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Questions and Answers
Why is it essential to collect the entire ejaculate for sperm testing?
What should be done if the sperm specimen does not liquefy after collection?
At what temperature should the sperm specimen be kept while awaiting analysis?
What is the consequence of missing the first portion of the ejaculate during collection?
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What is the purpose of liquefaction analysis in sperm testing?
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If a patient is shy about collecting a sperm sample, what alternative is allowed?
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What is a potential effect of collecting the last portion of the ejaculate?
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What should be noted when labeling the sperm specimen?
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What viscosity grading indicates a gel-like consistency in semen?
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Which pH range indicates normal conditions for semen?
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According to the WHO criteria, what motility grading corresponds to rapid, straight line motility?
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What finding is indicative of necrospermia?
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Which abnormalities of sperm heads and tails are most commonly observed?
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What does the modified Bloom's test indicate in terms of sperm viability?
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What is the criterion for normal forms under Kruger’s strict criteria?
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Which test specifically examines for spermine using saturated picric acid and TCA?
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What is the significance of a viscosity grading of 0?
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Which condition is characterized by an absence of spermatozoa?
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What is the normal lymphocyte to monocyte ratio in adults?
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Which of the following methods is not included in specimen concentration?
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Which type of white blood cells is typically associated with bacterial meningitis?
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What is the predominant protein found in cerebrospinal fluid (CSF)?
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Which abnormal finding in cerebrospinal fluid is indicated by the presence of immature leukocytes?
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Which cell represents the earliest stage of spermatogenesis?
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What is the effect of sperm-agglutinating antibodies on sperm?
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Which test is used to measure the motility of sperm in a semen analysis?
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What condition does a positive Amine (Whiff) test indicate?
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What is the main purpose of the Potassium Hydroxide (KOH) test in vaginal fluid analysis?
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What role does fructose play in semen analysis?
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In which situation would the presence of antisperm antibodies be expected?
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Which of the following tests specifically evaluates sperm's ability to penetrate cervical mucosa?
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What is a common application of vaginal swabbing in clinical practice?
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What does a mixed agglutination reaction detect in semen analysis?
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What is the normal opening pressure of cerebrospinal fluid (CSF) in mmHg?
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Which type of CSF appearance is characterized by a yellow color due to oxyhemoglobin?
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What is the primary cause of xanthochromia in CSF?
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When collecting CSF, how much total volume is typically removed into the tubes?
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What does the term xanthochromia refer to in CSF analysis?
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What is the least likely factor to affect cell count in CSF?
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Which of the following is NOT a reason for elevated xanthochromia in CSF?
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What is the typical CSF appearance associated with heavy hemolysis?
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What is the closing pressure range for cerebrospinal fluid (CSF) in mmHg?
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Which type of meningitis can result in xanthochromic CSF?
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Study Notes
Semen Analysis
- Complete collection of ejaculate is essential for accurate testing. Most sperm are in the first portion.
- Condom method is not recommended because lubricants contain antisperm agents.
- Specimen should be delivered to the laboratory within 1 hour of collection at room temperature.
- Analysis should be done after liquefaction (usually 30-60 minutes).
- Specimen awaiting analysis should be kept at 37°C.
- If it does not liquefy, treat with amylase or bromelain.
Missing portions of the ejaculate during collection can affect results:
- Missing the first portion can lead to decreased sperm count, falsely increased pH, and the sample will not liquefy.
- Missing the last portion can lead to decreased semen volume, falsely increased sperm count, falsely decreased pH, and the sample will not coagulate.
Viscosity
-
Normal: pours in droplets
- Immediately after ejaculation: 95%
- Within 1 hour: 50% - Normal
- After 3-6 hours: 25-40%
- After 12 hours: 0%
- Increased viscosity = decreased sperm motility.
pH
- Normal: 7.2-8.0
- Increased pH: infection
- Decreased pH: more prostatic fluid is present
Morphology
- Papanicolau stain/Wright-Giemsa stain differentiates morphology of semen.
- Routine criteria: >30% Normal forms
- Kruger’s Strict Criteria: >14% Normal forms
-
Measure the head, neck, and the tail:
- Head: normal shape is oval
- Midpiece: contains the mitochondria
- Tail: for motility
Sperm Abnormalities
- Double head and pinhead: most common
- Tapered head: varicocele
Motility Grading (WHO Criteria)
- Grade 4.0 (a): Rapid, straight-line motility
- Grade 3.0 (b): Slower speed, some lateral movement
- Grade 2.0 (b): Slow forward progression, noticeable lateral movement
- Grade 1.0 (c): No forward progression
- Grade 0 (d): No movement
Viability
-
Modified Bloom’s Test:
- Reagent: Eosin and Nigrosin Stain
- Living sperm: Unstained, Bluish white (75%)
- Dead sperm: Red colored
Viability Test Conditions
- Necrospermia: Presence of dead spermatozoa
- Oligospermia: Decreased number of spermatozoa
- Azoospermia: Absence of spermatozoa
Chemical Analysis
- Norma L Value: Indicates lack of seminal fluid volume.
Barbiero’s Test
- Very specific for Spermine.
- Reagents: Saturated Picric Acid + TCA
- (+) Dark Brown Rhombic Crystals
Antisperm Antibodies
- Detected in semen, cervical mucosa, or serum.
- Causes: Ruptured blood, testes barrier.
- Sperm cells exposed to male’s immune system.
- Sperm-agglutinating antibodies cause sperm to stick to each other.
Mixed Agglutination Reaction
- Detects the presence of IgG antibodies.
- Semen sample + AHG reagent + Latex particles or treated RBCs coated with IgG.
- Normal: 30 organisms or cells/HPF
Vaginal Fluid
- To identify: Pathologic conditions that may affect a female’s reproductive capability.
- To identify: Compelling signs of sexual assault and abuse.
Vaginal Swabbing
- Cotton: Toxic to Neisseria gonorrhoeae
- Wood: Toxic to Chlamydia trachomatis
- Calcium alginate: inactive herpes simplex virus (HSV)
- Room temperature: Ideal for Trichomonas vaginalis, Neisseria gonorrhoeae
Cerebrospinal Fluid (CSF)
-
Normal pressure:
- Opening pressure: 50 to 180 mmHg
- Closing pressure: 10 to 30 mmHg
- Typically, 10 to 20 mL of CSF is slowly removed into three or four tubes that are numbered sequentially.
CSF Tests
- Chemical & Serologic tests: Least affected by blood and bacteria introduced during the tap procedure.
- Microbiology Laboratory tests: Remain at room temperature.
- Cell count tests: Least likely to contain cells introduced by the spinal tap.
CSF Appearance
- Clear CSF: Normal
- Turbid CSF: Microorganisms, Protein
- Bloody CSF: RBCs
- Xanthochromic CSF:
- Pink: Slightly amount of oxyhemoglobin
- Yellow: Oxyhemoglobin
- Orange: Heavy hemolysis
Xanthochromia
- Term used to describe CSF supernatant that is pink, orange, or yellow.
- Due to degradation products of RBCs.
- Other causes: Elevated serum bilirubin, presence of the pigment carotene, markedly increased protein concentrations, and melanoma pigment.
Cell Count
- Lymphocyte:monocyte ratio: 70:30
- Children’s ratio is reversed.
- Occasional neutrophils are normal.
- Pleocytosis: Increased amount of normal cells.
- Abnormal: If immature leukocytes, eosinophils, plasma cells, macrophages, increased tissue cells, and malignant cells are present.
- Neutrophils: Bacterial meningitis
- Lymphocytes and Monocytes: Viral, tubercular, fungal, parasite origin
Protein
- Albumin is predominant, prealbumin is second predominant.
- Alpha globulins: Haptoglobin and ceruloplasmin
- Transferrin: Major Beta Globulin
- TAU Transferrin Fraction: Carbohydrate-deficient transferrin seen in CSF but not in blood.
Types of CSF
- Clotted CSF: Clotting factors, Tubercular meningitis
- FROZEN CSF: Contains protein introduced as a result of the tap procedure.
- REFRIGERATED CSF: Contains protein introduced by the spinal tap.
- Oily CSF: Radiographic contrast media
- Clotted CSF: Clotting factors.
- Protein levels: may be influenced by factors like a traumatic tap or disorders affecting the blood-brain barrier.
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Description
This quiz covers essential aspects of semen analysis, including the importance of specimen collection, viscosity, and the effects of missing portions of the ejaculate. Understand the protocols for ensuring accurate testing and the procedures for specimen handling and analysis.
