OUR LADY OF FATIMA UNIVERSITY
MLSP112
COLLEGE OF MEDICAL LABORATORY SCIENCE
SECOND SEMESTER - MIDTERMS
NON-BLOOD SAMPLES (URINE)
URINALYSIS
Magnesium
0.1g
URINALYSIS - Testing of urine with procedures commonly
performed in an expeditious, reliable, safe, and cost-effective
manner.
Calcium
0.3g
REASONS FOR URINALYSIS
Diagnostic of disease
Screening asymptomatic populations for undetected
disorders
Monitoring progress of disease and effectiveness of
therapy
URINE FORMATION
Ultrafiltrate of Plasma
Formed at Kidneys
Average Daily output is 1200mL – 1500mL.
Occurs as chloride,
sulfate, phosphate
salts
Occurs as chloride,
sulfate, phosphate
salts
URINE COLLECTION
-
Remember that Urine is classified as a BIOHAZARD.
Observe Standard Precautions
Requisition Forms are required.
Containers for routine urinalysis:
o Clean and Dry (sterile)
o Leak proof
o Screw top lids
o Should have a wide mouth.
o Made of clear material
o Recommended capacity: 50 mL.
o Labelled. (Attached to CONTAINER, not
the lid)
TERMINOLOGIES RELATED TO URINE OUTPUT
NORMAL DAILY OUTPUT – 1200 – 1500mL. (600-2000
also considered normal)
OLIGURIA – Decreased Urine Output: 400mL/day (Adults);
occurs at excessive water loss.
TYPES OF URINE SPECIMENS AND THEIR
PURPOSES
ANURIA – cessation of urine flow; suggests severe kidney
damage.
NOCTURIA – Increased excretion of urine during night.
MOST COMMON – Random Urine
POLYURIA – increased Urine Output: >2.5L/day (Adults)
MOST PREFFERED – First Morning, because it is more
concentrated.
URINE COMPOSITION
Urine is normally 95% water and 5% Solutes (Organic and
Inorganic)
ORGANIC SOLUTES IN URINE (24-HOUR SPECIMEN)
SOLUTE
AMOUNT
REMARK
UREA
25.0 – 35.0g
60-90% Nitrogenous
material (protein
metabolism)
CREATININE
1.5g
Derived from
creatine (muscle
metabolism)
URIC ACID
0.4 – 1.0g
Common component
of Kidney Stones
HIPPURIC ACID
0.7g
Derived from
Benzoic Acid
OTHERS
2.9g
INORGANIC SOLUTES IN URINE (24-HOUR
SPECIMEN)
SOLUTE
AMOUNT
REMARK
NaCl
15.0g
Principal salt
Potassium
3.3g
Occurs chloride,
sulfate, phosphate
salts
Sulfate
2.5g
Derived from
aminoacids
Phosphate
2.5g
Serves as buffers in
blood
Ammonium
0.7g
Derived from protein
and glutamine
metabolism
24 HOUR SPECIMEN
-
For Quantitative Measurements
Patients are given large container with preservative.
Container is stored at 2-8°C.
SUPRAPUBIC ASPIRATION
-
Commonly done on pediatrics
Needle is introduced through abdomen into bladder.
CATHETERIZED
-
Collected under sterile conditions by passing a
sterile hollow tube through the urethra into the
bladder.
MIDSTREAM CLEAN-CATCH
-
Alternative to catheterized specimens
Less traumatic
Less contaminated by epithelial cells and bacteria.
TOMAS, C.M. BSMLS 1-Y2-3
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PRINCIPLES OF MEDICAL LABORATORY SCIENCE PRACTICE 2
URINE DRUG SAMPLE COLLECTION
-
Sample collection is the most vulnerable part of the
Drug Testing.
Phlebotomist must ensure that no tampering of the
specimen was done by the patient.
-
-
Types of Tampering:
o Adulteration
o Substitution
o Dilution
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.
COLOR
CHAIN OF CUSTODY – Documentation of Sample
Handling. It must be properly documented.
URINE DRUG SAMPLE COLLECTION
May be “witnessed” or “unwitnessed.”
If witnessed, a same-gender collector will observe
the collection.
30 – 45mL of Urine is collected
Temperature, pH, color, and specific gravity of urine
will be tested immediately.
Colorless
Pale yellow
Recent fluid
consumption
Polyuria or
diabetes
insipidus
Dilute random
specimen
Diabetes mellitus
Ideal Temp (32.5 – 37.7°C)
Urine pH of greater than 9 suggests adulteration.
Specific Gravity less than 1.005 suggest dilution.
URINE SPECIMEN HANDLING AND STORAGE
-
CAUSE
Bilirubin
Specimen should be delivered and tested within 2
hours.
URINE PRESERVATIVES
PRESERVATIVE
ADVANTAGE
DISADVANTAGE
Refrigeration
Doesn’t
Raises Specific
(2-8°C)
interfere with
Gravity,
chemical tests
Precipitates
Urates
and Phosphates
Toluene
Doesn’t
Floats on surface
interfere with
of specimens and
routine tests
clings to
pipettes and
testing materials
Sodium fluoride
Ideal for drug
Inhibits Reagent
testing
Strip Tests
Formalin
Preserves
Interferes with
Sediments
Chemical Tests
Phenol
Doesn’t
Causes odor
interfere routine
change
test
Dehydration
B complex
vitamins
Dark yellow
Concentrated
specimen
Nitrofurantoin
Acriflavine
Phenindione
Orange yellow
PHYSICAL EXAMINATION OF URINE
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 color: pale yellow, yellow, dark yellow, and
amber.
Yellow color of urine is caused by the presence of a
pigment called urochrome.
Care should be taken to examine the specimen
under a good light source, looking down through a
container against a white background.
ABNORMAL URINE COLOR
Dark Yellow or Amber – presence of the abnormal
pigment bilirubin
Yellow orange – administration of phenazopyridine
(Pyridium) or azo-gantrisin compound to persons
with urinary tract infections.
Phenazopyridine
(Pyridium)
Yellow green
Green
Blue green
Bilirubin oxidized
to biliverdin
Pseudomonas
infection
Clorets
Methocarbamol
(Robaxin)
Amitriptyline
Indican
CORRELATION
Commonly
observed with
random
specimens
Increased 24hour volume
specific gravity
Recent fluid
consumption
Elevated specific
gravity and
positive glucose
test result
Yellow foam
when shaken
and positive
chemical test
results for
bilirubin
Fever or burns
May be normal
after strenuous
exercise or in
first morning
specimen
Antibiotic
administered for
urinary tract
infections
Negative bile test
results and
possible green
fluorescence
Anticoagulant,
orange in
alkaline urine,
colorless in acid
urine
Drug commonly
administered for
urinary tract
infection
Colored foam in
acidic urine and
false negative
chemical test
result for bilirubin
Positive urine
culture
None
Muscle relaxant,
may be greenbrown
Antidepressant
Bacterial
infections,
intestinal
disorders
TOMAS, C.M. BSMLS 1-Y2-3
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PRINCIPLES OF MEDICAL LABORATORY SCIENCE PRACTICE 2
Phenol
Methylene blue
Pink
Red blood cells
Hemoglobin
Menstrual
contamination
Red
Beets
Myoglobin
Rifampin
Port wine
Porphyrins
RBCs oxidized to
methemoglobin
Red brown
Myoglobin
Brown
Homogentisic
acid
(Alkaptonuria)
Malignant
melanoma
Metronidazole
(Flagyl)
Black
Argyrol
(antiseptic)
Phenol
derivatives
Melanin or
melanogen
Methyldopa or
levodopa
When oxidized
Fistulas
Cloudy urine with
positive chemical
test results for
blood and RBCs
visible
microscopically
Clear urine with
positive chemical
test results for
blood;
intravascular
hemolysis
Cloudy specimen
with our RBCs,
mucus, and clots
Alkaline urine of
genetically
susceptible
persons
Clear urine with
positive chemical
test results for
blood; muscle
damage
Tuberculosis
medication
Negative test for
blood, may
require additional
testing
Seen in acidic
urine after
standing; positive
chemical results
for blood
Clear urine with
positive chemical
test results for
blood; muscle
damage
Seen in alkaline
urine after
standing; specific
tests are
available
Urine darkens
understanding
and reacts with
nitroprusside and
ferric chloride
Darkens on
standing,
intestinal and
vaginal infections
Color disappears
with ferric
chloride
Interfere with
copper reduction
tests
Oxidation
product of the
colorless pigment
Antihypertensive
CLARITY
Clear
Hazy
Cloudy
Turbid
Milky
TERM
No visible particulates, transparent
Few particulates, print easily seen through
urine
Many particulates, print blurred through urine
Print cannot be seen through urine
May precipitate or be clotted
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.
ODOR
Freshly voided urine: faint aromatic odor
Causes of unusual orders include bacterial
infections, which cause a strong unpleasant odor
similar to ammonia, and diabetic ketones, which
produce a sweet or fruity odor.
ODOR
Aromatic
Foul, ammonialike
Fruity, sweet
Maple syrup
Mousy
Rancid
Sweaty feet
Cabbage
Bleach
CAUSE
Normal
Bacterial decomposition, urinary
tract infection
Ketones (diabetes mellitus,
starvation, vomiting)
Maple syrup urine disease
Phenylketonuria
Tyrosinemia
Isovaleric acidemia
Methionine malabsorption
Contamination
CHEMICAL EXAMINATION OF URINE
REAGENT STRIPS
Consists of a chemical impregnated absorbent pads
attached to a plastic strip.
Color-producing chemical reaction takes place
when the absorbent pad comes in contact with
urine.
Their reactions are interpreted by comparing the
color produced on the pad with the 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 in desiccant in an opaque, tightly closed
container.
2. Store below 30 degrees Celsius; 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.
Reagents strips must be checked with both positive and
negative controls a minimum of once every 24 hours.
CLARITY
Refers to the transparency or turbidity of a urine
specimen.
Common terminology used to report clarity includes
clear, hazy, cloudy, turbid, and milky.
TOMAS, C.M. BSMLS 1-Y2-3
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