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Level 13

Chemical Pathology Workshop III: Body fluid analys


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Red color urine
Hemoglobin, Myoglobin, Drugs, food, etc
Change urine color upon standing in air
Porphyrins etc (biodegraded of heme), from colorless -> red
Normal UO
750-2000 ml/day
Turbid color
Certain infection and high phosphate content
Microscopic Urinalysis
Cast & cells, Crystals, Bacterial staining and culture, Chyle
Bedside urinalysis
Urine strip test (multostix)
Bedside urinalysis limitation
False positive/ false negatives
Other urine strip test
Pregnancy, Ovulation, Drug of abuse test
Lower limit of detection of urine hCG
25 mIU/ mL, better confirmed with blood test
False positive of urine pregnancy test
Biochemical pregnancy (early miscarriage), missed reaction time, Drugs (HCG for infertility), Evaporation lines
Accurate collection of 24-h urine
8 am Day for emptying UB (discard), collect every void urine to bottle, 8am Day 2 void into the bottle (collect)
Plasma Cr (μmol/L) ~CrCl (ml/min) in 70kg 40y.o. men
Normal Cr (90-120 CrCl), 200 Cr (30-40 CrCl), 300 Cr (20-30 CrCl), 400 Cr(10-20CrCl)
24h CrCl
Urine Cr* Urine Volume / Plasma Cr* Time(min)
CrCl corrected for BSA
CrCl *1.73/BSA for comparison between people of different sizes
Under-collection of urine
Reflected by abnormally low urine creatinine
CSF
Clear fluid mostly made from choroid plexus, occupying subarachnoid space and ventricular system, acting as mechanical and immunological protection of the brain
CSF Ix
Inspection (color and appearance), Open pressure measurement, microbiological Ix, Chemical analysis, immunological Ix, Anatomical pathology Ix
CSF collection
4 tubes aseptic techniques, each 2-4 ml, #1 microbiology, #2 hemat, #3 chemistry, #4 others
CSF precaution
Send for analysis within one hour, don’t refrigerate (Hemophilus and Neisseria cant survive)
Pleural fluid analysis
Appearance, microbiology, Cytology, Chemical analysis (pH, LDH, Protein, TAG for chylothorax)
Transudate vs Exudate
Transudate with total protein ≤ 30g/L
Light’s critera
Exudate when 1 of the following 3 (Total protein >0.5, LDH >0.6, pleural LDH >2/3 of upper limit of serum LDH), p/s for first 2
TB pleurisy
Adenosine deaminase detection, <16.81 = unlikely
Xanthochromia CSF
In chronic hemorrhage
CSF analysis contraindications
↑ICP, hemorrhage, brain tumor, SOL
Bedside urinalysis indication
SG, pH, Blood, Protein, Glucose, Ketones, Bilirubin, Urobilinogen, nitrites, LE
Low pH
High protein diet, or acidosis (pathologic)
High pH
Low protein diet or recent meal, or renal tubular acidosis or UTI
High pH false +ve
Urease producing organism (Proteus mirabilis) or prolong standing in air
Blood non-pathologic
Menses, traumatic, catheterization, exercise
Blood pathologic
Glomerular/tubular disorder, UTI, stones, hypercalciuria, urinary tract trauma, tumor
Blood false negative
High ascorbic acid, large nitrate, high SG
Protein non-pathologic
Orthostatic proteinuria, fever, exercise
Protein pathologic
Glomerular/tubular disorder, UTI
Protein false +ve
fever, exercise, alkaline urine, con. Urine, presence of cells/bacteria
Protein false -ve
Diluted urine, low molecular weight protein
Glucose non-pathologic
Renal glycosuria
Glucose pathologic
DM, Fanconi syndrome
Glucose false -ve
Ascorbic acid, high SG, exposure to humid environment
Ketones non-pathologic
Restricted carbohydrate intake
Ketones pathologic
DM
Ketones false +ve
Captopril, methyldopa
Ketones false -ve
Prolong standing of urine, moisture on test pad
Bilirubin pathologic
Hepatitis, biliary obstruction
Bilirubin false +ve
Rifampin, chorpromazine
Bilirubin false -ve
Ascorbic acid, Prolong standing in light
Urobilinogen non-pathologic
Low: systemic antibody therapy
Urobilinogen pathologic
Hepatitis, intravascular hemolysis
Urobilinogen false +ve
Alkaline urine, sulfonamide
Urobilinogen false -ve
Broad spectrum antibiotics, discolored urine, Prolong standing in light
Nitrites
UTI
Nitrites false +ve
Urine contamination, medication that turns urine to red, gross hematuria
Nitrites false -ve
Inadequate dietary nitrate intake, non-nitrate reducing bacteria, insufficient incubation time, ascorbic acid, high Urobilinogen
Leukocyte esterase non-pathologic
Fever
Leukocyte esterase pathologic
UTI, GN, pelvic inflammation
Leukocyte esterase false +ve
Contamination with vaginal fluid, oxidizing agents, Trichomonas
Leukocyte esterase false -ve
Ascorbic acid, high protein, high glucose, high SG, cephalosporin, tetracycline, nitrofurantoin