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F ACULTY OF ALLIED MEDICAL SCIENCES Clinical chemistry (MLCC-203) 1.

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Presentation on theme: "F ACULTY OF ALLIED MEDICAL SCIENCES Clinical chemistry (MLCC-203) 1."— Presentation transcript:

1 F ACULTY OF ALLIED MEDICAL SCIENCES Clinical chemistry (MLCC-203) 1

2 2 Dr Eman El-Attar MLCC 203

3 3 ILOs 1- To understand the different types of urine samples 2- To be able to perform different tests of urine analysis 3- To be able to find abnormal findings in urine

4 COMPLETE URINE ANALYSIS 4  Simple, non-invasive diagnostic test that provides a window to the patient’s health (kidney diseases, DM,UTI…...) 1 st thing: you should learn about various types of urine specimens and how to properly instruct patients about sample collection.

5 5 S PECIMENS T YPES  Random  First morning  Midstream  Timed/ 24 hours

6 S PECIMENS T YPES ( CONT.)  Random – most common, taken anytime of day  First morning – higher concentration of substances, taken in morning  Midstream – genitalia is cleaned, urine is tested for microorganisms & presence of infection  Timed/ 24 hour – used for quantitative analysis of substances (Instructions??) 6

7 S PECIMEN COLLECTION  The specimen must be collected in a clean dry, disposable container.  The container must be properly labeled with the patient name, date, and time of collection. The labels should be applied to the container and not to the lid. 7

8 URINE CONTAINERS 8 The container should be labeled with: the patient name, date, and time of collection

9 The specimen must be delivered to the laboratory on time and tested within 1hr, OR it should be refrigerated or have an appropriate chemical preservative added. 9

10 CHANGES OCCUR IN NON PRESERVED SPECIMEN 10  Increase bacterial number.  Increase crystals deposition (amorphous)  Increase turbidity caused by bacteria & amorphous  Decrease glucose due to glycolysis and bacterial utilization.  Decrease ketones because of volatilization.  Decrease bilirubin from exposure to light.  Breakdown of RBCs  Transformation of urea to ammonia which increase pH.  Changes in color due to oxidation or reduction of metabolic

11 U RINE ANALYSIS Three types of testing should be learned:  Physical  Chemical  Microscopic 11

12 12 P HYSICAL E XAMINATION OF U RINE Visual examination:  Volume  Color  Aspect  pH (reagent strips, Acidic/Alkaline)  Specific gravity ( )  The refractometer or a reagent strip is used to measure specific gravity Reagent Strips Refractometer

13 13 Color: − Normal: Amber Yellow − Colorless Diluted urine − Deep YellowConcentrated Urine − Deep Yellow-GreenBilirubin − RedBlood (hematuria) / Hb (Hemoglobinuria) − Green Pseudomonas infection − Brownish-blackAlkaptonuria, Melaninuria − Diet (beet), drugs (rifampicin) Aspect: Normal aspect: Clear - Normal aspect: Clear − Turbidity indicates cells,crystals, bacteria, yeast. − Microscopic examination will determine which is present.

14 C HEMICAL E XAMINATION OF U RINE  Proteins  Glucose  Ketone bodies  Bilirubin  Urobilinogen 14

15 C HEMICAL E XAMINATION OF U RINE ( CONT.)  Proteins: Normal urine contains small quantity of proteins usually less than 20 mg/dL (150 mg/day). *Qualitative detection: Heat and acetic acid test. Urine reagent strips. 15

16 HEAT AND ACETIC ACID Boil the upper 1/3 of a test tube containing clear urine. If turbidity occurs, add few drops of 33% acetic acid. If turbidity disappears, it was phosphates. If turbidity persists, it was due to proteins (Trace,+,++,+++,++++). 16

17 U RINE REAGENTS STRIPS 17 Strips impregnated with indicator that changes its colour in presence of proteins. (Nil,Trace,+,++,+++,++++).

18 CHEMICAL EXAMINATION OF URINE (CONT.)  Glucose  Glucose – reagent strip Present in DM, renal glucosuria  Ketone bodies  Ketone bodies ( acetone ) –reagent strip Present in DKA/ starvation/vomiting 18

19  Bilirubin: Seen in Seen in obstructive jauindice, liver diseases Detection: Urine reagent strips. Iodine test. - Carefully, layer diluted iodine in absolute ethanol on urine. - A green ring is formed at the interphase due to oxidation of bilirubin to biliverdin. 19

20  Urobilinogen Normally, there is a normal trace of urobilinogen. Increased in hemolytic anemia *Detection:  Urine reagent strips.  Erlich test. 20

21 M ICROSCOPIC E XAMINATION OF U RINE  Microscopic examination used to view elements not visible without microscope  Centrifuge spins urine to cause heavier substances to settle to the bottom 21 Bacteria Yeast Cells Crystals Casts

22 MICROSCOPIC EXAMINATION OF URINE (CONT.) Cells: RBCs : (0-5/ HPF) Double wall, homogeneous,non- nucleated, 33%AA? Pus cells: (0-5/ HPF) Larger, grainy,colourless and nucleated. Epithelial cells: Larger, nucleated 22

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30 Crystals: According to urine pH  In acidic urine: Amorphous urates: granular dust powder (Pink). Uric acid: ellipses, triangles or rectangles. Ca oxalate: small envelops or octahedral.  In alkaline urine: Amorphous phosphates: granular dust powder (white). Triple phosphate: colourless prisms (coffin lid type). Ca oxalate : small envelops or octahedral. 30

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37 Casts: They are moulds of renal tubular endothelial lining which dislodge, and pass into the urine and indicate kidney disease.urinekidney They form via precipitation of Tamm-Horsfall mucoprotein which is secreted by renal tubule cells.Tamm-Horsfall mucoproteinrenal tubule 37

38 Significance:Kidney damage Types: Hyaline casts. Blood and leucocyte casts. Epithelial casts. Granular casts. 38

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48 STUDY QUESTIONS What is iodine test? What is the findings in a urine sample of a diabetic patient ? 48

49 ASSIGNMENT Describe in full details how to perform blood sampling on a female patient who wants to do the following tests: CBC PT, PTT SGOT, SGPt Urea, Creatinine By: Aysha khedr 49

50 50 END OF IT’S TIME FOR PRACTICAL APPLICATION!


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