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Laboratory Test Results. Brenda C. Barnes and Shawn Froelich. Objectives. Correlate urinalysis reagent strip results with microscopic test results. Correlate microscopic evaluation results of a vaginal swab with clinical symptoms.

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laboratory test results

Laboratory Test Results

Brenda C. Barnes and Shawn Froelich

objectives
Objectives
  • Correlate urinalysis reagent strip results with microscopic test results.
  • Correlate microscopic evaluation results of a vaginal swab with clinical symptoms.
  • Discuss proper collection procedures for anaerobic cultures.
  • Interpret microbiology susceptibility reports.
  • Explain the procedure for microscopic examination of skin scrapings.
  • Describe rapid testing available that is applicable to the clinical setting.
chemical exam glucose
Chemical Exam – Glucose
  • Presence of glucose indicates the amount blood glucose has exceeded tubular reabsorptive capacity
  • Clinical correlation
    • Diabetes mellitus
    • Pancreatitis
    • Hyperthroidism
    • Gestational diabetes
glucose
Glucose
  • Clinitest
    • Nonspecific test for reducing substances
    • If performed, done so on pediatric specimens (< 2 years old)
      • Screening for galactosemia – may be part of state mandated newborn screening program
  • Microscopic Correlation
    • No elements seen
    • Yeast may be present
chemical exam bilirubin
Chemical Exam – Bilirubin
  • Presence indicates liver disease or biliary obstruction
    • False-positives due to urine pigments
    • Ictotest – confirmatory test
      • Less subject to interference
    • False-negatives
      • Age of specimen – bilirubin is unstable
  • No microscopic correlation
chemical exam ketones
Chemical Exam – Ketones
  • Presence indicates increased fat metabolism
  • Clinical significance
    • Diabetic acidosis
    • Insulin dosage monitoring
    • Starvation
    • Malabsorption
  • Microscopic correlation - none
chemical exam sp gravity
Chemical Exam – Sp. Gravity
  • Strip reading is adequate for routine screening
  • Clinical significance
    • Monitoring patient hydration and dehydration
    • Loss of renal tubular concentrating ability
    • Diabetes insipidus
    • Determination of unsatisfactory specimens
  • Microscopic correlation – none
chemical exam blood
Chemical Exam – Blood
  • Presence of red blood cells, hemoglobin, or myoglobin
    • Hematuria - bleeding
    • Hemoglobinuria
      • Lysis of rbc in specimen
      • Intravascular hemolysis
    • Myoglobinuria – muscle destruction
  • Microscopic correlation – rbc seen in hematuria
chemical exam ph
Chemical Exam – pH
  • Of little diagnostic value – primarily used for determining systemic acid-base disorders
  • Microscopic correlation – none
chemical exam protein
Chemical Exam – Protein
  • Presence indicates abnormality in glomerular filtration barrier – renal disease
  • Correlates with:
    • Nitrite
    • Leukocytes
    • Microscopic
chemical exam urobilinogen
Chemical Exam - Urobilinogen
  • Increased in any condition that causes an increase in production or retention of bilirubin
  • Clinical significance
    • Early detection of liver disease
    • Lever disorders, hepatitis, cirrhosis, carcinoma
    • Hemolytic disorders
  • Microscopic correlation – none
chemical exam nitrite
Chemical Exam – Nitrite
  • Rapid screening for UTI
    • Sample needs to be fresh to avoid false-positive reactions
    • Correlates with:
      • Protein
      • Leukocytes
      • Microscopic
chemical exam leukocytes
Chemical Exam – Leukocytes
  • Screening test for presence of wbc in urine
  • Quantification should be done by microscopic examination
  • Correlates with:
    • Protein
    • Nitrite
    • Microscopic
microscopic examination
Microscopic Examination
  • Detect and identify insoluble materials present in urine
  • Time-consuming = cost
  • Lacks standardization

Protocols used by many labs to improve standardization and cost-effectiveness

vaginitis
Vaginitis
  • Occurs when the mucosal lining of the vagina becomes inflamed and irritated
  • Typical signs:
    • Vaginal discharge
    • Vulvar itching irritation
    • Odor
  • Commonly associated diseases:
    • Bacterial vaginosis
    • Trichomoniasis
    • Candidiasis
laboratory diagnosis
Laboratory Diagnosis
  • Vaginal pH
  • KOH Amine “Whiff” test
  • Vaginal microscopy (wet mount)
  • Kit testing
    • BD Affirm
    • QuickVue Advance pH an Amines test
    • QuickVue Advance G. vaginalis test
    • OsomTrichomonas Rapid Test
sample collection
Sample Collection
  • Swab vaginal vault and walls with one or two swabs
    • Include any areas where fluid has pooled
  • Place swab(s) in test tube containing 0.5 mL saline
  • Sample should remain at room temperature and tested within two hours of collection

http://www.acponline.org/running_practice/mle/wm_exams.htm

vaginal ph
Vaginal pH
  • Typical vaginal pH = 4.0-4.5
  • > 4.5
    • BV
    • Trichomoniasis
  • Tested at time of collection
wet mount
Wet Mount
  • Vigorously mix swab(s) in and out of saline – collect all material adhering to side of tube
  • Remove swab from saline and depress onto clean, dry microscope slide – express small amount of fluid
  • Coverslip and examine under microscope

http://www.acponline.org/running_practice/mle/wm_exams.htm

koh whiff test
KOH “Whiff” Test
  • Prepare wet mount slide as directed, adding one drop of 10% KOH to slide prior to coverslipping
  • Positive test demonstrates typical “fishy” odor
anaerobic specimens
Anaerobic Specimens
  • Most anaerobic infections are caused by endogenous microbiota
  • Improper collection may result in the growth of many anaerobes, resulting in difficulty to determine the cause of infection
  • Labs follow criteria for rejection of inappropriately collected and/or transported specimens
acceptable specimens for anaerobic culture
Acceptable Specimens for Anaerobic Culture
  • Aspirated material
    • CSF, blood, bone marrow, synovial fluid
    • Aspiration of closed abscess, ascites fluid, peritoneal fluid
    • Deep tissue or bone biopsy
    • Aspirated pus from decubitus ulcers
    • Suprapubic bladder aspiration
    • Pleural fluid obtained by thoracentesis, open lung biopsy, “sulfur granules” from draining fistula
unacceptable specimens for anaerobic culture
Unacceptable Specimens for Anaerobic Culture
  • Swabs
    • Throat, nasopharyngeal, gingival, rectal, vaginal, cervical, urethral, surface wounds and abscesses
  • Expectorated or suctioned sputum, bronchial washings
  • Contents of large bowel, feces, colostomy effluents, gastric and small bowel contents
  • Voided or catheterized urine
transport and processing of anaerobic specimens
Transport and Processing of Anaerobic Specimens
  • Transport and processing should be quick to maintain temperature, avoid exposure to oxygen and avoid dessication
  • Oxygen-free transport tubes/vials such as PRAS media (prereduced, anaerobically sterilized)
  • Anaerobic bags or pouches if delays in transport
  • Blood cultures require aseptic collection with bactericidal agent such as tincture of iodine or chlorhexidinegluconate with 70% alcohol to minimize contamination with normal skin biota