2 OTHER NON-BLOOD SPECIMENS

• Other non-blood specimens

  • Semen
  • Cerebrospinal fluid
  • Synovial fluid
  • Serous fluid
  • Amniotic fluid
  • Gastric fluid
  • Sputum
  • Buccal swabs
  • Saliva
  • Hair
  • Breath
  • Tissue samples
• Semen


  To evaluate fertility and post vasectomy procedures
• Semen collection

  1. Abstain from sexual activity for 3-5 days before collecting

  2. Collected at the laboratory in a warm sterile container

  3. Collected by the male patient, not the doctor or medical technologist

  4. Not collected in a condom

  5. If collected at home, must be kept warm and delivered to the lab within 1 hour
• Semenalysis


  Test we do for semen
• Semenalysis procedure

  1. Record time of sample collection and receipt

  2. Wait 1 hour minimum before testing to allow liquefaction

  3. Keep sample at 37 degrees Celsius
• Normal semen analysis values

  • Volume: 2-5 mL
  • Viscosity: Pours in droplets
  • pH: 7.2-8.0
  • Sperm concentration: > 20 million/mL
  • Sperm count: > 40 million/mL
  • Motility: > 50% within 1 hour
  • Quality: > 2.0
  • Morphology: > 14% normal forms (Strict Criteria), > 30% normal forms (Routine Criteria)
  • Round cells: < 1.0 million/mL
• Cerebrospinal fluid (CSF)


  To diagnose meningitis, subdural hemorrhage, and other neurological disorders
• CSF


  • Surrounds the brain and spinal cord to supply nutrients
  • Removes metabolic waste
  • Produces a barrier to cushion the brain and spinal cord against trauma
• CSF collection

  1. Routinely collected by lumbar puncture

  2. Physician will collect CSF
• Routine tests performed on CSF

  • Cell counts
  • Chemistry tests (Chloride, Glucose, Total protein)
  • No red blood cells should be present
• CSF sample collection

  1. Sterile tubes numbered 1-3 or 1-4

  2. Tube 1: Chemistry and Immunology

  3. Tube 2: Microbiology

  4. Tube 3: Hematology

  5. Tube 4: Hematology

  6. CSF should be kept at room temperature, delivered to lab stat, and analyzed immediately
• CSF fluid appearance and causes

  • Crystal clear: Normal
  • Hazy, turbid, milky, cloudy: WBCs, microorganisms, protein (Meningitis)
  • Oily: Radiographic contrast media
  • Bloody: RBCs (Hemorrhage, traumatic tap)
  • Clotted: Protein, clotting factors (Disorders affecting blood-brain barrier)
  • Pellicle: Protein, clotting factors (Disorders affecting blood-brain barrier)
  • Xanthochromic: Hemoglobin, bilirubin, carotene, protein, melanin (Old hemorrhage, lysed cells from traumatic tap, elevated serum bilirubin, meningeal melanosarcoma)

  
• Synovial fluid


  Clear, pale-yellow, viscous fluid that lubricates and decreases friction in movable joints
• Synovial fluid

  • Normally occurs in small amounts but increases with inflammation (Arthritis)
  • Collected to identify or differentiate arthritis, gout, and other inflammatory conditions
• Synovial fluid collection

  1. Collected by the doctor through arthrocentesis, usually from the knee joint

  2. Collected in 3 tubes: EDTA/Heparin, sterile, and non-additive
• Normal synovial fluid parameters

  • Volume: < 3.5 mL
  • Color: Colorless to pale yellow
  • Clarity: Clear
  • Viscosity: Able to form string 4-6 cm long
  • Leukocyte count: < 200 cells/uL
  • Neutrophils: < 25% of differential
  • Crystals: None present
  • Glucose difference from plasma: < 10 mg/dL
  • Total protein: < 3 g/dL

  
• Serous fluid


  Pale-yellow, watery, serum-like fluid found between the double-layered membranes enclosing the pleural, pericardial, and peritoneal cavities
• Serous fluid


  • Lubricates the membranes and allows them to slide past one another with minimal friction
  • Normally present in small amounts, but volumes increase with inflammation, infection, or decreased serum protein levels
• Serous fluid collection

  Collected by the physician in 4 tubes: EDTA, Heparin/Sodium Fluoride, non-anticoagulant, and sterile heparinized
• Amniotic fluid


  Clear, almost colorless to pale yellow fluid that fills the membrane (amnion or amniotic sac) that surrounds and cushions a fetus in the uterus

  
• Amniotic fluid collection

  1. Preferably collected after 15 weeks of gestation

  2. Obtained by the physician using transabdominal amniocentesis

  3. Can be analyzed to detect genetic disorders, hemolytic disease, and fetal lung maturity

  4. Amniotic fluid creatinine levels used to estimate gestational age

  5. Amniotic fluid is normally sterile and must be collected in a sterile container

  6. Specimens for chromosome analysis kept at room temperature, other specimens kept on ice
• Alpha-fetoprotein (AFP)


  An antigen normally present in the human fetus that is also found in amniotic fluid and maternal serum
• AFP testing is initially performed on maternal serum, and abnormal results are confirmed by amniotic fluid analysis
• Amniocentesis


  • Can be analyzed to detect genetic disorders such as Down's syndrome
  • Identify hemolytic disease resulting from blood incompatibility between the mother and fetus
  • Determine gestational age
• Most Common Reasons for Amniocentesis

  • Detect problems in fetal development
  • Assess fetal lung maturity
• Amniotic fluid creatinine levels

  • Used to estimate gestational age of the developing fetus
  • Amniotic fluid is normally sterile and must be collected in a sterile container
  • Aluminum foil or carbon paper (alternative)
  • The specimen should be protected from light to prevent breakdown of bilirubin and delivered to the laboratory ASAP
  • Specimens from chromosome analysis must be kept at room temperature
  • Specimens for some chemistry tests must be kept on ice (or refrigerator temperature)
• Alpha-Fetoprotein (AFP)


  • An antigen normally present in the human fetus that is also found in amniotic fluid and maternal serum
  • AFP testing is initially performed on maternal serum, and abnormal results are confirmed by amniotic fluid AFP testing
  • Can also be seen in adults also, but in very small amounts; marker for liver disorder
  • Abnormal AFP levels can indicate problems in fetal development (such as neural tube defects or the potential for Down's syndrome)
  • Neural tube defects - precursor to the brain and spinal cord
• Fetal Lung Maturity


  • Can be assessed by measuring the amniotic fluid levels of substances called phospholipids, which act as surfactants to keep the alveoli of the lungs inflated
  • Results are reported as a lecithin-to-sphingomyelin (L/S) ratio
  • Lungs are most likely to be immature if the L/S ratio is less than 2
  • Amniotic fluid testing to assess fetal lung maturity may be ordered on or near the patient's due date and is often ordered stat when the fetus is in distress
• Gastric Fluid

  Stomach Fluid
• Gastric Analysis


  Examines stomach contents for abnormal substances and measures gastric acid concentration to evaluate stomach acid production
• Basal Gastric Analysis

  1. Aspirating a sample of gastric fluid by means of a tube passed through the mouth and throat (oropharynx) or nose and throat (nasopharynx) into the stomach after a period of fasting tested to determine acidity prior to stimulation

  2. Fasting sample (patient should not have eaten for a certain period of time)

  3. First collected

  4. After the basal sample has been collected, a gastric stimulant, commonly histamine or pentagastrin, is administered intravenously and several more gastric samples are collected at timed intervals

  5. All specimens are collected in sterile containers
• Role of the phlebotomist in Basal Gastric Analysis

  • Help label specimens
  • Draw blood for serum gastrin (a hormone that stimulates gastric acid secretion) determinations
• Sputum


  • 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)
  • Acid Fast Bacillus (AFB) - the microbe that causes TB
  • AFB Culture - the sputum test for TB
  • Sputum - thick and sticky
  • Saliva - thin and watery
  • Patient will collect this sample themselves
  • Preferred specimen collection: First morning (at least 1 hour after meal) or Random specimen is good enough (at least 1 hour after meal or before any meal)
• Sputum Collection Procedure

  1. The patient must first remove dentures (if applicable)

  2. Rinse his or her mouth and gargle with water to minimize contamination with mouth flora and saliva

  3. The patient is instructed to take three or four slow, deep breaths, inhaling to full capacity and exhaling fully, then to cough forcefully on the last breath and expectorate (cough up and expel sputum) into a special sterile container

  4. The process is repeated until a sufficient amount of sputum is obtained
• A minimum of 3-5 mL of sputum is typically required for most tests
• Sputum specimens are transported at room temperature and require immediate processing upon arrival in the laboratory to maintain specimen quality
• Buccal Swabs


  • A less invasive, painless alternative to blood collection for obtaining cells for DNA analysis
  • The phlebotomists collects the sample by gently massaging the mouth on the inside of the cheek with a special swab
  • DNA is later extracted from cells on a swab
  • Often, these samples are collected for legal purposes such as paternity testing: therefore, follow strict COC protocol
• Saliva


  • Fluid secreted by glands in mouth
  • Used to monitor hormone levels and detect alcohol and drug abuse (recent drug use)
  • Marker for recent drug use
  • Saliva specimens for hormone tests, however, are typically frozen to ensure stability and sent to a laboratory for testing
• Hair (and Nails)


  • Collected for trace an heavy metal analysis and the detection of drugs of abuse
  • Use of hair samples for drug testing is advantageous because hair is easy to obtain and cannot be easily altered or tampered with (unlike urine and saliva)
  • Hair shows evidence of chronic drug use rather than recent use
  • Ample size is grams
  • Scalp hair
• Breath


  • Collected and analyzed for hydrogen content in one type of lactose tolerance tests and to detect the presence of Helicobacter pylori (H. pylori)
  • Collected by the patient but assisted by a medical technologist