L10

• Urine

  • Most analyzed non-blood specimen
  • Inexpensive
  • The urine analysis also helps in:
  • Monitoring wellness
  • Determination and treatment of urinary tract infections
  • Detection and monitoring progress of treatment in metabolic diseases
  • Determines the effectiveness of an administered therapy as well as checking if the patients exhibited any therapy-related complications
• The accuracy of urine analysis results will largely depend on several factors such as:

  • collection method
  • container use
  • transportation and handling of specimen
  • timeliness of testing
• Routine Analysis

  • Frequently ordered urine test
  • Screens the patient for any urinary or systematic disorders
  • Physical analysis – color, clarity, and odor
  • Chemical analysis – pH, specific gravity, detection of bacteria, etc.
  • Microscopic analysis – urine components such as cells, crystals, and microorganisms
• Routine Analysis

  • Midstream collection
  • Recommended and ideal specimen to ensure that there is no contamination caused by genital secretions, pubic hair, or bacteria surrounding the urinary opening
  • Specimen container - clear and dry with tight-fitting lids and should be chemically cleaned
  • transported immediately or held at room temperature for 2 hours or could be refrigerated
  • protected from light
• Culture and Sensitivity (C&S)

  • Requested if the patient has symptoms of a urinary tract infection (UTI)
  • Midstream clean-catch collection which is placed in a sterile container
  • 18-24 hours
  • If a microorganism is present and identified, a sensitivity or antibiotic susceptibility test is performed to determine the most effective antibiotic that should be prescribed for treatment
• Urine Cytology Studies

  • To detect cancer, cytomegalovirus, and other viral and inflammatory diseases in the urinary system
  • Fresh clean-catch specimen
  • A smear from the cells of the lining of the urinary tract is stained using the Papanicolaou (PAP) method and examined under the microscope for abnormal cells
  • Examined immediately
  • The specimen is preserved by adding an equal volume of 50% alcohol
• Urine Drug Testing

  • Many drugs are detected in the urine but not in the blood
  • This test is performed to detect:
  • Illicit use of recreational drugs
  • Use of anabolic steroids to enhance performance in sports
  • Unwarranted use of prescription drugs
  • Also monitors therapeutic drug use to minimize the symptoms associated with the withdrawal and also confirm drug overdose
• Urine Glucose and Ketone Testing

  • Performed to screen diabetes and determine the glucose level for patients who are already diabetics
  • The urine ketone level test is used to determine if the patient is suffering from diabetic ketoacidosis
  • The color changes in the test strip are compared to a color chart to interpret the result of the test
• Urine Pregnancy Testing

  • Used to confirm pregnancy which can be detected 8-10 days from conception
  • First morning urine specimen
  • Preferred because it has the highest concentration of human gonadotropin (hCG)
• Types of Urine Specimens

  1. Random – collected at any time
  2. First morning/8-hour urine specimen – collected immediately upon waking up from an 8-hour sleep
  3. Fasting – second specimen voided after fasting (glucose monitoring)
  4. Timed – collected at specific times or pooled throughout a specific time period
  5. Tolerance test (glucose) – fasting, 1/2 hour, 1 hour, etc.
  6. 2-hour postprandial – 2 hours after a meal
  7. 24-hour – collection & pooling of all urine which is voided in 24 hours
  8. Double-voided – wait for a specific time (30 minutes) after emptying the bladder
• 24 Hour Urine Collection Procedure

  1. Empty the bladder upon waking up.
  2. Affix the label in the container and write down the time and date of the specimen collection. Start timing.
  3. Collect all urine that has been passed for the next 24 hours.
  4. If instructed, refrigerate the specimen collected all throughout the collection period.
• 24 Hour Urine Collection Procedure

  5. The urine is collected prior to bowel movement.

  6. Drink fluid as needed to avoid dehydration.

  7. Take one last void at the end of the 24-hour collection period.

  8. Make sure to seal the container before placing it in the cooler. Arrange to transport the specimen to the laboratory at the soonest possible time.
• Urine Collection Methods

  1. Regular voided - all parts
  2. Midstream - middle part
  3. Midstream clean-catch - middle part and container not touching the skin
  4. Catheterized - catheter bag
  5. Suprapubic aspiration - tube inserted in the bladder
  6. Pediatric - wee bag
• Amniotic Fluid

  • A clear and slightly yellowish liquid contained in the amniotic sac that is surrounding and cushioning the fetus during the pregnancy
  • Collected using transabdominal amniocentesis preferably 15 weeks after gestation
  • Procedure is guided by the ultrasound machine
  • 10 mL of fluid
  • Detect any genetic disorder, problem in fetal development and verify the gestational age
• Cerebrospinal Fluid

  • Liquid that surrounds brain and spinal cord
  • Used to diagnose meningitis and other disorders such as brain abscess, CNS cancer, and multiple sclerosis
  • Collected in 3 special sterile tubes:
  • First tube – chemistry and immunology test
  • Second tube – microbiology studies
  • Third tube – cell counts
• Gastric Fluid/Analysis

  • To check the contents of the stomach for abnormal substances and evaluate the production of acid by evaluating the gastric acid concentration
  • Sample is aspirated to determine acidity before the stimulation
  • A gastric stimulant is administered intravenously after the specimen collection
  • A series of collection will follow with timed intervals
• Nasopharyngeal Secretions

  • Collected and cultured to determine the presence of bacteria that causes:
  • Diphtheria – Corynebacterium diphtheriae
  • Meningitis
  • Pertussis (whooping cough) – Bordetella pertussis
  • Pneumonia
  • Collection is performed by gently inserting a dacron or sterile cotton-tipped flexible wire swab into the nose into the nasopharynx (nasal cavity and pharynx)
  • The swab is rotated and gently removed then placed in a properly labeled sterile container containing transport medium for immediate transport to the laboratory
• Saliva

  • Used to check the hormone levels and also determine alcohol and drug or substance abuse
  • The specimen needs to be frozen to ensure stability prior to the delivery to the clinical laboratory
• Semen

  • A thick yellowish-white fluid that contains sperm released during the male ejaculation
  • To evaluate the fertility
  • Assess the effectiveness of sterilization after a vasectomy procedure
  • Forensic or legal reasons such as criminal investigation involving sexual assault
  • Sterile container, kept warm and protected from light
• Serous Fluid

  • Found between the membrane that encloses that pleural, pericardial, and peritoneal cavities
  • Collected by the physician by aspiration and placed in tubes depending on the type of test
  • EDTA tubes – used for cell counts and smears
  • Heparin or sodium fluoride tubes – chemistry tests
  • Non-anticoagulant tubes – biochemical tests
  • Heparinized tubes – cultures
• Sputum

  • Used to diagnose and/or monitor lower respiratory tract infections like tuberculosis
  • Recommended to be done first thing in the morning since larger volume have accumulated overnight and at least 1 hour after meal to avoid gagging
  • The collection procedure is repeated until adequate amount is collected which is about 3-5 mL
• Sweat

  • Used to analyze the chloride content of patients under the age of 20 symptoms of cystic fibrosis (exocrine gland disorder)
  • During the sweat chlorides test, electrical stimulation in the forearm or thigh (iontophoresis) is used to transport the pilocarpine (sweat-stimulating drug) into the skin
  • The sweat is then collected, the weight is recorded and the chloride content is analyzed
• Synovial Fluid

  • Viscous fluid that lubricates movable joints
  • Determine conditions such as arthritis, gout, and other inflammatory conditions since increase in volume is attributed to inflammation
  • Collected in 3 tubes:
  • EDTA/heparin – for cell counts, ID of crystals, smear preparation
  • Sterile – culture & sensitivity
  • Non-additive – macroscopic appearance, chemistry, immunology tests, and observing the clot formation
• Buccal (Cheek) Swabs

  • Used to obtain loose cells inside the cheek for purposes of DNA analysis
  • Less invasive and painless alternative to blood collection
  • Phlebotomist collects sample by placing the swab inside the cheek and gently massages the area
• Bone Marrow

  • Examined to identify blood diseases
  • The physician inserts a large-gauge needle into the sternum (breastbone) or iliac crest (hip bone) and aspirated 1.0-1.5 mL of specimen
  • A hematology technologist makes special slides from the first marrow aspiration
• Breath Samples

  • After the collection of the baseline breath sample, the patient is asked to drink a special substance that has synthetic urea
  • Two types of testing for breath:
  • C-Urea Breath Test (C-UBT)
  • Px is asked to breath into a Mylar balloon at specific intervals
  • The breath specimens are analyzed for carbon-13 which confirms the presence of Helicobacter pylori
• Breath Samples

  • Hydrogen Breath Test
  • Helps in the detection of carbohydrate digestion problems such as lactose (milk sugar) and fructose (fruit sugar)
  • Detect bacterial overgrowth in the small intestine
  • In preparation for the test, the patient must not take antibiotics 2 weeks prior to the scheduled test
• Feces (Stool)

  • Determine gastrointestinal disorder
  • Analyze for presence of intestinal ova and parasites
  • Cultured for the presence of pathogenic bacteria and viruses
  • Check fat and urobilinogen content
  • Test for presence of occult blood
  • Collected in a clean and wide-mouth container that are sealed and sent to the laboratory after collection
• Hair

  • For trace and heavy metal analysis
  • Used to detect chronic drug abuse where hair is the preferred specimen
• Throat Swabs

  • Mostly collected to aid in streptococcal (strep) infection
  • A special kit contains a sterile polyester-tipped swab and a covered transport tube
  • The tube contains transport medium
• Tissue Specimen

  • Collected using biopsy
  • The phlebotomist should check the proper handling procedure if the specimen arrived not immersed in solution
  • In the case of genetic analysis, the tissue samples are not to be placed in formalin
  • Improper handling is costly, inconvenient, and cannot be easily repeated
• Routine Handling

  • Adhere to time limits set for delivery of specimen to the laboratory
  • Mixing tubes by inversion – usually between 3-10 inversions
  • Transporting specimens – should be transported with the stopper:
  • Avoid contact between contents and the stopper
  • Minimize agitation of the specimen
  • Aid clot formation for serum tubes
• Body Temperature

  • Specimen that precipitates or agglutinates if allowed to cool below body temperature should be transported at near body temperature which is 37 degrees C
  • The tubes should also be pre-warmed at 37 degrees C and portable heat blocks are used during transport which could hold the temperature for 15 minutes from removal from the incubator
  • A heel warmer can be used for specimen that can withstand a temperature slightly higher than 37 degrees C
  • Examples:
  • Cold agglutinin
  • Cryofibrinogen
  • Cryoglobulins
• Chilled Specimens

  • Chilling
  • Slows the metabolic process
  • Completely submerged in crushed ice and water slurry during transport and immediately tested or refrigerated
  • Examples:
  • Adrenocorticotropic hormone (ACTH)
  • Acetone
  • angiotensin-converting enzyme (ACE)
  • Ammonia
  • Catecholamines
  • Free fatty acids
  • Gastrin
  • Glucagon
  • Homocysteine
  • Lactic acid
  • Parathyroid hormone (PTH)
  • pH/blood gas (if included)
  • Pyruvate
  • Renin
• Light-Sensitive Specimens

  • The phlebotomist should wrap the tube with aluminum foil or use light-blocking amber-colored container
  • Examples:
  • Bilirubin
  • Carotene
  • Red cell folate
  • Serum folate
  • Vitamin B2
  • Vitamin B6
  • Vitamin B12
  • Vitamin C
  • Urine porphyrins
  • Urine porphobilinogen
• Criteria for Specimen Rejection

  • The collected specimen is transported to the central processing or triage for screening and prioritizing
  • The specimen are:
  • Identified
  • Logged or accessioned
  • Sorted by department and type of processing
  • Evaluated for specimen suitability which is necessary for accurate reasons
• • Criteria for specimen rejection:
  • Specimen is not identified properly
  • Hemolysis
  • Wrong tube for collection
  • Outdated tube
  • Improper handling (improper mixing)
  • Contaminated specimen
  • Insufficient specimen or “Quality Not Sufficient” (QNS)
  • Incorrect collection time
  • Exposure to light
  • Did not follow testing time limits
  • Delay or error in processing
• Delivery Time Limits

  • Transported to the laboratory immediately after collection
  • Routine blood specimen = within 45 minutes
  • For specimen that needs centrifugation = 1 hour
  • Hematology specimen with EDTA = should not be centrifuged
• Time Limit Exceptions

  • “STAT” or “Emergency”
  • Priority over all other specimen in terms of transportation, processing, and testing ○ Other exceptions to the time limit rule are as follows:
  • Blood smear from EDTA specimen
  • EDTA specimen for CBC
  • EDTA specimen for erythrocyte sedimentation rate
  • EDTA specimen for reticulocyte counts
  • Glucose test drawn in sodium fluoride tubes
  • Prothrombin time (PT)
• OSHA-Required Protective Equipment Worn when Processing Specimen

  • Includes wearing gloves to prevent contact with blood, laboratory gown, laboratory coats, and masks