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Clin Lab Lecture
Test 1
324
Anatomy
Graduate
02/06/2012

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Term
What is the type of laboratory used by the campus clinic?
Definition
Commercial laboratory like quest diagnostics.
Term
Name 5 indications for ordering laboratory tests?
Definition
1. Confirmation of a clinical impression or establishment of a diagnosis. 2. Rule out a diagnosis. 3. Monitor therapy. 4. Establish a prognosis. 5. Screen for health; preventative medicine.
Term
What is wellness screening?
Definition
Testing asymptomatic individuals who are basically healthy.
Term
What type of diseases should be screened for with a wellness screening test?
Definition
prevalent, can be detected before clinical findings develop, are treatable, have harmful consequences if left untreated.
Term
What is acuracy and what is percision?
Definition
Acuracy- Correctness. How close a test result comes to the true biologic value. Percision- reproducability, how consistant a test result is via multiple testing of the same specimen.
Term
What is sensitivity and specificity?
Definition
Sensitivity- True-positive, A highly sensitive test will rule negatives out. Specificity- True-negative, A highly specific test will rule positives in.
Term
In order to detected a disease a tests needs maximum what?
Definition
Sensitivity.
Term
If a test has a very high sensitivity what will specificity be like and what will this mean?
Definition
specificity will probably be low, and this results in healthy people being labeled as sick.
Term
A good screening test will have high what?
Definition
High sensitivity so it will catch almost all true-positives, but it will include people who are not sick.
Term
What type of test will have a high specificity?
Definition
A confirmatory.
Term
What type of test is used when there is high clinical evidence of a disease?
Definition
A highly specific.
Term
What are reference ranges?
Definition
Patients test results are reported along with a numerical range of test values that are found in healthy individuals.
Term
How are reference ranges RR established?
Definition
Testing on a large number of healthy individuals, then perform a statistical analysis and the results ideally represent a gaussian distribution.
Term
Where will the healthy numbers come from in a RR?
Definition
plus or minus 2 standard deviations and this will include 95% of the healthy people so 5% of healthy people will be outliers.
Term
RR are of most value when?
Definition
When there are age, gender, and population specific.
Term
What are the test result values given as?
Definition
In USA- conventional units. Everywhere besides the USA- SI units or International units which are purely metric.
Term
What are the host factors that add variablity to test results?
Definition
age, gender, race.
Term
What is a coefficient of variation (CV)?
Definition
a statistical evaluation to determine if the variation of test results from multiple analyses of the same sample is acceptable. The lower the CV the better.
Term
What will make a CV high?
Definition
Analytic variation due to methodology. So manual methods can have a CV of 10-15% and automated CV are a few %.
Term
Give some examples of improper patient instructions that can be sources of error in laboratory testings?
Definition
Poor patient compliance with fasting vs. non-fasting. Collection of specimen. Exercising prior to test.
Term
What is a profile or panel testing?
Definition
Collection of different tests related to a particular organ, organ system, or disease group.
Term
Panels or profile tests allow for what?
Definition
Lots of tests at low costs, they help with pattern recognition.
Term
What is the problem with panels or profile tests?
Definition
Each test adds an increased probability of an increased number of abnormal test results in healthy patients.
Term
Where are the 2 places to obtain blood for hematology?
Definition
1. Periferal blood via venipuncture. 2. Bone marrow via bone marrow aspiration.
Term
Bone marrow is aka?
Definition
Myeloid, myelogenous or intramedullary tissue.
Term
What is the most common type of hematologic test?
Definition
Complete blood count CBC.
Term
In a CBC which cells are biggest and smallest?
Definition
Biggest---> smallest; WBC, RBC, HGB, HCT, MCV, MCH, MCHC, RDW, Platelets.
Term
List WBC from largest to smallest?
Definition
Neutrophils, Band, Lymphocytes, Monocytes, Eosinophils, Basophils.
Term
What is hematopoiesis?
Definition
The formation and development of all types of blood cells from their parental precursors.
Term
Where will a fetus's hematopoiesis happen at?
Definition
Starts with yolk sack then moves to liver and spleen, then axial skeleton.
Term
Where will an adult's hematopoiesis happen at?
Definition
For the first few decades in the distal long bones and axial skeleton, and then later in life mainly the axial skeleton.
Term
What is erythropoiesis?
Definition
Production of RBC and it is a type of hematopoiesis.
Term
What will the cytoplasm color be like from beginning to the end of erythropoiesis?
Definition
It will start blue and eventually turn to orange.
Term
During erythropoiesis it starts with a stem cell---> progenitor cell ----> ?
Definition
Rubriblast.
Term
1 Rubriblast will eventually make how many RBC?
Definition
Many.
Term
How long will erythropoiesis take?
Definition
5-6 days for bone marrow development.
Term
What is the nucleus like during erythropoiesis?
Definition
It is present at the beginning and will disappear after 2-3 days.
Term
What is the name of the first cell during erythropoiesis that will not have a nucleus?
Definition
Reticulocyte.
Term
What part of erythropoiesis will cells enter the circulating blood?
Definition
Very promptly, even before the last maturational events have occurred as reticulocytes.
Term
How long will a RBC last in circulation and what will happen to it?
Definition
120 days, senescence and destruction.
Term
What is the last stage of RBC maturation that occurs after the nucleus is extruded in the bone marrow?
Definition
Reticulocyte.
Term
Why are reticulocytes slightly larger than Mature RBC?
Definition
Because they are still maturing and contain residual fragments of cytoplasmic RNA and mitochondria.
Term
Why will reticulocytes have a different color than mature RBC's and what is the color?
Definition
Polychromatic from fragments of mitochondria.
Term
When will reticulocytes finish maturing?
Definition
1-2 days after entering the peripheral circulation.
Term
What % of circulating Red cells are reticulocytes?
Definition
0.5-2.5 %.
Term
What are reticulocytes counts commonly used for?
Definition
Diagnosis of various anemia and in monitoring the recovery in factor deficiency anemias.
Term
Will a CBC have a reticulocyte count?
Definition
No.
Term
Where will erythropoietin be made at?
Definition
Peritubular interstitial cells of the kidenys.
Term
When will erythropoietin be made?
Definition
With blood loss the kidneys sense a loss of O2 and make EPO. This can also happen with chronic obstructive pulmonary disease since O2 levels will be low.
Term
What will EPO do?
Definition
Increases the number of stem cells that commit to rubriblasts, and speeds up the maturation time by 20-30%. EPO also allows for early release of immature cells into peripheral circulation.
Term
Where is hemoglobin synthesized at?
Definition
Within the maturing nucleated red cell within the bone marrow via a series of biochemical enzymatically driven reactions intimately involving the mitochondria.
Term
How is heme produced?
Definition
when iron is enzymatically inserted into protoporphyrin.
Term
How is globin produced?
Definition
Polyribosomes produce globin chains in pairs (alpha, gamma, beta, delta).
Term
Each globin chain provides what?
Definition
a site for insertion of one heme molecule.
Term
What will go into making 1 hemoglobin?
Definition
four globin chains (2 pairs) and four heme molecules.
Term
How can different types of hemoglobin be made?
Definition
Various combinations of pairings of globin chains produce different types of hemoglobin.
Term
What type of hemoglobin will fetuses make?
Definition
F= 2 alpha, 2 gamma globulins.
Term
What type of hemoglobin will infants make?
Definition
95-97% is A1- 2 alpha, 2 beta globulins. And 2-3% will be A2- 2 alpha, 2 delta globulins.
Term
What test can be done to determine what types of hemoglobin are present?
Definition
Hemoglobin electrophoresis.
Term
How will iron be transported in the body?
Definition
By transferrin.
Term
Iron is essential for what?
Definition
Erythropoiesis.
Term
What % of dietary iron is absorbed and where?
Definition
10% is absorbed via proximal small intestine.
Term
What happens to dietary iron not absorbed?
Definition
Excreted in feces, and small amounts in urine.
Term
Where will transferrin take iron once in the plasma, and what will the iron do in these places?
Definition
Bone marrow- hemoglobin synthesis. Muscles- myoglobin synthesis. Liver- storage.
Term
Name 4 tests that reflect the status of iron metabolism?
Definition
1. Serum iron concentration (SI). 2. Total iron binding capacity (TIBC). 3. % saturation of iron (% sat or TSAT). 4. Serum ferritin concentration.
Term
What is the serum iron concentration (SI) test?
Definition
the concentration of circulating iron that is bound to transferrin.
Term
Is SI a good test for iron metabloism why or why not?
Definition
No there are physiological causes of altered concentrations.
Term
What is total iron binding capacity (TIBC)?
Definition
An indirect assay of transferrin concentration performed by measuring the amount of iron (added in vitro) needed to totally saturate the unbound iron-binding sites on the transferrin molecules.
Term
Normally how many of the transferrin binding sites are bound with iron?
Definition
only 1/3.
Term
TIBC should not be ordered as what type of test?
Definition
An individual test it should be ordered in combination with the SI.
Term
% saturation of iron test?
Definition
Calculated value estimating the % of binding sites on transferrin that are bound with iron.
Term
What is needed to measure the % saturation of iron test?
Definition
SI and TIBC.
Term
% saturation of iron test is much more sensitive indicator of what?
Definition
Iron deficiency or iron overload than is SI.
Term
How is iron stored in the body?
Definition
Ferritin is the body's major iron storage compound.
Term
Where is ferritin found at?
Definition
In nearly every cell, but the major sites of storage are hepatocytes, spleen, and bone marrow.
Term
Each ferritin molecule contains how much iron?
Definition
as many as 4,000 iron molecules.
Term
Ferritin that is in circulation is in direct proportion to what?
Definition
The amount of ferritin stored in the tissues.
Term
OF all the tests what is the gold standard to evaluate iron storage?
Definition
Serum ferritin.
Term
What type(s) of test(s) should be done to investigate iron related abnormalities?
Definition
SI< TIBC, % sat, and serum ferritin.
Term
Name 3 groups of white blood cells?
Definition
Granulocytes, lymphocytes, and monocytes.
Term
What are granulocytes?
Definition
Maturation of leukocytes that contain granules so they are Neurtophils, eosinophils and basophils.
Term
Production and maturation of granulocytes is under what influence?
Definition
Humoral growth factors.
Term
What is the difference between erythropoisis and granulopoiesis?
Definition
With granulopoiesis stem cells commit, differentiate and accumulate into different compartments or pools both within and outside of the bone marrow.
Term
Where will granulocytes pool?
Definition
about 50% are available mature granulocytes circulating.
Term
What else besides humoral growth factors can influence leukocyte production?
Definition
Chemical mediators (cytokines and chemokines) released during inflammatory and immune reactions.
Term
Granulocytes have how long of a life span and are in circulation how long?
Definition
They live for 9-15 days and are in circulation 7-24 hours.
Term
What is a band neutrophil?
Definition
An immature form of neutrophil which is observed both within and outside of the bone marrow.
Term
What is a PMN?
Definition
a mature neurtophil.
Term
What is shift to the left?
Definition
Any increase in numbers of immature neurotphils in peripheral circulation.
Term
Shift to the left is indicative of what?
Definition
acute infection or other cause of neutrophila.
Term
What is lymphopoiesis?
Definition
Growth and maturation of lymphocytes.
Term
Where will lymphocytes mature at?
Definition
within bone marrow and is mediated by a poorly understood control mechanism.
Term
What do lymphocytes do in circulation?
Definition
repopulate lymph nodes and lymphatic tissue.
Term
Lymphocytes are conditioned by what?
Definition
Thymus- T-lymphocytes. Bone marrow- B lymphocytes.
Term
T-lymphocytes and B-lymphocytes are for what?
Definition
T- cellular immunity. B- humoral immunity.
Term
What are atypical lymphocytes?
Definition
Abnormal appearing T-lymphocytes usually observed in peripheral blood of an immunologically stimulated patient, most often viral infections.
Term
Atypical lymphocytes are classically seen with what and are aka?
Definition
Mononucleosis and may be known as Downey cells or reactive lymphocytes.
Term
What is the name of WBC when they are elevated and decreased?
Definition
Elevated; neutrophilia, lymphocytosis, moncytosis, eosinophilia, basophilia. Decreased; neutropenia, lymphocytopenia, moncytopenia, eosinopenia, basopenia.
Term
What can cause neutophilia?
Definition
physical or emotional stress, acute suppurative infeciton, myelocytic leukemia, inflammatory disorders.
Term
What can cause lymphocytosis?
Definition
Chronic bacterial infections, viral infections, lymphocytic leukemias.
Term
What can cause moncytosis?
Definition
Chronic inflammatory disorders, tuberculosis.
Term
What can cause eosinophilia?
Definition
Parsitic infections, allergic reactions, hodgkin lymphoma.
Term
What can cause basophilia?
Definition
Myeloproliferative diseases.
Term
What can cause neutropenia?
Definition
dietary deficiencies (B12 and folate), some overwhelming bacterial infections, viral infections, radiation and chemotherapy.
Term
What can casue lymphocytopenia?
Definition
Immunodeficiency diseases, radiation therapy.
Term
What can cause moncytopenia?
Definition
Very uncommon.
Term
What can cause eosinopenia?
Definition
Very uncommon.
Term
What can cause basopenia?
Definition
Very uncommon.
Term
Is platelet count part of the CBC?
Definition
Yes.
Term
What is megakaryopoiesis?
Definition
Production of thrombocytes (platelets).
Term
Maturation and growth of thrombocytes is influenced by what?
Definition
Thrombopoietin TPO, megakaryocyte growth and development factor MGDF, and same cytokines and chemokines as granulocytes.
Term
Name 3 tests to evaluate hematopoeiesis?
Definition
CBC, reticulocyte count, bone marrow aspiration and biopsy.
Term
Are there any special times of collection or patient preparation needed for a CBC?
Definition
No.
Term
What is a RBC count?
Definition
Absolute quantification of RBCs in a unit volume of blood.
Term
What are the units for conventional and international for a red blood count?
Definition
Conventional- mm^3. International- L
Term
How often is a Red blood cell count used alone?
Definition
Not often not even to determine if a blood transfusion is needed.
Term
What is the most widely used single test used to evaluate a patient for anemia?
Definition
Hemoglobin concentration.
Term
What is a hemoglobin concentration test testing?
Definition
Direct measurment of the weight of hemoglobin in a unit volume of blood.
Term
What are the conventional and international units used for hemoglobin concentration tests?
Definition
Conventional- gm/dL. International- gm/L
Term
What is the hematocrit test testing?
Definition
The ratio of the volume of the RBCs after centrifugation to that of whole blood.
Term
Hematocrit is aka?
Definition
crit, and packed cell volume PCV.
Term
What are the conventional and international units used for the hematocrit test?
Definition
Conv- %. Internat- L/L
Term
How can the PCV aka hematocrit(HCT) aka crit approximate the hemoglobin (HGB)?
Definition
Divide the HCT by 3.
Term
What are the RBC, HGB, HCT tests used to determine?
Definition
Anemia, erythrocytosis, and polycythemia.
Term
What are the 3 types of polycythemia and what are they?
Definition
Polycythemia vera- myeloproliferative disorder. Secondary polycythemia- hypoxia= not getting enough oxygen. Relative polycythemia- dehydration.
Term
Name the RBC indicies?
Definition
mean corpuscular volume MCV, Mean corpuscluar hemoglobin MCH, Mean corpuscular hemoglobin concentration MCHC.
Term
What is MCV?
Definition
Measure of the intracellular volume of the average circulating RBC. So this is the size of the average circulating RBC.
Term
What are the units used for MCV?
Definition
fenta Liter.
Term
Name 3 types of anemias?
Definition
microcytic, macrocytic, normocytic.
Term
What will the MCV test be like for the 3 types of anemia?
Definition
Microcytic- decreased MCV. Macrocytic- Increased MCV. Normocytic- normal MCV.
Term
What is the MCH used for?
Definition
Measure of the weight of hemoglobin within the average circulating RBC. It will relate to the intensity of the coloration of the RBCs when stained.
Term
What are the types of MCH?
Definition
Hypochromic, normochromic, hyperchromic
Term
Of the 3 types of MCH which one is very uncommon?
Definition
Hyperchromic.
Term
What is the MCHC?
Definition
% of the intracellular volume of the average circulating RBC that is hemoglobin. This is essentially the same info as the MCH.
Term
What are the clinical applications of RBC indicies?
Definition
To determine what type of anemia is present.
Term
What type of anemia is present with decreased RBC, HGB, HCT and decreased MCV, MCH, MCHC?
Definition
microcytic and hypochromic anemia (iron deficiency).
Term
What would the blood tests be like for macrocytic anemia and how is this caused?
Definition
decreased RBC, HGB, HCT and increased MCV, normal MCH and normal MCHC. This is caused by B12 and folate deficiencies.
Term
What would the blood tests be like for normocytic anemia and how is this caused?
Definition
Decreased RBC, HGB, HCT and normal RBC indicies and this is caused by chronic illness.
Term
What is the Red cell distribution width RDW test?
Definition
index of RBC size difference or the variability in RBC size populations.
Term
what type of variation in RBC is normal?
Definition
Minimal.
Term
Increased RDW correlates with what?
Definition
increased anisocytosis- variability in cell size populations done by a person looking through a microscope.
Term
When will a decreased RDW be given?
Definition
It wont only increased variation.
Term
What tests will be used to define the presence or absence of anemia?
Definition
RBC count, Hemoglobin concentration HGB, hematocrit HCT.
Term
What tests wil help to initially categorize the type of anemia?
Definition
MCV, MCH, MCHC aka the RBC indicies.
Term
What is the RDW test used for clinically?
Definition
as an early sign of developing anemia.
Term
What type of stain is used to look at a blood smear?
Definition
Wright.
Term
Can machines report morphological variations in RBC?
Definition
Yes with limited capability.
Term
What is polychromatophilia, poikilocytosis?
Definition
Polychromatophilia a RBC that is a little bluer. Poikilocytosis is abnormal shapes of RBC.
Term
How will the lab report poikilocytosis?
Definition
They shape should be given like teardrop, sickle, etc.
Term
When doing a vena puncture what vein should you never try to shift the needle to the side if you did not draw blood?
Definition
Bascilic vein.
Term
What should you do if you are drawing blood and you notice a mound is starting to build under the skin?
Definition
Finish the blood draw and then add lots of pressure after to avoid brusing.
Term
What are the different ways the lab will report microcytes?
Definition
Few microcytes, slight microcytes, and a scale of 1-4+ microcytes.
Term
What is anioscytosis?
Definition
Variable size of RBC.
Term
What test will be increased with anisocytosis?
Definition
RDW.
Term
What test will be increased with macrocytosis?
Definition
MCV.
Term
What test will be decreased with microcytosis?
Definition
MCV
Term
What test will be decreased with hypochromia?
Definition
MCH and or MCHC.
Term
What is a WBC count?
Definition
The absolute quantification of the total number of circulating WBC.
Term
What are the conventional and international units for the WBC count?
Definition
Convent- mm^3. Intern- L.
Term
What info is important about WBC's?
Definition
The proportion of each, not the total leukocyte count.
Term
What are the 2 types of WBC differential counts and how are they done?
Definition
Relative- performed by microscopic evaluation, and counting 100 WBC. Absolute- more accurate and is done by modern hematology instuments.
Term
How can absolute differential be calculated if only relative WBC differential count is given?
Definition
Relative % X total WBC = absolute count.
Term
What would the diagnosis be given; WBC- 3.5 x10^3/ mm^3 (reference 4-11 x 10^3/ mm^3), neutrophils- 30% (reference 50-70% or 4.7x10^3), lymphocytes 70% (reference 20-40% 2.4x10^3).
Definition
Neutropenia.
Term
What will the RBC morphology tests help to determine?
Definition
Correlates with changes in indices and RDW, may provide specific evidence of certain hematologic abnormalities.
Term
WBC Count is used to determine what?
Definition
Leukopenia or leukocytosis.
Term
What is the WBC differential count used for?
Definition
Provides more specific info about underlying pathology causing altered WBC count.
Term
What type of test is a platelet count?
Definition
Absolute quantification of the number of circulating thrombocytes and this test is considered a hemostatic test.
Term
What is the correlation of platlet function and platelet count?
Definition
There is none.
Term
What are the conventional units and international units for the platelet count?
Definition
Convet- mm^3. Inter- L
Term
Spontaneous bleeding can occur at what platelet count?
Definition
40-50 X 10^3/mm^3.
Term
How serious is gaining platelets?
Definition
Not very the serious part is droping down.
Term
What is the reference range for normal platelet count?
Definition
150-450.
Term
What is the mean platelet volume (MPV)?
Definition
This calculates the internal volume of the average circulating platelet, therefore it is the size of the average platelet.
Term
What may correlate with an abnormal MPV?
Definition
Autoimmune disorders and some hematologic malignancies.
Term
Will the MPV be inculded in the CBC?
Definition
Maybe but many labs do not report the MPV.
Term
Is a reticulocyte count part of a CBC, and what is a reiculocyte count used for?
Definition
No. This is used to determine if the bone marrow is responding to therapy in factor deficiency anemias such as iron, folate, and vitamin B12 deficiencies.
Term
How is a reticulocyte count calculated?
Definition
Count 1000 RBC and determine the # of them that are reticulocytes. Take the total amount of reticulocytes and multiply this by 100 and then divide by 1000.
Term
What is essential for redering a definitive diagnosis about reticulocyte count?
Definition
Aspiration and biopsy of marrow. This would be needed for lymphoproliferative disorders such as leukemia and others.
Term
How is aspirated marrow studied?
Definition
Histologicaly and cytochemically by a MD clinical pathologist.
Term
What happens to Hemoglobin when RBC undergo senescence?
Definition
Heme is converted to unconjugated-bilirubin in the blood, and globin will go to the AA pool to be recyled.
Term
What happens to unconjugated-bilirubin?
Definition
It is transferred to the liver and then it is converted to conjugated-bilirubin.
Term
What are the paths that conjugated-bilirubin can take?
Definition
Leave the liver as bile or become part of urine and be excreted (however there is only the smallest of amounts of conjugated-bilirubin in urine).
Term
What happens to bile as it leaves the liver?
Definition
It is concentrated in the gallbladder and then gets converted to urobilinogen in the intestines.
Term
What are the options for urogilinogen?
Definition
It can be converted to stercobilin and be excreted in the feces. It can be recycled into the liver. It can be sent to the kidney and excreted in urine (urobilinogen is the major part of urine that comes from heme).
Term
What part of the heme is converted into unconjugated-bilirubin?
Definition
The porphyrin component.
Term
How is unconjugated-bilirubin transported to the liver?
Definition
By the protein albumin.
Term
How will the RBC count be different for pediatrics?
Definition
It will be high 0-1 months after birth and then be low 2months-1year.
Term
how will the Hematocrit be different for pediatrics?
Definition
High for the first 2 months and then low until 1 year old.
Term
How will the hemoglobin be different for pediatrics?
Definition
High for the first 2 months and then low until 1 year old.
Term
How will the MCV be different for pediatrics?
Definition
High for the first 6 months and then low until 1 year.
Term
How will the white cell count be different for pediatrics?
Definition
High for the first 4 years.
Term
How will the neutrophils be different for pediatrics?
Definition
High for the first 3 months and then normal.
Term
How will the lymphocytes be different for pediatrics?
Definition
normal from 0-1 month and then high until 4 years.
Term
Urinalysis is a poor mans ____.
Definition
Renal biopsy.
Term
What does it mean that the importance of a urinalysis is often undersold?
Definition
It will lead to mistakes especially regarding collection and handling which can lead to errors.
Term
What is the pH of glomerular filtrate vs urine?
Definition
GF-7.4. Urine- 6.0.
Term
What is the difference in specific gravity of glomerular filtrate vs urine?
Definition
GF- 1.005. Urine- 1.020.
Term
How much glomerular filtrate is produced a day?
Definition
180 Liters.
Term
How much urine is produced a day?
Definition
1-2 liters.
Term
What is anuria?
Definition
No urine output.
Term
What is oliguria?
Definition
Less than 500 ml of urine produced a day.
Term
What is nocturia?
Definition
more than 500 ml of urine produced a night this is not nocturnal frequency.
Term
What is nocturnal frequency?
Definition
Waking up often to pee and this will not be more than 500 ml of urine all together at night unless there is also a nocturia.
Term
What is polyuria?
Definition
More than 2 liters a urine produced a day.
Term
Who will create more urine volume an adult or child per kilogram of body weight?
Definition
Children by 3-4 times as much.
Term
How often should one urinate?
Definition
should be around 2 hours inbetween.
Term
What is urgency and dysuria?
Definition
Urgency- instantly needing to pee. Dysuria- painful urination.
Term
Will urine odor be performed in labs?
Definition
No.
Term
What is the normal description of urine odor?
Definition
Faintly aromatic.
Term
Name 5 things that can cause abnormal urine odors?
Definition
vitamins, drugs, foods (like asparagus), bacterial contamination, metabolic disorders (like diabetics).
Term
What is CCMS?
Definition
Clean catch midstream specimen.
Term
What is the first step in a CCMS?
Definition
Wash hands with soap and water.
Term
What is the second step in a CCMS?
Definition
Clean urinary opening with a towlelette 3 times for females and once for males.
Term
When is the best time to take a urine sample?
Definition
First thing in the morning due to most concentrated and bladder incubated.
Term
What type of urine sample is most often taken?
Definition
Random specimen.
Term
Name three things that a 24 hour urinary collection might be needed for?
Definition
protein, calcium, and hormone and their metabolites.
Term
How long between sample and test should there be for urine?
Definition
within 1 hour, or refrigerate or add a perservative.
Term
What is used to test urine and what are the results like?
Definition
Reagent strip and results are semi-quantitative at best.
Term
Name 10 things that can be determined by using a reagent strip testing urine?
Definition
pH, specific gravity, protein, glucose, ketones, urobilinogen, bilirubin, leukocyte esterase, nitrate, blood (hemoglobin).
Term
With capillary tubes what is the difference between blue and red tipped?
Definition
Blue- no preservative. Red- has heparin to keep blood from clotting.
Term
What is the normal color of urine?
Definition
colorless to amber yellow.
Term
Dark yellow urine can be caused by what?
Definition
Concentrated urine or bilirubin which can come from dehydration or hepatobiliary.
Term
What can cause red urine?
Definition
Blood, hemoglobin, food dyes, beets.
Term
What can cause brown urine?
Definition
Acid hematin bilirubin.
Term
What can cause green urine?
Definition
Pseudomonas from a urinary tract infection.
Term
Anything that makes urine hazy will come from ______.
Definition
formed elements.
Term
What things will be seen with urinary infections?
Definition
back pain, cloudy urine from hematuria, inability to urinate, frequent urinate or painful urination, malaise (general discomfort).
Term
What is the normal pH of urine?
Definition
4-8 pH.
Term
What 3 things can cause an acidic urine?
Definition
Western diet, ketosis, systemic acidosis.
Term
What are 4 things that can cause an alkaline urine?
Definition
vegetarian/ vegan or diet high in citrus fruits, postparandial specimen (alkaline tide- kidneys getting rid of the extra bicarbonate from the pancrease after a meal.), stale unrefrigerated specimen, urinary tract infection.
Term
What is the specific gravity of urine used to evaluate?
Definition
the concentration and excretory power of the kidneys.
Term
How is a true kidney funciton test done?
Definition
water depravation for 16 hours prior to testing since it is easily altered by consumption.
Term
When would a urine sample be more concentrated?
Definition
With decreased fluid intake, first morning specimen, with other solutes like with diabetics increased glucose, ketones and proteins.
Term
When would a urine sample be dilute?
Definition
Increased fluid intake, random specimens, renal disease.
Term
What is the normal amount of protein in urine?
Definition
None.
Term
What would protiens in the urine help us diagnose?
Definition
Protein in the urine is the easiest and earliest way to find a kidney disease.
Term
What is the most common and significant protein that is found in urine?
Definition
Albumin.
Term
What are the 2 types of proteinuria?
Definition
Functional and organic.
Term
What is a functional proteinuria?
Definition
Benign. Associated with fever, exposure to extremes of heat or cold, excessive exercise, or emotional stress. It tends to be a minimal amount of protein lost.
Term
What is organic proteinuria?
Definition
Proteinuria associated with demonstrabale systemic disease or renal damage and most often resulting in more than 500 mg/day.
Term
What are the 3 areas of origin for protein being lost?
Definition
pre-renal, renal, post-renal.
Term
What would a trace, or 1+ measure of protein in urine likely mean?
Definition
Functional problem not organic.
Term
What are the 3 categories of quantity of protein lost per day?
Definition
minmal- less than .5 gm/24 hours. Moderate- 0.5-4.0 gm/ 24 hour. Marked- more than 4.0 gm/24 hours.
Term
What will likely cause the minimal protein loss in urine?
Definition
exercise, stress, postural/ orthostatic, pregnancy, early effects of kidney disfunction, lower UTI.
Term
What will likely cause the moderate protein loss in urine?
Definition
chronic glomerlonephritis, pyelonephritis, diabetic nephropathy, mutliple myeloma, pre-eclampsia.
Term
What will likely cause the marked protein loss in urine?
Definition
Acute and chronic glomerulonephritis, diabetic nephropathy, nephrotic syndrome and nephrosis, lupus nephritis.
Term
What is the normal amount of glucose in the urine?
Definition
none.
Term
What are the 2 types of glucosuria?
Definition
With hyperglycemia and without hyperglycemia.
Term
What can cause glucosuria with hyperglycemia?
Definition
DM, cushings syndrome, thyrotoxicosis (hyperthyroidism), exocrine pancreatic disease, drugs.
Term
What can cause glucosuria without hyperglycemia?
Definition
Renal tubular disease, late (normal) pregnancy.
Term
What is the normal amount of ketones aka ketone bodies in the urine?
Definition
none.
Term
What are the 3 types of ketones and where do they come from?
Definition
acetoacetic acid, acetone, betahydroxybutyric acid. They are byproducts of fatty acid catabolism which is often due to impaired glucose metabolism.
Term
Name 5 things that can cause ketonuria?
Definition
Inadequate carbohydrates in the diet, malnutrition, defect in carbohydrate metabolism, DM, Defect in carbohydrate absorption.
Term
What are the normal amounts of bilirubin and urobilinogen in the urine?
Definition
Bilirubin- none. Urobilinogen- 0.1-1 ehrlich unit.
Term
What 2 things will cause bilirubinuria?
Definition
Intrahepatic obstructive disorder and extrahepatic obstructive disorder.
Term
What is the type of bilirubin that can be excreted by the kidneys?
Definition
Conjugated bilirubin.
Term
Since urobilinogen is found in urine what can make the levels go up or down?
Definition
Up- hemolytic diseases, hepatic diseases. Down- Biliary obstruction.
Term
What is leukocyte esterase and what are the normal urine levels?
Definition
White blood cells in urine and there is normaly none found in urine.
Term
Reagent strip turns positive in the presence of what for leukocyte esterase?
Definition
WBC's either lysed or intact.
Term
Leukocyte esterase is a sensitive test for what?
Definition
UTI.
Term
What can give a false positive for leukocyte esterase tests?
Definition
vaginal contamination, conditions causing heavy mucus discharge and irritation.
Term
What is pyuria and what causes it?
Definition
Pyuria is white blood cells/ pus in urine and it is caused by 3 things; 1. Inflammation within the urinary tract. 2. Infection within the urinary tract. 3. Sterile pyuria.
Term
What are the catagories for things that cause sterile pyuria?
Definition
Infective and non-infective.
Term
What would be under the infective and non-infective sterile pyuria?
Definition
infective- virus, fungi, atypical organims. Non-infective- systemic and localized diseases, structural and physiologicla abnormalities, drugs, recent antibiotic use.
Term
What is the normal amount of nitrite in urine?
Definition
none.
Term
What will cause nitrite in the urine?
Definition
Dietary urinary nitrAte is reduced to nitrite by many urinary tract pathogens.
Term
Can there be urinary pathogens without nitrite in the urine?
Definition
Yes because they require adequate time for incubation.
Term
How powerful is the nitrite test of urine?
Definition
Very specific indicator of UTI, but lacks sensitivity.
Term
What will blood in the urine mean?
Definition
RBC's only.
Term
How much blood should be in the urine?
Definition
none.
Term
What is the difference between hemoglobinuria vs. hematuria?
Definition
hemoglobinuria- presence of hemoglobin in the urine coming from the circulation. Hematuria- presence of RBC's in the urine which are leaking into the urinary tract.
Term
What can or cant be seen of a microscopic examinatino of the urine sediments when blood is in the urine?
Definition
No RBC's can be seen.
Term
Can the terms hemoglobinuria and hematuria be interchanged?
Definition
No, but they often are.
Term
What will the presence of blood in the urine require?
Definition
Always warrents investigation into the site and cause of the bleeding.
Term
Where are casts formed at?
Definition
Only in the kidneys.
Term
What can cause hematuria with casts and proteinuria?
Definition
Kidney based; acute or chronic glomerulonephritis, rheumatoid disease.
Term
What can cause hematuria without casts?
Definition
may or may not be kidney involvment. Vigorous exercise, urinary tract trauma, Lower urinary tract infection, hypertension, bleeding disorders, kidney stones, kidney tumors.
Term
How will EDTA and Hepparin prevent coagulation?
Definition
EDTA- binds Ca2+. Hepparin- binds thrombin.
Term
What can the presence of ascorbic acid do to a urinalysis?
Definition
Reduce positive or false negatives for blood, glucose, nitrite and bilirubin.
Term
What is the normal amount of RBC's seen in High power field (HPF)?
Definition
0-4 per HPF.
Term
What can often be mistaken for RBC's while doing a microscopic evaluation of urine crystals?
Definition
yeaste.
Term
What is the normal amount of WBC's seen while doing a microscopic evaluation of urine?
Definition
0-4 per hpf.
Term
What will the significance be of WBC's clumping together?
Definition
It will increase the probability that problems are coming from the kidney or bladder.
Term
What are the 3 types of epithelial cells found in microscopic analysis of urine? What is the normal amount seen?
Definition
Squamous, transitional- and renal. The normal amounts for all 3 are occasional per lpf.
Term
Where are squamous epithelial cells derived from in the urine?
Definition
Distal urethra and female vulva.
Term
What is the index of contamination for squamous epithelial cells?
Definition
Indicates urine not collected via CCMS technique especially in women.
Term
Where are transitional epithelial cells derived from that are found in the urine?
Definition
Renal pelvis to the proximal urethra.
Term
When would transitional epithelial cells found in the urine be significant?
Definition
When large numbers exhibiting unusual morphology are found.
Term
What should be done if there are unsual morpholgy found in transitional epithelial cells?
Definition
They should be sent for cytologic examination for malignancy.
Term
Where are the renal epithelial cells derived from that are seen in the urine?
Definition
Nephron to the collecting tubules.
Term
What will an increased number of renal epithelial cells in the urine indicate?
Definition
Tubular necrosis or tubular damage in a variety of renal tubular disorders.
Term
Of the 3 types of epithelial cells found in the urine which one is the most significant?
Definition
Renal epithelial cells.
Term
Name the 2 common types of crystals found in the urine?
Definition
Calcium oxalate crystals, uric acid.
Term
Most crystals found in the urine are clinically insignificant, except when?
Definition
except crystals that appear in acidic or neutral pH urine.
Term
Calcium oxalate crystals in urine are related to what in your diet?
Definition
A diet rich in oxalic acid. This is seen with high doses of ascorbic acid in certain predisposed individuals.
Term
Calcium oxalate crystals in urine are associated with what 2 things?
Definition
1. Calcium urinary stones. 2. Hypercalcemia.
Term
Calcium oxalate crystals are seen in what pH?
Definition
Neutral to slightly alkaline.
Term
Uric acid crystals are seen in urine with what type of diet?
Definition
Food rich in purines.
Term
Uric acid crystals are seen in patients with what?
Definition
Hyperuricemia.
Term
What is hyperuricemia?
Definition
high levels of uric acid.
Term
What things will be seen with or cause hyperuricemia?
Definition
Gout, leukemia because of rapid turnover of nucleic acid, cancer patients because of chemotherapy.
Term
What is amorphous sediment?
Definition
Urate or phosphates and are of no clinical significance.
Term
What pH will urate and phosphate be seen in?
Definition
Urate- acid. Phosphate- alkaline.
Term
Where will urinary casts come from?
Definition
Kidney.
Term
What is the most observed cast in urine?
Definition
Hyaline casts.
Term
What are hylaine casts made of?
Definition
2 proteins; Tamm-horsfall protein which is a normal secretion within the tubules and IgA.
Term
What is the clinical significane of hyaline casts?
Definition
when found in the absence of other types of casts or proteins there is usually no clinical significance.
Term
Increased numbers of hyaline casts can happen during what?
Definition
Strenuous exercise, dehyration, heat exposure and emotional stress.
Term
How will RBC or hemoglobin casts come about?
Definition
Damaged RBC's and proteins leak into urine and are concentrated and form casts.
Term
What is the clinical significance of RBC or hemoglobin casts?
Definition
the presence of even just one is very significant and is most often associated with glomerulonephritis.
Term
How will WBC casts come about?
Definition
WBC's mobilize to destroy bacteria and proteins usually accompany infections and the proteins percipitate forming WBC casts, but protein may be absent.
Term
What is the clinical significance of WBC casts?
Definition
The presence of even just one is very significant and is most often associated with pyelonephritis.
Term
How are epithelial casts formed?
Definition
When tubular epithelium is damaged due to a variety of glomerular and tubular conditions.
Term
What are granular casts?
Definition
Either disintegrating white cell casts or epithelial casts.
Term
What is required for the formation of granular casts?
Definition
Significant urine statis within the tubules.
Term
What are waxy casts?
Definition
Most advanced stage of disintegrating cellular casts.
Term
What is the significance of waxy casts?
Definition
Exisiting or impending renal failure.
Term
What are broad casts?
Definition
Very wide casts that are seen in chronic renal failure a form of a waxy cast that forms in the collecting tubules.
Term
Urine shouldn’t have bacteria in it, but when would increased numbers of bacteria indicate a urinary tract infection?
Definition
Increased numbers in the absence of squamous epithelium.
Term
What might need to be done with bacteria in urine?
Definition
A culture or sensitivity test.
Term
When can yeast be found in urine?
Definition
If a CCMS was not done correctly. Yeast is not a urinary tract infection.
Term
What type of people have higher chances of yeast infections (of course not in the urinary tract)?
Definition
Diabetics, prolonged antibiotic use, Estrogens for ERT or OCA.
Term
What is the most common protozoa seen in urine?
Definition
Trichomonas vaginalis.
Term
When can protozoa's be seen in the urine?
Definition
Protozoa are not seen in the urine so this is seen with an incorrectly done CCMS and the urine must be freshly voided and warm.
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