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LESSON ELEVEN (11)

bodies test (Rothera's test)

Procedure:

1. Saturate 5ml of urine with annonium sulphate.
2. Add small crystals of sodium nitropruside and shake.

3. Add ammonia in amount equal to sodium nitropruside at the side of the test tube.

Results: Formation of purple ring indicate (+ve).

C. Bile pigment test (Harrison test)

The normal value of bile pigment in urine specimen less than or equal to 0.02 mg%.

Procedure:

1. Add 5 ml of 10% Barium chloride to 5 ml of urine in a test tube.
2. Filter the sample by filter paper, and let the filter paper to dry.
3. Add 1-2 drop of Fouchet's reagent to the dried precipitate.

Results: Green color indicate +ve test.

D. Urobilinogen test (Ehrlich's test)

Procedure:

1. Add 1 ml of Ehrlich's reagent to 10 ml of urine.
2. Invert the tube several times and let it stand fro 5 minutes.

Results: Pink color is normal, while another color is +ve test.

General Urine Examination (GUE)

Or Urinalysis

• URINALYSIS

Methodology

A sample of well-mixed urine (usually 10-15 ml) is centrifuged in a test tube at relatively low speed (about 2-3,000 rpm) for 5-10 minutes until a moderately cohesive button is produced at the bottom of the tube. The supernate is decanted and a volume of 0.2 to 0.5 ml is left inside the tube. The sediment is resuspended in the remaining supernate by flicking the bottom of the tube several times. A drop of resuspended sediment is poured onto a glass slide and cover slipped.

Examination

The sediment is first examined under low power to identify most crystals, casts, squamous cells, and other large objects. The numbers of casts seen are usually reported as number of each type found per low power field (LPF). Example: 5-10 hyaline casts/L casts/LPF. Since the number of elements found in each field may vary considerably from one field to another, several fields are averaged. Next, examination is carried out at high power to identify crystals, cells, and bacteria. The various types of cells are usually described as the number of each type found per average high power field (HPF). Example: 1-5 WBC/HPF.

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LESSON TEN (10)

▪Chemical analysis
A. Protein test
1) Heat & acetic acid

Urine is putting in a test tube, heating the upper part of specimen (the lower part not heating for comparison). If the heated part of specimen cloudiness or turbid that may be indicate for protein presence. Add few drops of (10%) acetic acid prove the presence of protein if the cloudiness permanent, and when the cloudiness absent that mean the cloudiness as a result of presence the phosphate or carbonate.

Results:

- No cloudiness

+ Definite cloudiness, but no granularity

++ Granular cloudiness in upper part, dense and transparence

+++ High dense and opaque cloudiness

++++ Dense precipitation and often it is solid

2) Sulphosalicylic acid test:

In the case of clear and acidic urine specimen add 3 drops of (20%) Sulphosalicylic acid to 1 ml of specimen then heating the specimen. If the cloudiness continue means positive result (presence of protein).

3) Detecting the protein by strips. Glucose test (Benedict's test)

In this method the (Cu) ions redact to the (Cu2O) by the glucose if present. If the glucose concentration 0.1% or less there are no precipitate was seen after cooling specimen.

Procedure:

Add 8 drops of urine to 5ml of benedict, heating the tube until boiling and examinant.

Results:

- Blue color , Negative result

+ Green (

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LESSON NINE (9)

pH

pH estimate by pH meter or by paper strip. The glomerular filtrate of blood plasma is usually acidified by renal tubules and collecting ducts from a pH of 7.4 to about 6 in the final urine. However, depending on the acid-base status, urinary pH may range from as low as 4.5 to as high as 8.0. The change to the acid side of 7.4 is accomplished in the distal convoluted tubule and the collecting duct.

▪Specific Gravity (sp.gr.)

Specific gravity (which is directly proportional to urine osmolality which measures solute concentration) measures urine density, or the ability of the kidney to concentrate or dilute the urine over that of plasma. Dipsticks are available that also measure specific gravity in approximations. Most laboratories measure specific gravity with a refractometer (Urinometer).

Specific gravity between 1.002 and 1.035 on a random sample should be considered normal if kidney function is normal. Since the sp.gr. of the glomerular filtrate in Bowman's space ranges from 1.007 to 1.010, any measurement below this range indicates hydration and any measurement above it indicates relative dehydration.

If sp.gr. is not > 1.022 after a 12 hour period without food or water, renal concentrating ability is impaired and the patient either has generalized renal impairment or nephrogenic diabetes insipidus. In end-stage renal disease, sp. gr. tends to become 1.007 to 1.010.

Any urine having a specific gravity over 1.035 is either contaminated, contains very high levels of glucose, or the patient may have recently received high density radiopaque dyes intravenously for radiographic studies or low molecular weight dextran solutions. Subtract 0.004 for every 1% glucose to determine non-glucose solute concentration.

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for follow-up of patients

is abbreviation of MUAC?

LESSON EIGHT (8)

Urine Examination (GUE)
Or Urinalysis.

Urinalysis can reveal diseases that have gone unnoticed because they do not produce striking signs or symptoms. Examples include diabetes mellitus, various forms of glomerulonephritis, and chronic urinary tract infections.

OF URINE COLLECTION

1. Random collection taken at any time of day with no precautions regarding contamination. The sample may be dilute, isotonic, or hypertonic and may contain white cells, bacteria, and squamous epithelium as contaminants. In females, the specimen may cont contain vaginal contaminants such as trichomonads, yeast, and during me**es, red cells.

2. Early morning collection of the sample before ingestion of any fluid. This is usually hypertonic and reflects the ability of the kidney to concentrate urine during dehydration which occurs overnight. If all fluid ingestion has been avoided since 6 p.m. the previous day, the specific gravity usually exceeds 1.022 in healthy individuals.

3. Clean-catch, midstream urine specimen collected after cleansing the external urethral meatus. A cotton sponge soaked with benzalkonium hydrochloride is useful and non-irritating for this purpose. A midstream urine is one in which the first half of the bladder urine is discarded and the collection vessel is introduced into the urinary stream to catch the last half. The first half of the stream serves to flush contaminating cells and microbes from the outer urethra prior to collection. This sounds easy, but it isn't (try it yourself before criticizing the patient).

4. Catherization of the bladder through the urethra for urine collection is carried out only in special circumstances, i.e., in a comatose or confused patient. This procedure risks introducing infection and traumatizing the urethra and bladder, thus producing iatrogenic infection or hematuria.

5. Suprapubic transabdominal needle aspiration of the bladder. When done under ideal conditions, this provides the purest sampling of bladder urine. This is a good method for infants and small children.

URINALYSIS

The first part of a urinalysis is direct visual observation. Normal, fresh urine is pale to dark yellow or amber in color and clear. Normal urine volume is 750 to 2000 ml/24hr.

Turbidity or cloudiness may be caused by excessive cellular material or protein in the urine or may develop from crystallization or precipitation of salts upon standing at room temperature or in the refrigerator. Clearing of the specimen after addition of a small amount of acid indicates that precipitation of salts is the probable cause of tubidity.

A red or red-brown (abnormal) color could be from a food dye, eating fresh beets, a drug, or the presence of either hemoglobin or myoglobin. If the sample contained many red blood cells, it would be cloudy as well as red.

Three urine samples are shown. The one at the left shows a red, cloudy appearance. The one in the center is red but clear. The one on the right is yellow, but cloudy.

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LESSON SEVEN.

Delivery of the laboratory results
Laboratory staff should provide as much relevant information as as possible to assist those requesting tests. Standardization in the presentation of reports and use
Of units is important because it helps in the interpretation and comparison of results, contributes to the efficiency of a laboratory service, and is of great value when patients are referred from one health unit or hospital to another. Reports should be clearly and neatly written particularly figures. Therefore, to ensure the validity and accuracy of the test results.
The following points should be taken into consideration.
1. Experienced member of medical laboratory personnel must check all laboratory results before dispatching them to the respective departments or units.
2. Any unexpected result should be investigated and repeated if necessary.
Professional code of conduct and ethics
The code includes those attitudes and practices which characterize a responsible medical laboratory technician and which are necessary to ensure that a person works up to the level of a recognized standard.
The people receiving the service expect such a situation.
Above all, a code of professional conduct can keep up our motivation and remind us that the medical laboratory profession is primarily dedicated to the service of the service of the sick and the promotion of good health care.
Major codes of professional conduct are enumerated below:
1. Place the well- being and service of the sick above your own interests.
2. Be loyal to your medical laboratory profession by maintaining high standards of work and by improving your professional skills and knowledge.
3. Work scientifically and with complete honesty.
4. Do not misuse your professional skills or knowledge for personal gain.
5. Never take anything from your place of work that does not belong to you.
6. Do not disclose a patient’s information to any unauthorized person.
7. Only the requested doctor or department can have a knowledge of the patient’s information, no one else.

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