Non-blood

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• Non Blood Specimens


  Specimens other than blood such as urine, amniotic fluid, saliva, semen, sputum, etc.
• Phlebotomists


  • They should be familiar with the proper handling procedures to ensure the integrity of the specimens in order to produce accurate results
• Urine


  Consists of urea and other organic and inorganic chemicals dissolved in water
• Urine


  • 95% water and 5% solutes
  • Urine volume depends on the amount of water that the kidneys excrete
  • Factors that influence urine volume includes: fluid intake, variations in the secretion of antidiuretic hormone, and need to excrete increased amount of dissolved solids (glucose and salts)
  • Normal daily urine output: 1200-1500 mL
  • Range of 600-2000 mL is considered normal
• Specimen Collection


  1. Gloves should be worn at all times when in contact with the specimen

  2. All specimens must be labeled properly with the patient's name and identification number, the date and time of collection, and additional information such as the patient's age and location and the healthcare provider's name, as required by institutional protocol

  3. Requisition form must accompany specimens delivered to the laboratory

  4. Clean, dry, leak-proof containers, screw top lids, wide mouth, clear - Disposable containers are recommended - Recommended capacity of the container is 50mL, which allow 12 mL of specimen needed for microscopic analysis

  
• Reasons for Rejecting Specimen

  • specimens in unlabeled containers
  • nonmatching labels and requisition forms
  • specimens contaminated with feces or toilet paper
  • containers with contaminated exteriors
  • specimens of insufficient quantity
  • specimens that have been improperly transported
• Specimen Handling


  1. specimens should be delivered to the laboratory promptly and tested within 2 hours

  2. a specimen that cannot be delivered and tested within 2 hours should be refrigerated or have an appropriate chemical preservative added
• Specimen Preservation


  • Refrigeration
  • Boric acid
  • Formalin (Formaldehyde)
  • Sodium fluoride
• Types of Specimens


  • Random Specimen
  • First Morning Specimen
  • 24 hour Specimen (Timed specimens)
  • Catheterized Specimen
  • Midstream Clean-Catch Specimen
  • Suprapubic Aspiration
  • Three Glass Collection

  
• Color


  Color of urine varies from almost colorless to black. These variations may be due to normal metabolic functions, physical activity, ingested materials or pathologic conditions.
• Normal Urine Color


  • pale yellow
  • yellow
  • dark yellow
  • amber
• Abnormal Urine Color


  • Dark Yellow or amber - presence of the abnormal pigment bilirubin
  • Yellow-orange – administration of phenazopyridine (Pyridium) or azo-gantrisin compounds to persons with urinary tract infections
  • Red - presence of blood
  • Brown urine containing blood - glomerular bleeding
  • Brown or black - melanin or homogentisic acid, levodopa, methyldopa, phenol derivatives, and metronidazole (Flagyl)
  • Blue/green - bacterial infections, including urinary tract infection by Pseudomonas species and intestinal tract infections resulting in increased urinary indican
• Clarity


  Refers to the transparency or turbidity of a urine specimen
• Odor


  • Freshly voided urine: faint aromatic odor
  • Causes of unusual odors include bacterial infections, which cause a strong unpleasant odor similar to ammonia, and diabetic ketones, which produce a sweet or fruity odor
• Color and Clarity Procedure

  1. Use a well-mixed specimen

  2. View through a clear container

  3. View against a white background

  4. Maintain adequate room lighting

  5. Evaluate a consistent volume of specimen

  6. Determine color and clarity
• Reagent Strips


  • Consist of chemical-impregnated absorbent pads attached to a plastic strip
  • Color-producing chemical reaction takes place when the absorbent pad comes in contact with urine
  • The reactions are interpreted by comparing the color produced on the pad with a chart supplied by the manufacturer
  • Chemical analysis of urine including pH, protein, glucose, ketones, blood, bilirubin, urobilinogen, nitrite, leukocytes, and specific gravity
• Care of Reagent Strips

  1. Store with desiccant in an opaque, tightly closed container

  2. Store below 30 degrees Celcius; do not freeze

  3. Do not expose to volatile fumes

  4. Do not use past the expiration date

  5. Do not use if chemical pads become discolored

  6. Remove strips immediately prior to use

  7. Reagent strips must be checked with both positive and negative controls a minimum of once every 24 hours
• Sediment Preparation of Urine

  1. Specimen should be examined while fresh or adequately preserved

  2. 10 and 15 mL is centrifuged in a conical tube

  3. 5 minutes at a relative centrifugal force (RCF) of 400

  4. All specimens must be centrifuged in capped tubes

  5. Sediment should remain in the tube after decantation

  6. Sediment must be thoroughly resuspended by gentle agitation
• Feces


  • Routine fecal examination includes macroscopic, microscopic, and chemical analyses for the early detection of gastrointestinal (GI) bleeding, liver and biliary duct disorders, maldigestion/malabsorption syndromes, pancreatic diseases, inflammation, and causes of diarrhea and steatorrhea
  • Normal fecal specimen contains: bacteria, cellulose, undigested foodstuffs, GI secretions, bile pigments, cells from the intestinal walls, electrolytes, and water
• Feces


  • Approximately 100 to 200 g of feces is excreted in a 24-hour period
  • Approximately 9000 mL of ingested fluid, saliva, gastric, liver, pancreatic, and intestinal secretions enter the digestive tract each day. Under normal conditions, only between 500 to 1500 mL of this fluid reaches the large intestine, and only about 150 mL is excreted in the feces
• Feces Specimen Collection


  1. Normally collected in clean, dry, wide-mouthed containers that should be sealed and sent to the laboratory immediately after collection

  2. Special containers with preservative are available for ova and parasite collection

  3. Preserved specimens can usually be kept at room temperature

  4. Large gallon containers, similar to paint cans, are used for 24-, 48-, and 72-hour stool collections for fecal fat and urobilinogen; these specimens must normally be refrigerated throughout the collection period
• Macroscopic Screening of Feces

  Color and Appearance: The first indication of GI disturbances can often be changes in the brown color and formed consistency of the normal stool. Appearance: watery consistency present in diarrhea; small, hard stools seen with constipation; and slender, ribbon-like stools, which suggest obstruction of the normal passage of material through the intestine
• Chemical Testing of Feces

  • Occult Blood: Annual testing for occult blood has a high positive predictive value for detecting colorectal cancer in the early stages
  • Guaiac-Based Fecal Occult Blood Tests: most frequently used screening test for fecal blood, based on detecting the pseudoperoxidase activity of hemoglobin
• Quantitative Fecal Fat Testing

  • Confirmatory test for steatorrhea
  • Steatorrhea (fecal fat) - Absence of bile salts that assist pancreatic lipase in the breakdown and subsequent reabsorption of dietary fat (triglycerides) produces an increase in stool fat
• Cerebrospinal Fluid


  Major fluid in the body that provides a physiologic system to supply nutrients to the nervous tissue, remove metabolic wastes, and produce a mechanical barrier to cushion the brain and spinal cord against trauma
• Cerebrospinal Fluid


  • CSF is produced in the choroid plexuses of the two lumbar ventricles and the third and fourth ventricles. In adults, approximately 20 mL of fluid is produced every hour. The fluid flows through the subarachnoid space located between the arachnoid and pia mater
  • Body maintains a volume of 90 to 150 mL in adults and 10 to 60 mL in neonates
• Cerebrospinal Fluid Specimen Collection

  1. CSF is routinely collected by lumbar puncture between the third, fourth, or fifth lumbar vertebra

  2. Specimens are obtained by a physician; most often through lumbar puncture (spinal tap)

  3. Tube No. 1: Chemistry and Immunology

  4. Tube No. 2: Microbiology

  5. Tube No. 3: Hematology (Cell counts)

  6. A Fourth tube may be drawn for the microbiology lab
• Cerebrospinal Fluid Appearance


  • Normal CSF: Clear, Crystal-clear and Colorless
  • The major terminology used to describe CSF appearance includes crystal-clear, cloudy or turbid, milky, xanthocromic, and hemolyzed/bloody
  • Xanthochromia - used to describe CSF supernatant that is pink, orange, or yellow
• Cerebrospinal Fluid


  • Reason for collection: to diagnose meningitis, subdural hemorrhage, and other neurological disorders
  • Routine tests performed on CSF: cell counts, chloride, glucose, and total protein
• Semen


  • Semen is composed of four fractions that are contributed by the testes, epididymis, seminal vesicles, prostate gland, and bulbourethral glands
  • Semen Composition: Spermatozoa 5%, Seminal fluid 60% to 70%, Prostate fluid 20% to 30%, Bulbourethral glands 5%
• Terminology used to describe CSF appearance


  • Crystal-clear
  • Cloudy or turbid
  • Milky
  • Xanthocromic
  • Hemolyzed/bloody
• Xanthochromia


  Used to describe CSF supernatant that is pink, orange, or yellow
• Cerebrospinal Fluid (CSF)


  • Reason for collection: to diagnose meningitis, subdural hemorrhage, and other neurological disorders
  • Routine tests performed: cell counts, chloride, glucose, and total protein
• Semen composition


  • Spermatozoa 5%
  • Seminal fluid 60% to 70%
  • Prostate fluid 20% to 30%
  • Bulbourethral glands 5%
• Normal sperm


  • Oval-shaped head approximately 5 µm long and 3 µm wide and a long, flagellar tail approximately 45 µm long
  • Contains a head, neckpiece, midpiece, and tail
• Semen specimen collection

  1. Collected and tested to evaluate fertility and postvasectomy

  2. When a part of the first portion of the ejaculate is missing, the sperm count will be decreased, the pH falsely increased, and the specimen will not liquefy

  3. When part of the last portion of ejaculate is missing, the semen volume is decreased, the sperm count is falsely increased, the pH is falsely decreased, and the specimen will not clot

  4. Specimens are collected following a period of sexual abstinence of at least 2 days to not more than 7 days

  5. Warm sterile glass or plastic containers should be given

  6. If the sample is collected at home, it must be kept warm and delivered to the laboratory within 1 hour

  7. Specimens should be collected by masturbation; only nonlubricant-containing rubber or polyurethane condoms should also be used to collect the specimen
• Semen specimen handling


  • The time of sample collection, and the sample receipt, must be recorded on the requisition form
  • Sample should be kept at 37°C
  • A fresh semen specimen is clotted and should liquefy within 30 to 60 minutes after collection
  • Normal semen volume ranges between 2 and 5 mL
  • pH: 7.2 to 8.0
• Normal semen


  Gray-white color, appears translucent, and has a characteristic musty odor
• Semen analysis for fertility evaluation consists of both macroscopic and microscopic examination