Analysis of urine and
other body fluids (AUBF)
Clinical Microscopy
Urine and other Body Fluids
◦Semen
◦Synovial Fluid
◦Serous Fluid
◦Amniotic Fluid
◦Feces
◦Vaginal Secretions
Biologic Hazards
◦Potentially harmful to human
◦They may contain infectious agents such as bacteria, fungi,
virus, or parasites.
Infection Control
◦Procedures that will control and monitor infections occurring
within the facility
Standard Precaution
◦Standard set of guidelines to prevent the transmission of
pathogens from exposure
Means of transmission

Unprotected host touch the patient,
specimen or Contaminated object.

Inhalation of dried aerosol particles
circulating in air currents or attached to dust particles.

Host inhales material from reservoir (aerosol droplet
droplet from a patient).

Ingestion of contaminated substance (food, water).

From an animal or insect bite.
Chain of Infection
o Blood, Body Fluids, secretions, excretions, contaminated
items
3. Mouth, Nose, and Eye Protection
o Mucus membrane protection, sprays, aerosols
4. Gown
5. Patient Care Equipment
o Dispose or sterilize as per protocol
6. Environmental Control
o Cleaning and disinfection of surfaces
7. Linen
o Prevent exposure when handling
8. Occupational Health and Blood-borne pathogens
o No needle recapping
9. Patient Placement
o Isolation if needed
10. Respiratory hygiene or Cough Etiquette
Occupational Exposure to Blood-borne
Pathogens Standard
Monitored by OSHA (Occupational Safety and Health
Administration)
1) All employees practice UP and SP
2) Employer provides gowns, coats, face and respiratory
protection, gloves
and laundry facilities for non-disposables
3) Provides sharps disposal, prohibits needle recapping
4) Prohibits eating, drinking, smoking, applying cosmetics
in work area
5) Label all hazardous materials
6) Provide free immunization for HBV
7) Establish daily disinfectant protocol
8) Household bleach 1:10
9) Provide medical follow-up for workers exposed to bloodborne pathogens
10) Document regular employee safety training
Safety hazards
Radioactive Hazards
• Radioisotopes in lab
• Slight danger in lab
• Symbol on doors
• Radiographers wear badges to measure exposure
• Pregnancy: avoid areas with this symbol
Regulations and Guidelines
UNIVERSAL PRECAUTIONS (UP)
◦1987, blood-borne pathogens (HIV, HBV)
◦Gloves and face shields with visibly bloody specimens
BODY SUBSTANCE ISOLATION (BSI)
◦Puncture-resistant containers
◦All body fluids and moist body substances
◦Gloves at all times; did not stress hand washing
Standard precaution
1. Hand Hygiene: hand washing + Alcohol-based antiseptic
cleansers
o Immediately after removing gloves
2. Gloves
Electrical Hazards
• Avoid water and fluid contact
• Do not operate equipment with wet hands
• Observe for frayed cords, overloads; report
• Unplug and dry wet equipment
• Equipment grounded with three-prong plugs
Electrical Shock Accident
✔ Do not touch person
✔ Remove electrical source
✔ Turn off circuit breaker
✔ Unplug equipment
✔ Move equipment using wood or glass
❖Must be nonconductive
Fire/Explosive Hazards
JCAHO requires evacuation routes and detailed plan
RACE
◦Rescue: anyone in danger
◦Alarm: activate
◦Contain: close affected area doors
◦Extinguish: if possible, or exit
Physical Hazards
• Running in rooms and hallways
• Wet floors
• Lifting heavy objects
• Long hair not pulled back
• Dangling jewelry
• Open-toed shoes
NFPA Hazardous material symbol
Quality assessment (QA)
Overall process of guaranteeing quality patient care
Regulated throughout the total testing system.
Composed of:
1. Quality Control – testing of control samples prior to testing.
2. Pre-examination variables – specimen collection, handling,
and storage
3. Examination variables – reagent and test performance,
instrument calibration and maintenance, personnel
requirements and technical competence.
4. Post-examination variables – reporting of results and
interpretation.
Quality control
-Internal QC
-External QC
-Electronic QC
-Proficiency Testing (External Quality Assessment)
Pre-examination variables
“Pre-Analytical Phase”
- Occurs before the actual testing of the specimen
- Test Request Form
- Patient preparation
- Timing of collection
- Manner of specimen collection
- Handling and Storage
Types of Fire Extinguisher
Policy for handling specimens
DO NOT ASSUME - DO NOT ASSUME any information about
the specimen or patient.
DO NOT RELABEL - Do NOT RELABEL an incorrectly labeled
specimen.
DO NOT DISCARD - DO NOT DISCARD the specimen until
investigation is complete.
Leave - Leave the specimen EXACTLY as you received it, put
in the refrigerator for preservation until errors can be solved.
Notify - Notify the floor/nursing station/doctor’s office of
problem and why must it be corrected for analysis to continue.
Identify - Identify problem on specimen requisition with date,
time and your initials.
Make - Make person responsible for specimen collection
participate in solution of problem(s). Any action taken should
be documented on the requisition slip.
Report - Report all mislabeled specimens to the appropriate
supervisor.
Examination variables
-“Analytical Phase”
-Reagents and Type of Water (Deionized, distilled, or clinical
laboratory reagent water)
-Instrumentation and Equipment
-Testing Procedures
-Quality Control – monitor the accuracy, precision, and
reliability of results
• Ultrafiltrate of plasma, formed by the kidneys.
• Reabsorption of water and filtered substances essential to
body function converts 170,000 ml of filtered plasma to the
average daily urine output of 1200ml.
Urea
• Primary organic component Product of protein and amino
acid metabolism.
• Product of protein and amino acid metabolism.
Post-examination variables
-“Post Analytical Phase”
- Reporting of results
-Delivery of results
- Interpretation of results
Errors in the laboratory
PRE-EXAMINATION
􏰀 Patient misidentification
􏰀 Wrong test ordered
􏰀 Incorrect specimen collection
􏰀 Insufficient specimen volume
􏰀 Delayed transport of specimen
􏰀 Incorrect storage or preservation
EXAMINATION
􏰀 Sample misidentification
􏰀 Erroneous instrument calibration
􏰀 Reagent deterioration
􏰀 Poor testing technique
􏰀 Instrument malfunction
􏰀 Interfering substances present
􏰀 Misinterpretation of quality control data
POST EXAMINATION
􏰀 Patient misidentification
􏰀 Poor handwriting
􏰀 Transcription error
􏰀 Poor quality of instrument printer
􏰀 Failure to send report
􏰀 Failure to call critical values
􏰀 Inability to identify interfering substances
URINALYSIS
History
-Early civilization (Egyptian hieroglyphs) where people are
shown examining a bladder-shaped flask of urine.
-Middle Ages: physicians concentrated their efforts on the art of
Uroscopy.
-Color charts have been developed that describes the
significance of 20 different urine colors.
-Chemical testing: “ant testing” and “taste testing” for glucose.
Boiling urine for the presence of albumin.
-17th century: development of microscope led to the
microscopic examination of urine.
Why is Urine tested?
>Urine is readily available and easily collected.
>Urine contains information, which can be obtained by
inexpensive laboratory tests, about many of the body’s major
metabolic functions.
>“Urinalysis is the testing of urine with procedures commonly
performed in an expeditious, reliable, accurate, safe, and costeffective manner”.
- CLSI (Clinical and Laboratory Standards Institute)
URINE
Chloride
• Primary inorganic component found in combination with
sodium.
• Found in combination with sodium.
Creatinine
• From creatine metabolism by muscles.
Uric Acid
• Nucleic acid breakdown in food and cells
Sodium, Potassium
Phosphate, Calcium
Ammonia
Normal Urine volume:
1200 – 1500ml (600 – 2000ml)
OLIGURIA
o Decrease in Urine Output
o Infants: <1ml/kg/hr
o Children: <0.5ml/kg/hr
o Adults: <400ml/day
ANURIA
o Cessation of urine flow
o May be a result of any serious damage to the kidneys or from
a decrease in the flow of blood in the kidneys
POLYURIA
o Increase in Urine Output
o Children: >2.5-3.0 ml/kg/hr
o Adults: >2.5 L/day
NOCTURIA
o Increase in nocturnal excretion of urine
o Diabetes mellitus
o Diabetes insipidus
DIABETES
DIABETES MELLITUS
o Decreased insulin or decreased function of insulin
o Increased in glucose
o Increased specific gravity of urine
DIABETES INSIPIDUS
o Decreased production or function of ADH
(Adrenocorticotropic hormone/ vasopressin)
o Decreased specific gravity of urine
Urine collection
CONTAINERS
• Clean, dry, leak-proof
• Disposable or washable containers
• Wide mouthed to facilitate collections from female patients
and a wide flat bottom to prevent overturning.
• Clear material to allow determination of color and clarity
• Recommended capacity: 50ml
LABELS
•Labeled properly with patient’s name and identification
number
•Date and time of collection
•Additional information: age, sex, location of health care
provider
•Attached to the container not the lid.
REQUISITIONS
• Manual or Computerized
• Accompany the specimens delivered to the laboratory
• Method of collection or type of specimen
• Time the specimen is received in the laboratory.
Specimen rejection
1. Specimens in unlabeled containers
2. Non-matching labels and requisition forms
3. Specimens contaminated with feces or toilet paper
4. Containers with contaminated exteriors
5. Specimens of insufficient quantity
6. Specimens that have been improperly transported.
NOTE: Never discard a specimen before checking with a
supervisor.
Specimen integrity
◦ Urine specimens should be delivered to the laboratory
promptly and tested within 2 hours
◦ If specimen cannot be delivered and tested within 2 hours, it
should be refrigerated or have an appropriate chemical
preservative
◦ Refrigeration at 2-8 C
◦ Chemical preservatives: Boric Acid, Formalin, Sodium fluoride
NOTE: Specimens must be returned to room temperature
before chemical testing by reagent strip.
Types of Specimen
Purpose
Routine Screening
Routine screening,
Pregnancy tests, Orthostatic
proteinuria
24-hour or timed
Quantitative chemical
test
Catherized
Bacterial culture
Mid stream clean-catch
Routine screening, bacterial
culture
Suprapubic Aspiratiton
Bladder urine for bacterial
culture, cytology
Three-glass collection
Prostatic infection
Type of Specimen
Random
First morning
Drug specimen collection
Urine collection is the most vulnerable part of drug-testing
program.
Chain of Custody (COC)
◦ the process that provides documentation of proper sample
identification from the time of collection to the receipt of
laboratory results.
Volume: 30-45 ml
Collections:
◦ Witnessed – same-gender collector will observe the
collection
◦ Unwitnessed
Urine analysis
Physical examination
>Urine color, clarity, specific gravity
Chemical examination
>Different chemical composition of urine
>Glucose
>Protein
Microscopic examination
>Detect and identify insoluble materials
>Cells
>Urinary Sediments