Clinical Microscopy Notes PDF

CLINICAL MICROSCOPY Renal Anatomy, Physiology,  Urochrome excretion is increased during fever, And Function Testing thyrotoxicosis and starv...

CLINICAL MICROSCOPY Renal Anatomy, Physiology,  Urochrome excretion is increased during fever, And Function Testing thyrotoxicosis and starvation.  Other pigments responsible for the urine color Nephrons includes:  Two types of nephrons o ______________, Unerythrin a pink colored  _____________ pigment, is most evident in specimens  _____________ eaumans that have been refrigerated, resulting in the precipitation of amorphous urates. Function o _____________, unmin an oxidation product  _____________ Renal blood flow of the normal urinary constituent  Glomerular _____________ Filtration urobilinogen, imparts an  Tubular _____________ Reabsorption  Tubular _____________ ______________ brown orange color that is not secretion fresh. Glomerular Filtrate How does urine form?  Normal ___ mL/min of filtrate 120 The Renal/Excretory System  Composition  Components include: ____________,  Ultrafiltrate of _____________ Plasma __________ f'uneter Bladder and ___________ urethra  Same composition minus plasma I'm.no iiiignien proteins, protein-bound substances,  Kidneys are the main organ of excretory system; also produceserythropoietin _______________ fffigffifiEd time'd't and cells can in response to miff.iq tissue hypoxia; also produces ____________ pan 1.010  Ultrafiltrate specific gravity = _____________ which is responsible for maintaining blood miiin fi Diabetes _____________ insipidus nggigmiitEsI'ftp.iifniiiat.im apyin.iq production  Decreased _____________ pressure and aldosterone production.  ______________ nephrons functional unit of the kidney. Each kidney contains around 1-1.5M of it. ADH ignina  Inability of tubules to respond to _____________ hormonalc ontrols  Normal adult blood passes through the kidneys  After ADH injection at a rate of 1200 _____________ roommin (renal blood flow)  1:1 ratio = no ADH receptors in CD Renal plasma flow is equivalent to toomymi ompresefffii.tt  3:1 ratio = inability to produce ADH ____________ aoo if  Blood Flow: RAGEPV Urinalysis p it Urine formation in the nephrons: iiiii What is Urine?  Afferent in.am  It refers to an _____________ containing waste ________________ arterioles are arterioles formed from the renal artery, carry blood towards the products excreted by the kidneys. nephrons  It is temporarily stored in the urinary bladder and  ________________ Glomerulus filtering apparatus of the 41,47 bacterial excreted through the _____________. urethra  Urine is composed of ___% water andorthicainonganic ___% nephrons; produces filtrate with a constant specific gravity of ________ 1010 a pH of 7.4 and an solutes. am iaqueous components osmolality similar to plasma. ftp.fhfffehberenlar ______________ chloride is the major inorganic  renal _______________ tubules responsible for concentrating component of urine. Other inorganic components and diluting the urine; includes the PCT, LH, DCT NormalCSF and CD iral Lymphocyte include sodium, potassium, sulfate, phosphate,  Majority (65-80%) of the reabsorption process ammonium, magnesium and calcium. occurs in the ______. pct This is responsible for  _____________ Urea is the major organic component reabsorbing glucose, electrolytes, water and of urine. Other organic components include nti DLHDescendingcoopotHenle albumin m.IE creatinine, uric acid and hippuric acid. amino acids.  ________________________ is permeable to L  Normal day to night urine ratio is ________ in water but impermeable to salt I  Normal urine is clear, with color ranging from straw (pale yellow) to amber.  ________________________ ALA salt but impermeable to water is permeable to 194 fam.fm giiik  The yellow color of the urine is caused by the  ADH acts in the ___________ Det and presence of the pigment _________ urochrome ____________ duct to promote water reabsorption. I collecting L.FI.am Laarni Hannah C. Lacorte, RMT, MSMLS CLINICAL MICROSCOPY Renal Function Tests  2.5-3mL/kg/day children _______________________ improperly collected minespecimen Emil.int iffiiit  Calculated Glomerular Filtration Estimates DM vs DI include: __________________________ formula and  Diabetes _____________ ______________________. modification Other tests to  Increased volume caused by need to assess GFR: _________________, excrete the excess glucose not amacrogi.fi _________________, _________________ beta othalamate reabsorbed from the ultrafiltrate;  ym GFR is reported in ______________ m patients exhibit polydypsia; urine  First step in creatine clearance: appears dilute with a high specific _______________________________ measure the total volume the of urine gravity  Creatinine clearance can be calculated using:  Diabetes _____________ Insipidus = urine creatinine x urine volume in mL per min x  Decreased production or function of 1. 73 ADH causing decreased reabsorption Plasma creatinine of water from ultrafiltrate; urine is dilute BSA with low specific gravity; patients also exhibit polydipsia Tubular Reabsorption/Concentration Tests Types of Specimen A. Fishberg Concentration Test and Mosenthal Concentration Tests  _____________________ Random urine - most commonly B. ______________ Gravity - most commonly used; Specific received specimen; can be sufficient for routine measured using urinometer, refractometer or urinalysis urine reagent strip; both the number and the  __________________ Firstmorning - also known as the 8- weight of particles contribute to the specific hour urine specimen; first voided specimen in gravity the morning; more concentrated; essential for C. _____________ osmolarity - more sensitive since is only preventing false negative results in pregnancy affected by the number of particles, and NOT by testing their molecular weight; can be measured directly  ________________ tastingurine - also known as the using osmometers that measure colligative _______________; second unine morning second voided urine after a properties. period of fasting; recommended for glucose  Normal urine osmolality: ____________ 300400 mosy monitoring  Urine to serum osmolality ratio: ___________  ___________________ 2hr postprandial - the patient is testusedtoAssestubular instructed to void shortly before consuming a Urine Volume routine meal and to collect specimen 2 hours after eating.  Determined by body’s state of hydration  __________________ Glucose tolerance - collected to correspond  Influenced by fluid intake, nonrenal fluid loss, with the blood samples drawn during a GTT. It antidiuretic hormone (ADH) variations, excretion may include fasting, half hour, 1-hr, 2-hr and 3 hr of large amounts of dissolved solids (e.g., specimens. glucose)  _________________ early - urine specimen collected  Usual daily volume = 1200-1500 mL at aroundT.im ______; used for evaluation of urine  Normal range = 600 _____________ 2000mi day urobilinogen levels  Oliguria: adults = 35 mg/dL o Neubauer counting chamber fishermia o Diluting fluid such as ______ or  Viral 30% should have normal _________________ Hamster Egg Penetration forms -Sperm are incubated with species-nonspecific hamster eggs and penetration is observed Sperm Viability microscopically. -used to evaluate if an individual produces dead or living sperm cells _________________ Cervical MucusPenetration -_____________ EosinN igrosin stain is used -Observation of sperm penetration ability of -Counting number of dead cells in 100 sperm cells partner’s midcycle cervical mucus -Live sperm cells remainbluish ______ w hitein color -Dead sperm cells become _____ in color _________________  Hypo o smoticswelling -Normal viability requires ___________cells Sperm exposed to low-sodium concentrations 75 wing are evaluated for membrane integrity and sperm Sperm Motility viability. -50% should have motility grade of A, B, C within ____ GRADE INTERPRETATION  InvitroAcrosomeReaction ____________________ -Evaluation of the acrosome to produce enzymes 4.0 A Rapid, straight line motility essential for ovum penetration 3.0 B slowerspeed somelateralmovement 2.0 B Slow forward progression with SYNOVIAL FLUID left noticeable lateral movements Group Classification Pathologic Significance I. Noninflammatory Degenerative joint 1.0 C No forward progression disorders, osteoarthritis 0 D No movement II. Inflammatory Immunologic disorders, rheumatoid arthritis, lupus  Seminal Fructose erythematosus, -assesses the function of theseminal ____________ vesicles scleroderma, -uses ______________ resorcinol as reagent polymyositis, -positive result is _____________ orangered anklylosing -normal levels is equal to or greater than 13umol spondylitis, per ejaculate rheumatic fever, -specimens for fructose should be tested within 2 Lyme arthritis hours or frozen to prevent fructolysis III. Crystal-induced Gout and -if cannot be analyzed within two hours, the pseudogout specimen should be kept in freezer IV. Septic Microbial infection V. Hemorrhagic Traumatic injury,  Neutral alpha-glucosidase tumors, hemophilia, -assesses function of ___________ epididymis other coagulation disorders,  Zinc, citric acid and acid phosphatase anticoagulant -assesses the function of _____________ gland prostate overdose  Anti-sperm antibodies Specimen Collection and Handling -assessed using MAR (mixed agglutination  _______________ Arthnocentesis : collection reaction) or immunobead test  200 g stool weight per day with  _____________ increased liquid and > 3 movements per day Dxylosetest for malabsorption: low level in urine indicates malabsorption; D-xylose does not  Mechanisms of diarrhea: secretory, osmotic, need to be digested but must be reabsorbed to altered motility appear in the urine  Laboratory tests: fecal sodium, potassium, osmolarity, and pH Specimen Collection  pH 50 mOsm/kg  Pale (acholic stools) may signify a blockage of  Secretory diarrhea 250 mg/d the second slide with normal fat content on the  Iron supplements containing vitamin C first slide  Maldigestion - increased neutral ________ on Quantitative Fecal Fats the first slide.  Confirm steatorrhea  3-day collection with diet, including normal  Microscopic screening for steatorrhea amount of fats  Lipids included: neutral fats  Paint cans ideal; can be homogenized using a (triglycerides), fatty acid salts (soaps), shaker free fatty acids, and cholesterol  Refrigerating specimens slows down bacterial  Stain with Sudan III or IV, oil red O actions (gases)  Two-part test: neutral fat and split fat  Classic is Van de Kamer titration, fatty acids  Neutral fat: large red-orange droplets titrated to neutral endpoint withNaOH ______  60 per hpf indicative of steatorrhea  Split fat is more indicative Apt Test for Fetal Hemoglobin  Checking bloody stools and vomit from neonates who may have swallowed maternal blood during Chemical Testing of Feces delivery Fecal Occult Blood Testing (FOBT)  Emulsify material in water to release Hgb  Most frequent test  Centrifuge, add 1% NaOH to pink supernatant;  Occult: “_______” hidden pink color remains = alkali-resistant fetal Hgb;  Appearance: black, tarry from upper yellow-brown = maternal Hgb gastrointestinal (GI) tract; lower GI is red  Maternal thalassemia major has ↑HgbF  2.5 mL of blood/150 g stool is significant, so may not be visible Fecal Enzymes Laarni Hannah C. Lacorte, RMT, MSMLS CLINICAL MICROSCOPY  Pancreatic enzymes  Associated with pancreatic insufficiency and cystic ____________ fibrosis  Trypsin, chymotrypsin, elastase-1  Classic trypsin test: stool dissolves gelatin on x-ray paper; not very sensitive  Chymotrypsin more sensitive, less degraded than trypsin, and spectrophotometric measuring is available  Elastase-1  Isoenzyme of elastase produced by pancreas  Present in high concentrations and resistant to degradation  Pancreas-specific enzyme; not affected by gastric motility and other mucosal defects  Immunoassay kit requires only a single specimen; monoclonal antibodies for ________________ human elastase 1  Differentiates pancreatic from nonpancreatic causes of steatorrhea Carbohydrate Test  Increased stool carbohydrates cause osmotic diarrhea because excess water is needed to remove the carbohydrates  Inability to reabsorb or lack ofdigestive ___________ enzymesis  Idiopathic lactase deficiency is common of thecause  Maldigestion: lactose tolerance test  Malabsorption: D-xylose tolerance test Laarni Hannah C. Lacorte, RMT, MSMLS