on synovial fluid.
d. Serous fluid
HEMATOLOGY TESTS - the differential cell count is the most diagnostically
significant hematology test performed on serous fluids.
TRANSUDATE VS. EXUDATE - Differentiation between ascitic fluid
transudates and exudates is more difficult than for pleural and pericardial
effusions.
MICROBIOLOGY TESTS - Gram stains and bacterial cultures for both aerobes
and anaerobes are performed when bacterial peritonitis is suspected. Inoculation
of fluid into blood culture bottles at the bedside increases the recovery of
anaerobic organisms.
SOURCE: Strasinger (2014) Urinalysis & Body Fluids by Davids pg. 181-198
