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324 Cards in this Set
- Front
- Back
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What is the type of laboratory used by the campus clinic?
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Commercial laboratory like quest diagnostics.
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Name 5 indications for ordering laboratory tests?
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1. Confirmation of a clinical impression or establishment of a diagnosis. 2. Rule out a diagnosis. 3. Monitor therapy. 4. Establish a prognosis. 5. Screen for health; preventative medicine.
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What is wellness screening?
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Testing asymptomatic individuals who are basically healthy.
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What type of diseases should be screened for with a wellness screening test?
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prevalent, can be detected before clinical findings develop, are treatable, have harmful consequences if left untreated.
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What is acuracy and what is percision?
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Acuracy- Correctness. How close a test result comes to the true biologic value. Percision- reproducability, how consistant a test result is via multiple testing of the same specimen.
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What is sensitivity and specificity?
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Sensitivity- True-positive, A highly sensitive test will rule negatives out. Specificity- True-negative, A highly specific test will rule positives in.
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In order to detected a disease a tests needs maximum what?
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Sensitivity.
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If a test has a very high sensitivity what will specificity be like and what will this mean?
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specificity will probably be low, and this results in healthy people being labeled as sick.
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A good screening test will have high what?
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High sensitivity so it will catch almost all true-positives, but it will include people who are not sick.
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What type of test will have a high specificity?
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A confirmatory.
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What type of test is used when there is high clinical evidence of a disease?
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A highly specific.
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What are reference ranges?
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Patients test results are reported along with a numerical range of test values that are found in healthy individuals.
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How are reference ranges RR established?
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Testing on a large number of healthy individuals, then perform a statistical analysis and the results ideally represent a gaussian distribution.
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Where will the healthy numbers come from in a RR?
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plus or minus 2 standard deviations and this will include 95% of the healthy people so 5% of healthy people will be outliers.
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RR are of most value when?
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When there are age, gender, and population specific.
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What are the test result values given as?
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In USA- conventional units. Everywhere besides the USA- SI units or International units which are purely metric.
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What are the host factors that add variablity to test results?
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age, gender, race.
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What is a coefficient of variation (CV)?
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a statistical evaluation to determine if the variation of test results from multiple analyses of the same sample is acceptable. The lower the CV the better.
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What will make a CV high?
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Analytic variation due to methodology. So manual methods can have a CV of 10-15% and automated CV are a few %.
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Give some examples of improper patient instructions that can be sources of error in laboratory testings?
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Poor patient compliance with fasting vs. non-fasting. Collection of specimen. Exercising prior to test.
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What is a profile or panel testing?
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Collection of different tests related to a particular organ, organ system, or disease group.
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Panels or profile tests allow for what?
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Lots of tests at low costs, they help with pattern recognition.
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What is the problem with panels or profile tests?
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Each test adds an increased probability of an increased number of abnormal test results in healthy patients.
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Where are the 2 places to obtain blood for hematology?
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1. Periferal blood via venipuncture. 2. Bone marrow via bone marrow aspiration.
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Bone marrow is aka?
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Myeloid, myelogenous or intramedullary tissue.
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What is the most common type of hematologic test?
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Complete blood count CBC.
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In a CBC which cells are biggest and smallest?
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Biggest---> smallest; WBC, RBC, HGB, HCT, MCV, MCH, MCHC, RDW, Platelets.
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List WBC from largest to smallest?
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Neutrophils, Band, Lymphocytes, Monocytes, Eosinophils, Basophils.
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What is hematopoiesis?
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The formation and development of all types of blood cells from their parental precursors.
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Where will a fetus's hematopoiesis happen at?
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Starts with yolk sack then moves to liver and spleen, then axial skeleton.
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Where will an adult's hematopoiesis happen at?
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For the first few decades in the distal long bones and axial skeleton, and then later in life mainly the axial skeleton.
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What is erythropoiesis?
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Production of RBC and it is a type of hematopoiesis.
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What will the cytoplasm color be like from beginning to the end of erythropoiesis?
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It will start blue and eventually turn to orange.
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During erythropoiesis it starts with a stem cell---> progenitor cell ----> ?
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Rubriblast.
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1 Rubriblast will eventually make how many RBC?
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Many.
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How long will erythropoiesis take?
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5-6 days for bone marrow development.
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What is the nucleus like during erythropoiesis?
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It is present at the beginning and will disappear after 2-3 days.
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What is the name of the first cell during erythropoiesis that will not have a nucleus?
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Reticulocyte.
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What part of erythropoiesis will cells enter the circulating blood?
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Very promptly, even before the last maturational events have occurred as reticulocytes.
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How long will a RBC last in circulation and what will happen to it?
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120 days, senescence and destruction.
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What is the last stage of RBC maturation that occurs after the nucleus is extruded in the bone marrow?
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Reticulocyte.
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Why are reticulocytes slightly larger than Mature RBC?
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Because they are still maturing and contain residual fragments of cytoplasmic RNA and mitochondria.
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Why will reticulocytes have a different color than mature RBC's and what is the color?
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Plychromatic from fragments of mitochondria.
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When will reticulocytes finish maturing?
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1-2 days after entering the peripheral circulation.
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What % of circulating Red cells are reticulocytes?
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0.5-2.5 %.
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What are reticulocytes counts commonly used for?
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Diagnosis of various anemia and in monitoring the recovery in factor deficiency anemias.
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Will a CBC have a reticulocyte count?
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No.
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Where will erythropoietin be made at?
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Peritubular interstitial cells of the kidenys.
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When will erythropoietin be made?
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With blood loss the kidneys sense a loss of O2 and make EPO. This can also happen with chronic obstructive pulmonary disease since O2 levels will be low.
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What will EPO do?
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Increases the number of stem cells that commit to rubriblasts, and speeds up the maturation time by 20-30%. EPO also allows for early release of immature cells into peripheral circulation.
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Where is hemoglobin synthesized at?
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Within the maturing nucleated red cell within the bone marrow via a series of biochemical enzymatically driven reactions intimately involving the mitochondria.
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How is heme produced?
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when iron is enzymatically inserted inot protoporphyrin.
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How is globin produced?
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Polyribosomes produce globin chains in pairs (alpha, gamma, beta, delta).
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Each globin chain provides what?
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a site for insertion of one heme molecule.
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What will go into making 1 hemoglobin?
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four globin chains (2 pairs) and four heme molecules.
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How can different types of hemoglobin be made?
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Various combinations of pairings of globin chains produce different types of hemoglobin.
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What type of hemoglobin will fetuses make?
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F= 2 alpha, 2 gamma globulins.
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What type of hemoglobin will infants make?
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95-97% is A1- 2 alpha, 2 beta globulins. And 2-3% will be A2- 2 alpha, 2 delta globulins.
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What test can be done to determine what types of hemoglobin are present?
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Hemoglobin electrophoresis.
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How will iron be transported in the body?
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By transferrin.
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Iron is essential for what?
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Erythropoiesis.
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What % of dietary iron is absorbed and where?
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10% is absorbed via proximal small intestine.
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What happens to dietary iron not absorbed?
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Excreted in feces, and small amounts in urine.
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Where will transferrin take iron once in the plasma, and what will the iron do in these places?
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Bone marrow- hemoglobin synthesis. Muscles- myoglobin synthesis. Liver- storage.
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Name 4 tests that reflect the status of iron metabolism?
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1. Serum iron concentration (SI). 2. Total iron binding capacity (TIBC). 3. % saturation of iron (% sat or TSAT). 4. Serum ferritin concentration.
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What is the serum iron concentration (SI) test?
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the concentration of circulating iron that is bound to transferrin.
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Is SI a good test for iron metabloism why or why not?
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No there are physiological causes of altered concentrations.
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What is total iron binding capacity (TIBC)?
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An indirect assay of transferrin concentration performed by measuring the amount of iron (added in vitro) needed to totally saturate the unbound iron-binding sites on the transferrin molecules.
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Normally how many of the transferring binding sites are bound with iron?
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only 1/3.
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TIBC should not be ordered as what type of test?
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An individual test it should be ordered in combination with the SI.
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% saturation of iron test?
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Calculated value estimating the % of binding sites on transferrin that are bound with iron.
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What is needed to measure the % saturation of iron test?
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SI and TIBC.
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% saturation of iron test is much more sensitive indicator of what?
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Iron deficiency or iron overload than is SI.
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How is iron stored in the body?
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Ferritin is the body's major iron storage compound.
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Where is ferritin found at?
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In nearly every cell, but the major sites of storage are hepatocytes, spleen, and bone marrow.
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Each ferritin molecule contains how much iron?
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as many as 4,000 iron molecules.
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Ferritin that his in circulation is in direct proportion to what?
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The amount of ferritin stored in the tissues.
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OF all the tests what is the gold standard to evaluate iron storage?
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Serum ferritin.
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What type(s) of test(s) should be done to investigate iron related abnormalities?
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SI< TIBC, % sat, and serum ferritin.
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Name 3 groups of white blood cells?
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Granulocytes, lymphocytes, and monocytes.
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What are granulocytes?
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Maturation of leukocytes that contain granules so they are Neurtophils, eosinophils and basophils.
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Production and maturation of granulocytes is under what influence?
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Humoral growth factors.
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What is the difference between erythropoisis and granulopoiesis?
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With granulopoiesis stem cells commit, differentiate and accumulate into different compartments or pools both within and outside of the bone marrow.
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Where will granulocytes pool?
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about 50% are available mature granulocytes circulating.
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What else besides humoral growth factors can influence leukocyte production?
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Chemical mediators (cytokines and chemokines) released during inflammatory and immune reactions.
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Granulocytes have how long of a life span and are in circulation how long?
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They live for 9-15 days and are in circulation 7-24 hours.
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What is a band neutrophil?
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An immature form of neutrophil which is observed both within and outside of the bone marrow.
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What is a PMN?
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a mature neurtophil.
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What is shift to the left?
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Any increase in numbers of immature neurotphils in peripheral circulation.
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Shift to the left is indicative of what?
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acute infection or other cause of neutrophila.
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What is lymphopoiesis?
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Growth and maturation of lymphocytes.
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Where will lymphocytes mature at?
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within bone marrow and is mediated by a poorly understood control mechanism.
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What do lymphocytes do in circulation?
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repopulate lymph nodes and lymphatic tissue.
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Lymphocytes are conditioned by what?
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Thymus- T-lymphocytes. Bone marrow- B lymphocytes.
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T-lymphocytes and B-lymphocytes are for what?
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T- cellular immunity. B- humoral immunity.
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What are atypical lymphocytes?
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Abnormal appearing T-lymphocytes usually observed in peripheral blood of an immunologically stimulated patient, most often viral infections.
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Atypical lymphocytes are classically seen with what and are aka?
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Mononucleosis and may be known as Downey cells or reactive lymphocytes.
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What is the name of WBC when they are elevated and decreased?
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Elevated; neutrophilia, lymphocytosis, moncytosis, eosinophilia, basophilia. Decreased; neutropenia, lymphocytopenia, moncytopenia, eosinopenia, basopenia.
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What can cause neutophilia?
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physical or emotional stress, acute suppurative infeciton, myelocytic leukemia, inflammatory disorders.
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What can cause lymphocytosis?
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Chronic bacterial infections, viral infections, lymphocytic leukemias.
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What can cause moncytosis?
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Chronic inflammatory disorders, tuberculosis.
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What can cause eosinophilia?
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Parsitic infections, allergic reactions, hodgkin lymphoma.
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What can cause basophilia?
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Myeloproliferative diseases.
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What can cause neutropenia?
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dietary deficiencies (B12 and folate), some overwhelming bacterial infections, viral infections, radiation and chemotherapy.
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What can casue lymphocytopenia?
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Immunodeficiency diseases, radiation therapy.
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What can cause moncytopenia?
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Very uncommon.
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What can cause eosinopenia?
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Very uncommon.
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What can cause basopenia?
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Very uncommon.
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Is platelet count part of the CBC?
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Yes.
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What is megakaryopoiesis?
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Production of thrombocytes (platelets).
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Maturation and growth of thrombocytes is influenced by what?
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Thrombopoietin TPO, megakaryocyte growth and development factor MGDF, and same cytokines and chemokines as granulocytes.
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Name 3 tests to evaluate hematopoeiesis?
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CBC, reticulocyte count, bone marrow aspiration and biopsy.
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Are there any special times of collection or patient preparation needed for a CBC?
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No.
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What is a RBC count?
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Absolute quantification of RBCs in a unit volume of blood.
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What are the units for conventional and international for a red blood count?
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Conventional- mm^3. International- L
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How often is a Red blood cell count used alone?
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Not often not even to determine if a blood transfusion is needed.
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What is the most widely used single test used to evaluate a patient for anemia?
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Hemoglobin concentration.
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What is a hemoglobin concentration test testing?
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Direct measurment of the weight of hemoglobin in a unit volume of blood.
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What are the conventional and international units used for hemoglobin concentration tests?
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Conventional- gm/dL. International- gm/L
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What is the hematocrit test testing?
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The ratio of the volume of the RBCs after centrifugation to that of whole blood.
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Hematocrit is aka?
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crit, and packed cell volume PCV.
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What are the conventional and international units used for the hematocrit test?
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Conv- %. Internat- L/L
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How can the PCV aka hematocrit(HCT) aka crit approximate the hemoglobin (HGB)?
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Divide the HCT by 3.
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What are the RBC, HGB, HCT tests used to determine?
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Anemia, erythrocytosis, and polycythemia.
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What are the 3 types of polycythemia and what are they?
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Polycythemia vera- myeloproliferative disorder. Secondary polycythemia- hypoxia= not getting enough oxygen. Relative polycythemia- dehydration.
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Name the RBC indicies?
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mean corpuscular volume MCV, Mean corpuscluar hemoglobin MCH, Mean corpuscular hemoglobin concentration MCHC.
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What is MCV?
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Measure of the intracellular volume of the average circulating RBC. So this is the size of the average circulating RBC.
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What are the units used for MCV?
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fenta Liter.
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Name 3 types of anemias?
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microcytic, macrocytic, normocytic.
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What will the MCV test be like for the 3 types of anemia?
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Microcytic- decreased MCV. Macrocytic- Increased MCV. Normocytic- normal MCV.
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What IS THE mch USED FOR?
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Measure of the weight of hemoglobin within the average circulating RBC. It will relate to the intensity of the coloration of the RBCs when stained.
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What are the types of MCH?
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Hypochromic, normochromic, hyperchromic
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Of the 3 types of MCH which one is very uncommon?
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Hyperchromic.
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What is the MCHC?
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% of the intracellular volume of the average circulating RBC that is hemoglobin. This is essentially the same info as the MCH.
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What are the clinical applications of RBC indicies?
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To determine what type of anemia is present.
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What type of anemia is present with decreased RBC, HGB, HCT and decreased MCV, MCH, MCHC?
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microcytic and hypochromic anemia (iron deficiency).
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What would the blood tests be like for macrocytic anemia and how is this caused?
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decreased RBC, HGB, HCT and increased MCV, normal MCH and normal MCHC. This is caused by B12 and folate deficiencies.
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What would the blood tests be like for normocytic anemia and how is this caused?
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Decreased RBC, HGB, HCT and normal RBC indicies and this is caused by chronic illness.
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What is the Red cell distribution width RDW test?
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index of RBC size difference or the variability in RBC size populations.
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what type of variation in RBC is normal?
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Minimal.
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Increased RDW correlates with what?
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increased anisocytosis- variability in cell size populations done by a person looking through a microscope.
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When will a decreased RDW be given?
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It wont only increased variation.
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What tests will be used to define the presence or absence of anemia?
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RBC count, Hemoglobin concentration HGB, hematocrit HCT.
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What tests wil help to initially categorize the type of anemia?
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MCV, MCH, MCHC aka the RBC indicies.
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What is the RDW test used for clinically?
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as an early sign of developing anemia.
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What type of stain is used to look at a blood smear?
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Wright.
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Can machines report morphological variations in RBC?
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Yes with limited capability.
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What is polychromatophilia, poikilocytosis?
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Polychromatophilia a RBC that is a little bluer. Poikilocytosis is abnormal shapes of RBC.
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How will the lab report poikilocytosis?
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They shape should be given like teardrop, sickle, etc.
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When doing a vena puncture what vein should you never try to shift the needle to the side if you did not draw blood?
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Bascilic vein.
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What should you do if you are drawing blood and you notice a mound is starting to build under the skin?
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Finish the blood draw and then add lots of pressure after to avoid brusing.
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What are the different ways the lab will report microcytes?
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Few microcytes, slight microcytes, and a scale of 1-4+ microcytes.
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What is anioscytosis?
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Variable size of RBC.
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What test will be increased with anisocytosis?
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RDW.
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What test will be increased with macrocytosis?
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MCV.
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What test will be decreased with mocrocytosis?
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MCV
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What test will be decreased with hypochromia?
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MCH and or MCHC.
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What is a WBC count?
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The absolute quantification of the total number of circulating WBC.
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What are the conventional and international units for the WBC count?
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Convent- mm^3. Intern- L.
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What info is important about WBC's?
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The proportion of each, not the total leukocyte count.
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What are the 2 types of WBC differential counts and how are they done?
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Relative- performed by microscopic evaluation, and counting 100 WBC. Absolute- more accurate and is done by modern hematology instuments.
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How can absolute differential be calculated if only relative WBC differential count is given?
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Relative % X total WBC = absolute count.
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What would the diagnosis be given; WBC- 3.5 x10^3/ mm^3 (reference 4-11 x 10^3/ mm^3), neutrophils- 30% (reference 50-70%), lymphocytes 70% (reference 20-40%)?
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Neutropenia.
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What will the RBC morphology tests help to determine?
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Correlates with changes in indices and RDW, may provide specific evidence of certain hematologic abnormalities.
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WBC Count is used to determine what?
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Leukopenia or leukocytosis.
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What is the WBC differential count used for?
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Provides more specific info about underlying pathology causing altered WBC count.
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What type of test is a platelet count?
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Absolute quantification of the number of circulating thrombocytes and this test is considered a hemostatic test.
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What is the correlation of platlet function and platelet count?
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There is none.
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What are the conventional units and international units for the platelet count?
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Convet- mm^3. Inter- L
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Spontaneous bleeding can occur at what platelet count?
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40-50 X 10^3/mm^3.
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How serious is gaining platelets?
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Not very the serious part is droping down.
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What is the reference range for normal platelet count?
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150-450.
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What is the mean platelet volume (MPV)?
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This calculates the internal volume of the average circulating platelet, therefore it is the size of the average platelet.
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What may correlate with an abnormal MPV?
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Autoimmune disorders and some hematologic malignancies.
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Will the MPV be inculded in the CBC?
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Maybe but many labs do not report the MPV.
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Is a reticulocyte count part of a CBC, and what is a reiculocyte count used for?
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No. This is used to determine if the bone marrow is responding to therapy in factor deficiency anemias such as iron, folate, and vitamin B12 deficiencies.
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How is a reticulocyte count calculated?
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Count 1000 RBC and determine the # of them that are reticulocytes. Take the total amount of reticulocytes and multiply this by 100 and then divide by 1000.
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What is essential for redering a definitive diagnosis about reticulocyte count?
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Aspiration and biopsy of marrow. This would be needed for lymphoproliferative disorders such as leukemia and others.
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How is aspirated marrow studied?
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Histologicaly and cytochemically by a MD clinical pathologist.
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What happens to Hemoglobin when RBC undergo senescence?
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Heme is converted to unconjugated-bilirubin in the blood, and globin will go to the AA pool to be recyled.
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What happens to unconjugated-bilirubin?
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It is transferred to the liver and then it is converted to conjugated-bilirubin.
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What are the paths that conjugated-bilirubin can take?
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Leave the liver as bile or become part of urine and be excreted (however there is only the smallest of amounts of conjugated-bilirubin in urine).
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What happens to bile as it leaves the liver?
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It is concentrated in the gallbladder and then gets converted to urobilinogen in the intestines.
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What are the options for urogilinogen?
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It can be converted to stercobilin and be excreted in the feces. It can be recycled into the liver. It can be sent to the kidney and excreted in urine (urobilinogen is the major part of urine that comes from heme).
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What part of the heme is converted into unconjugated-bilirubin?
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The porphyrin component.
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How is unconjugated-bilirubin transported to the liver?
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By the protein albumin.
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How will the RBC count be different for pediatrics?
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It will be high 0-1 months after birth and then be low 2months-1year.
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how will the Hematocrit be different for pediatrics?
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High for the first 2 months and then low until 1 year old.
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How will the hemoglobin be different for pediatrics?
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High for the first 2 months and then low until 1 year old.
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How will the MCV be different for pediatrics?
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High for the first 6 months and then low until 1 year.
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How will the white cell count be different for pediatrics?
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High for the first 4 years.
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How will the neutrophils be different for pediatrics?
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High for the first 3 months and then normal.
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How will the lymphocytes be different for pediatrics?
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normal from 0-1 month and then high until 4 years.
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Urinalysis is a poor mans ____.
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Renal biopsy.
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What does it mean that the importance of a urinalysis is often undersold?
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It will lead to mistakes especially regarding collection and handling which can lead to errors.
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What is the pH of glomerular filtrate vs urine?
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GF-7.4. Urine- 6.0.
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What is the difference in specific gravity of glomerular filtrate vs urine?
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GF- 1.005. Urine- 1.020.
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How much glomerular filtrate is produced a day?
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180 Liters.
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How much urine is produced a day?
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1-2 liters.
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What is anuria?
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No urine output.
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What is oliguria?
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Less than 500 ml of urine produced a day.
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What is nocturia?
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more than 500 ml of urine produced a night this is not nocturnal frequency.
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What is nocturnal frequency?
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Waking up often to pee and this will not be more than 500 ml of urine all together at night unless there is also a nocturia.
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What is polyuria?
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More than 2 liters a urine produced a day.
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Who will create more urine volume an adult or child per kilogram of body weight?
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Children by 3-4 times as much.
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How often should one urinate?
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should be around 2 hours inbetween.
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What is urgency and dysuria?
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Urgency- instantly needing to pee. Dysuria- painful urination.
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Will urine odor be performed in labs?
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No.
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What is the normal description of urine odor?
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Faintly aromatic.
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Name 5 things that can cause abnormal urine odors?
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vitamins, drugs, foods (like asparagus), bacterial contamination, metabolic disorders (like diabetics).
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What is CCMS?
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Clean catch midstream specimen.
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What is the first step in a CCMS?
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Wash hands with soap and water.
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What is the second step in a CCMS?
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Clean urinary opening with a towlelette 3 times for females and once for males.
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When is the best time to take a urine sample?
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First thing in the morning due to most concentrated and bladder incubated.
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What type of urine sample is most often taken?
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Random specimen.
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Name there things that a 24 our urinary collection might be needed for?
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protein, calcium, and hormone and their metabolites.
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How long between sample and test should there be for urine?
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within 1 hour, or refrigerate or add a perservative.
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What is used to test urine and what are the results like?
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Reagent strip and results are semi-quantitative at best.
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Name 10 things that can be determined by using a reagent strip testing urine?
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pH, specific gravity, protein, glucose, ketones, urobilinogen, bilirubin, leukocyte esterase, nitrate, blood (hemoglobin).
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With capillary tubes what is the difference between blue and red tipped?
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Blue- no preservative. Red- has heparin to keep blood from clotting.
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What is the normal color of urine?
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colorless to amber yellow.
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Dark yellow urine can be caused by what?
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Concentrated urine or bilirubin which can come from dehydration or hepatobiliary.
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What can cause red urine?
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Blood, hemoglobin, food dyes, beets.
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What can cause brown urine?
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Acid hematin bilirubin.
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What can cause green urine?
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Pseudomonas from a urinary tract infection.
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Anything that makes urine hazy will come from ______.
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formed elements.
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What things will be seen with urinary infections?
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back pain, cloudy urine from hematuria, inability to urinate, frequent urinate or painful urination, malaise (general discomfort).
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What is the normal pH of urine?
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4-8 pH.
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What 3 things can cause an acidic urine?
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Western diet, ketosis, systemic acidosis.
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What are 4 things that can cause an alkaline urine?
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vegetarian/ vegan or diet high in citrus fruits, postparandial specimen (alkaline tide- kidneys getting rid of the extra bicarbonate from the pancrease after a meal.), stale unrefrigerated specimen, urinary tract infection.
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What is the specific gravity of urine used to evaluate?
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the concentration and excretory power of the kidneys.
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How is a true kidney funciton test done?
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water depravation for 16 hours prior to testing since it is easily altered by consumption.
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When would a urine sample be more concentrated?
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With decreased fluid intake, first morning specimen, with other solutes like with diabetics increased glucose, ketones and proteins.
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When would a urine sample be dilute?
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Increased fluid intake, random specimens, renal disease.
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What is the normal amount of protein in urine?
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None.
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What would protiens in the urine help us diagnose?
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Protein in the urine is the easiest and earliest way to find a kidney disease.
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What is the most common and significant protein that is found in urine?
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Albumin.
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What are the 2 types of proteinuria?
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Functional and organic.
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What is a functional proteinuria?
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Benign. Associated with fever, exposure to ectremes of heat or cold, excessive exercise, or emotional stress. It tends to be a minimal amount of protein lost.
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What is organic proteinuria?
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Proteinuria associated with demonstrabale systemic disease or renal damage and most often resulting in more than 500 mg/day.
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What are the 3 areas of origin for protein being lost?
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pre-renal, renal, post-renal.
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What would a trace, or 1+ measure of protein in urine likely mean?
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Functional problem not organic.
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What are the 3 categories of quantity of protein lost per day?
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minmal- less than .5 gm/24 hours. Moderate- 0.5-4.0 gm/ 24 hour. Marked- more than 4.0 gm/24 hours.
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What will likely cause the minimal protein loss in urine?
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exercise, stress, postural/ orthostatic, pregnancy, early effects of kidney disfunction, lower UTI.
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What will likely cause the moderate protein loss in urine?
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chronic glomerlonephritis, pyelonephritis, diabetic nephropathy, mutliple myeloma, pre-eclampsia.
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What will likely cause the marked protein loss in urine?
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Acute and chronic glomerulonephritis, diabetic nephropathy, nephrotic syndrome and nephrosis, lupus nephritis.
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What is the normal amount of glucose in the urine?
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none.
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What are the 2 types of glucosuria?
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With hyperglycemia and without hyperglycemia.
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What can cause glucosuria with hyperglycemia?
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DM, cushings syndrome, thyrotoxicosis (hyperthyroidism), exocrine pancreatic disease, drugs.
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What can cause glucosuria without hyperglycemia?
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Renal tubular disease, late (normal) pregnancy.
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What is the normal amount of ketones aka ketone bodies in the urine?
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none.
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What are the 3 types of ketones and where do they come from?
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acetoacetic acid, acetone, betahydroxybutyric acid. They are byrpoducts of fatty acid catabolism which is often due to impaired glucose metabolism.
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Name 5 things that can cause ketonuria?
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Inadequate carbohydrates in the diet, malnutrition, defect in carbohydrate metabolism, DM, Defect in carbohydrate absorption.
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What are the normal amounts of bilirubin and urobilinogen in the urine?
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Bilirubin- none. Urobilinogen- 0.1-1 ehrlich unit.
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What 2 things will cause bilirubinuria?
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Intrahepatic obstructive disorder and extrahepatic obstructive disorder.
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What is the type of bilirubin that can be excreted by the kidneys?
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Conjugated bilirubin.
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Since urobilinogen is found in urine what can make the levels go up or down?
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Up- hemolytic diseases, hepatic diseases. Down- Biliary obstruction.
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What is leukocyte esterase and what are the normal urine levels?
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White blood cells in urine and there is normaly none found in urine.
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Reagent strip turns positive in the presence of what for leukocyte esterase?
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WBC's either lysed or intact.
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Leukocyte esterase is a sensitive test for what?
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UTI.
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What can give a false positive for leukocyte esterase tests?
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vaginal contamination, conditions causing heavy mucus discharge and irritation.
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What is pyuria and what causes it?
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Pyuria is white blood cells in urine and it is caused by 3 things; 1. Inflammation within the urinary tract. 2. Infection withing the urinary tract. 3. Sterile pyuria.
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What are the catagories for things that cause sterile pyuria?
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Infective and non-infective.
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What would be under the infective and non-infective sterile pyuria?
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infective- virus, fungi, atypical organims. Non-infective- systemic and localized diseases, structural and physiologicla abnormalities, drugs, recent antibiotic use.
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What is the normal amount of nitrite in urine?
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none.
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What will cause nitrite in the urine?
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Dietary urinary nitrAte is reduced to nitrite by many urinary tract pathogens.
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Can there be urinary pathogens without nitrite in the urine?
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Yes because they require adequate time for incubation.
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How powerful is the nitrite test of urine?
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Very specific indicator of UTI, but lacks sensitivity.
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What will blood in the urine mean?
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RBC's only.
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How much blood should be in the urine?
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none.
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What is the difference between hemoglobinuria vs. hematuria?
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hemoglobinuria- presence of hemoglobin in the urine coming from the circulation. Hematuria- presence of RBC's in the urine which are leaking into the urinary tract.
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What can or cant be seen of a microscopic examinatino of the urine sediments when blood is in the urine?
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No RBC's can be seen.
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Can the terms hemoglobinuria and hematuria be interchanged?
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No, but they often are.
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What will the presence of blood in the urine require?
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Always warrents investigation into the site and cause of the bleeding.
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Where are casts formed at?
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Only in the kidneys.
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What can cause hematuria with casts and proteinuria?
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Kidney based; acute or chronic glomerulonephritis, rheumatoid disease.
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What can cause hematuria without casts?
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may or may not be kidney involvment. Vigorous exercise, urinary tract trauma, Lower urinary tract infection, hypertension, bleeding disorders, kidney stones, kidney tumors.
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How will EDTA and Hepparin prevent coagulation?
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EDTA- binds Ca2+. Hepparin- binds thrombin.
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What can the presence of ascorbic acid do to a urinalysis?
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Reduce positive or false negatives for blood, glucose, nitrite and bilirubin.
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What is the normal amount of RBC's seen in High power field (HPF)?
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0-4 per HPF.
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What can often be mistaken for RBC's while doing a microscopic evaluation of urine crystals?
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yeaste.
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What is the normal amount of WBC's seen while doing a microscopic evaluation of urine?
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0-4 per hpf.
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What will the significance be of WBC's clumping together?
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It will increase the probability that problems are coming from the kidney or bladder.
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What are the 3 types of epithelial cells found in microscopic analysis of urine? What is the normal amount seen?
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Squamous, transitional- and renal. The normal amounts for all 3 are occasional per lpf.
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Where are squamous epithelial cells derived from in the urine?
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Distal urethra and female vulva.
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What is the index of contamination for squamous epithelial cells?
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Indicates urine not collected via CCMS technique especially in women.
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Where are transitional epithelial cells derived from that are found in the urine?
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Renal pelvis to the proximal urethra.
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When would transitional epithelial cells found in the urine be significant?
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When large numbers exhibiting unusual morphology are found.
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What should be done if there are unsual morpholgy found in transitional epithelial cells?
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They should be sent for cytologic examination for malignancy.
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Where are the renal epithelial cells derived from that are seen in the urine?
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Nephron to the collecting tubules.
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What will an increased number of renal epithelial cells in the urine indicate?
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Tubular necrosis or tubular damage in a variety of renal tubular disorders.
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Of the 3 types of epithelial cells found in the urine which one is the most significant?
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Renal epithelial cells.
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Name the 2 common types of crystals found in the urine?
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Calcium oxalate crystals, uric acid.
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Most crystals found in the urine are clinically insignificant, except when?
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except crystals that appear in acidic or neutral pH urine.
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Calcium oxalate crystals in urine are related to what in your diet?
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A diet rich in oxalic acid. This is seen with high doses of ascorbic acid in certain predisposed individuals.
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Calcium oxalate crystals in urine are associated with what 2 things?
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1. Calcium urinary stones. 2. Hypercalcemia.
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Calcium oxalate crystals are seen in what pH?
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Neutral to slightly alkaline.
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Uric acid crystals are seen in urine with what type of diet?
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Food rich in purines.
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Uric acid crystals are seen in patients with what?
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Hyperuricemia.
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What is hyperuricemia?
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high levels of uric acid.
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What things will be seen with or cause hyperuricemia?
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Gout, leukemia because of rapid turnover of nucleic acid, cancer patients because of chemotherapy.
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What is amorphous sediment?
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Urate or phosphates and are of no clinical significance.
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What pH will urate and phosphate be seen in?
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Urate- acid. Phosphate- alkaline.
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Where will urinary casts come from?
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Kidney.
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What is the most observed cast in urine?
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Hyaline casts.
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What are hylaine casts made of?
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2 proteins; Tamm-horsfall protein which is a normal secretion within the tubules and IgA.
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What is the clinical significane of hyaline casts?
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when found in the absence of other types of casts or proteins there is usually no clinical significance.
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Increased numbers of hyaline casts can happen during what?
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Strenuous exercise, dehyration, heat exposure and emotional stress.
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How will RBC or hemoglobin casts come about?
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Damaged RBC's and proteins leak into urine and are concentrated and form casts.
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What is the clinical significance of RBC or hemoglobin casts?
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the presence of even just one is very significant and is most often associated with glomerulonephritis.
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How will WBC casts come about?
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WBC's mobilize to destroy bacteria and proteins usually accompany infections and the proteins percipitate forming WBC casts, but protein may be absent.
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What is the clinical significance of WBC casts?
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The presence of even just one is very significant and is most often associated with pyelonephritis.
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How are epithelial casts formed?
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When tubular epithelium is damaged due to a variety of glomerular and tubular conditions.
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What are granular casts?
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Either disintegrating white cell casts or epithelial casts.
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What is required for the formation of granular casts?
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Significant urine statis within the tubules.
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What are waxy casts?
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Most advanced stage of disintegrating cellular casts.
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What is the significance of waxy casts?
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Exisiting or impending renal failure.
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What are broad casts?
|
Very wide casts that are seen in chronic renal failure a form of a waxy cast that forms in the collecting tubules.
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Urine shouldn’t have bacteria in it, but when would increased numbers of bacteria indicate a urinary tract infection?
|
Increased numbers in the absence of squamous epithelium.
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What might need to be done with bacteria in urine?
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A culture or sensitivity test.
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When can yeast be found in urine?
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If a CCMS was not done correctly. Yeast is not a urinary tract infection.
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What type of people have higher chances of yeast infections (of course not in the urinary tract)?
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Diabetics, prolonged antibiotic use, Estrogens for ERT or OCA.
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What is the most common protozoa seen in urine?
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Trichomonas vaginalis.
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When can protozoa's be seen in the urine?
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Protozoa are not seen in the urine so this is seen with an incorrectly done CCMS and the urine must be freshly voided and warm.
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