➢ It then rises above 2.

0 mg/dl, providing a
AMNIOTIC FLUID means of determining fetal as a greater than 36
weeks.
AMNIOTIC FLUID EXAM
➢ Is frequently associated with Cytogenic
analysis DIFFERENTIATING MATERNAL URINE FROM
➢ Product of FETAL METABOLISM AMNIOTIC FLUID:
➢ Present in the Amnion ➢ Levels of creatinine and urea are much lower in
amniotic fluid than in urine.
➢ AMNIOTIC FLUID: creatinine does not exceed
AMNION
3.5 mg/dl; urea does not exceed 30 mg/dl.
➢ It is a membranous sac that surrounds the fetus
➢ URINE: as high as 10mg/dl for creatinine; and
➢ it is metabolically active and is involved in the 300 mg/dl for urea.
exchanges of H2O and chemicals between fluid ➢ FERN TEST - differentiate amniotic fluid from
and maternal circulation, produces peptides, urine.
growth factors and cytokines ➢ Vaginal fluid specimen or smear is examined
microscopically
FUNCTIONS OF AMNIOTIC FLUID: o (+) screen for AF = “fern-like crystals”
➢ To provide a protective cushion for the fetus
➢ Allow fetal movement
➢ Stabilize temperature to protect the fetus from SPECIMEN COLLECTION AMNIOCENTESIS:
extreme temperature changes ➢ To know if there is an increased risk of a
➢ To permit proper lung development hereditary disease
VOLUME: ➢ To know if there are irregular findings are
➢ Amniotic fluid volume is regulated by a detected
balance between the production of fetal urine
& lung fluid & the absorption from fetal
swallowing & intramembranous flow AMNIOTIC FLUID COLLECTION:
➢ Intramembranous flow is the absorption of Step 1:
amniotic fluid water and solutes into the fetal ➢ Lie the patient in the supine position
vascular system Step 2:
The amount of amniotic fluid; ➢ Use ultrasound to determine the position of the
➢ Increases throughout pregnancy, reaching a fetus and pocket of amniotic fluid
peak approximately 1 liter during the 3rd o To create an image of the fetus and
trimester, & then gradually decreases prior to nearby structure on a computer
delivery. o To estimate and can choose a good
➢ During the 1st trimester, the approximately spot to insert a needle
35ml/g of A.F derived primarily from the Step 3:
maternal circulation. ➢ Prepare the mother’s abdomen
➢ After the 1st trimester, FETAL URINE is the major Step 4:
contributor to the A.F. volume. ➢ Anesthetize the are locally
➢ When fetal urine production occurs, fetal o To provide numbness on the surface of
swallowing of A.F. begins & regulates the the abdomen (Enable to be immune to
increase in fluid from the fetal urine. feeling the pain)
➢ POLYHYDRAMNIOS – excessive accumulation Step 5:
of A.F. resulting from the failure of the fetus to ➢ Perform AMNIOCENTESIS (Amniocentesis
begin swallowing. This indicates fetal distress, procedure)
often associated w/ neural tube disorders. o This is a procedure where doctors
➢ OLIGOHYDRAMNIOS – decreased A.F. due to detect or rule out problems with the
increase fetal swallowing, urinary tract fetus or the baby's health status long
deformities, & membrane leakage. before the birth
It is associated w/ umbilical cord compression, o The physician will take a sample of the
resulting in decelerated heart rate & fetal fluid to test for (specific genetic
death disorders and birth defects)
o NOTE: This is mostly and usually
performed in the second trimester of
CHEMICAL COMPOSITION: pregnancy at 15 to 18 weeks
➢ PLACENTA - Ultimate Source of AF H2O & o This is performed in the second
solutes. trimester because it is generally offered
➢ Small amount of sloughed fetal cells from the: to women with certain risk factors:
DUS • With the age of 35 and older
1. Digestive System (Which has a high chance that
2. Urinary Tract increasing the risk of
3. Skin chromosomal disorders)
➢ Biochemical substances produced by the fetus • Has a history of pregnancy
such as: BELPEN with a birth defect
1. Bilirubin • A blood test or ultrasound that
2. Enzyme shows the sign of defects
3. Lipids • Family history of genetic
4. Proteins disorders
5. Electrolytes ➢ Note: This can be performed in the third
6. Nitrogenous compound trimester enable to:
➢ CREATININE MEASUREMENT - used to determine o To Determine if the baby’s lungs are
fetal age. mature enough if they should perform
➢ Prior to 36 weeks gestation, the amniotic fluid early delivery if it becomes necessary
creatinine level ranges bet 1.5 and 2.0 mg/dl. o To diagnose a uterine infection
o Or to check for anemia in babies with
RH incompatibility
1
 TEST FOR FETAL MATURITY:
COLLECTING CONTENT: FETAL LUNG MATURITY
➢ The Spinal needle of 20 or 22 gauge is inserted 1. RESPIRATORY DISTRESS SYNDROME (RDS)
into uterine • Most frequent complication of early
➢ 10-20 ml fluid is aspirated in a sterile syringe and delivery & cause of morbidity &
its being transfer into the specimen container mortality in the premature infant.
➢ (Note: As the physician collects some of the • Caused by a lack of lung surfactant, a
specimens, it won't be harmful due to reducing substance that normally appears in
the amount or the volume of the patient’s mature lungs & allows the alveoli to
amniotic fluid, because the body will make an remain open throughout the normal
additional fluid to replace what was removed.) cycle of inhalation & exhalation.
Step 6: • SURFACTANT - keeps the alveoli from
➢ Cover the site with a bandage and continue to collapsing by decreasing surface
monitor by using the ultrasound tension & allows them to inflate w/ air
➢ To check the fetal heartbeat more easily.
➢ After the collection: There will be a mild 2. LECITHIN-SPHINGOMYELIN RATIO
cramping or pressure in lower abdomen and • The reference method to which tests of
the physician will give an advice to avoid FLM are compared is the
physical stress for 24 hours Lecitinspingomyelin ratio (L/S ratio)
• LECITHIN- primary component of the
surfactants.
SPECIMEN HANDLING AND PROCESSING: • Quantitative measurement of lecithin
FECAL LUNG MATURITY TEST and sphingomyelin is performed using
➢ specimen should be placed in ice for delivery thin-layer chromatography.
to the lab & refrigerated up to 72 hrs prior to 3. AMNIOSTAT-FLM
testing or kept frozen & tested w/in 72 hrs. • uses anti-sera specific for phosphatidyl
➢ For cytogenetic studies 3 maintained at room glycerol and is not affected by
temp or body temp (37°c incubation) prior to specimen contamination with blood
analysis to prolong the life of the cells. and meconium
➢ All fluid for chemical testing should be
separated from cellular elements & debris as
soon as possible to prevent distortion of MICROVISCOSITY: FLOURESCENCE POLARIZATION
chemical constituents by cellular metabolism or ASSAY
disintegration. ➢ The presence of PHOSPOLIPIDS decreases the
➢ This can be performed using micro viscosity of amniotic fluid
Centrifugation/filtration. ➢ FLUORESCENCE POLARIZATION ASSAY -
➢ FILTRATION is recommended for FLM to prevent measures fluorescent dye that combines with
loss of phospholipids. both SURFACTANTS and ALBUMIN

✓ Low polarization, longer fluorescence lifetime =

COLOR AND APPEARANCE DYE BOUND
COLORLESS Normal ✓ High polarization, low fluorescence lifetime=
YELLOW Presence of BILIRUBLIN DYE BOUND TO ALBUMIN
DARK GREEN Presence of MECONIUM newborn’s ✓ ALBUMIN- used as internal standard in the same
first bowel movement. Results for manner as sphingomyelin
fetal intestinal secretions.
DARK FETAL DEATH
REDBROWN LAMELLAR BODIES AND OPTICAL DENSITY
BLOODSTREAKED Result of a TRAUMATIC TAP, ➢ Lamellated phospholipids that represent a
ABNORMAL TRAUMA, & storage form of surfactants
INTRAAMNIOTIC HEMORRHAGE ➢ SURFACTANT
• responsible for FLM
• produced and secreted by the type II
TEST FROM FETAL DISTRESS pneumocytes of fetal lung & stored in
HEMOLYTIC DISEASE OF THE NEWBORN (HDN) a form of structures termed lamellas
➢ Measurement of bilirubin in the AF determines bodies about 20 weeks of gestation
the extent the hemolysis. LAMELLAR BODIES
➢ Performed by Spectrophotometric Analysis. ➢ Enter alveolar spaces to provide surfactants
➢ Liley Graph determines the severity of the and enter the amniotic fluid at about 26 weeks
hemolytic disease. of gestation
➢ as fetal lung mature, increased lamellar body
production is reflected by an increased in AF
NEUTRAL TUBE DEFECTS: phospholipids and the L/S ratio.
Levels of alpha-fetoprotein (AFP) in both the maternal ➢ presence of lamellar bodies increased the OD
circulation and the AF indicates fetal neural tube of the AF
defects, such as anencephaly & spina bifida. TEST FOR LAMELLAR BODIES:
1. SULFOSALYCITIC ACID TEST (SSA)
ALPHA-FETOPROTEIN (AFP) ➢ confirmatory for procedure testing for
➢ Major CHON produced by the fetal liver during urinary CHON detects not only albumin
gestation (prior to 18 weeks). but also globulin, mucoprotein and
➢ Bence Jones protein.
AMNIOTIC ACETYLCHOLINESTERASE (ACHE) TEST 2. REAGENT STRIP RAPID SCREENING METHOD
➢ More specific for neural tube disorder than AFP, ➢ which is more sensitive to the presence
provided it is not performed on a bloody of albumin than globulin, mucoprotein
specimen because blood contains AChE. and Bence Jones protein

2
 blood glucose
SYNOVIAL FLUID (JOINT FLUID) UA Equal to blood
• Is a viscous liquid found in cavities of movable joint
(diarthroses) or synovial joints. 1. PLAIN RED TOP TUBE (No Anticoagulant)
• Is formed as an ultrafiltrate of plasma across the ▪ Chemical & Immunologic
synovial membrane. 2. WITH ANTICOAGULANT
▪ Microscopic exams
SYNOVIOCYTES – cells lining the synovial membrane, 3. STERILE ANTICOAGULANT TUBE (SPS- SODIUM
secrete a mucopolysaccharide containing hyaluronic POLYANETHOLSULFONATE)
acid & a small amount of CHON into the fluid. ▪ Microbiological studies

FUNCTIONS OF SYNOVIAL FLUID ➢ SODIUM HEPARIN – best anticoagulant

✓ Provide lubrication in the joints for synovial fluid oxalate.
✓ Provides nutrient to the articular cartilage ➢ Powdered EDTA must be avoided
✓ Lessens the shock of joint compression because they can produce crystalline
occurring during activities such as walking & structure resembling monosodium
jogging. urate crystals.
➢ ARTHROCENTESIS – collection of
synovial fluid by needle aspiration.
ARTHRITIS ➢ Syringe used for collection is moistened
✓ Damage to the articular membranes produces with heparin.
pain & stiffness in the joints.
✓ A variety of conditions including infection,
inflammation, metabolic disorders, trauma, 3 tubes:
physical stress, and advanced age are ➢ 1 – micro – HEPARINIZED TUBE
➢ 1 – hema – EDTA TUBE (LIQUID)
associated with arthritis.
➢ 1 – other tests – NON-ANTICOAGULATED TUBE
CLASS. & PATH. SIGNIFICANCE OF JOINT DISORDERS
GROUP PATHOLOGIC SIGNIFICANCE
CLASSIFICATION ➢ Powdered anticoagulants should not be used
NONINFLAMMATORY • Degenerative joint because they may produce artifacts that will
disorders, interfere with crystal analysis.
• Osteoarthritis ➢ Polymerization of the hyaluronic acid is
INFLAMMATORY • Immunologic disorders responsible for the viscosity of S.F. & is essential for
• Rheumatoid arthritis proper lubrication of the joints.
• Lupus erythematosus ➢ In arthritis, production of hyaluronate & its ability
• Scleroderma to polymerize is affected thus ↓ decreasing
• Polymyositis viscosity.
• Ankylosing spondylitis ➢ ROPES OR MUCIN CLOT TEST
• Rheumatic fever • Measures the degree of hyaluronate
• Lyme arthritis crystal
polymerization.
induced gout and
➢ 2-5% HAC + normal S.F. = form solid clot
pseudogout
• RA CELL (RAGOCYTE)
SEPTIC • Microbial infection
▪ Neutrophil with dark cytoplasmic
HEMORRHAGIC • Traumatic injury
• Tumors granules containing immune
• Hemophilia complexes.
• Other coagulation • LE CELL
disorders ▪ Neutrophil containing
Anticoagulant characteristic ingested “round
overdose body”
• REITER CELL
▪ vacuolated macrophage with
FREQUENTLY PERFORMED TESTS: ingested neutrophils
1. WBC count ➢ MONOSODIUM URATE (UA)
2. Diff. count • found in cases of gout
3. Gram stain ➢ CALCIUM PHOSPHATE (CPPD)
4. Culture • found in Pseudogout
5. Polarized microscopy exam for crystals • produces blue color
➢ Fluid is examined unstained under polarized &
NORMAL SYNOVIAL FLUID VALUES
compensated polarized light for detection of
Volume <3.5 mL
MSU&CPPD.
Color Colorless to pale yellow
Clarity Clear
Viscosity Able to form a string 4 – 6 SEROUS FLUID
cm long
Total protein <3 g/dL ➢ Fluid between the membrane’s w/c provides
(CHON) lubrication as the surfaces move against each
Erythrocyte count <2000 cells/ml other.
Leukocyte count <200 cells/ml ➢ Formed as ultrafiltrate of plasma.
Neutrophil <20% of the differential
FUNCTION OF SEROUS FLUID
Lymphocyte <15% of the differential
➢ Provides lubrication as the surfaces move
Monocyte and 65% of the differential
against each other.
macrophage
Glucose <10 mg/dL Lower than
SOURCE
3
 ➢ Ultrafiltrate of plasma; fills organ cavities ➢ ↑ amylase – is associated with pancreatitis,
esophageal rupture & malignancy
APPEARANCE ➢ ↓ glucose level – are seen w/ Rheumatoid
➢ Normal; clear and pale yellow inflammation & purulent infections

PLEURAL, PERICARDIAL, PERITONEAL SIGNIFICANCE OF CELLS SEEN IN PLEURAL FLUID:

➢ Closed cavities 1. NEUTROPHILS – pneumonia, pancreatitis,
➢ Each are lined by 2 membranes known as pulmonary infection
serous membranes. 2. LYMPHOCYTES – TB, viral inf., autoimmune
• Parietal membrane – lines the cavity disorders, malignancy
wall 3. MESOTHELIAL CELLS – normal & reactive forms
• Visceral membrane – cover the organs have no clinical significance.
w/in the cavity EFFUSION • Mesothelial cells are associated with TB
➢ an increase in fluid between the membranes 4. PLASMA CELLS – TB
due to disruption of the mechanisms of serous 5. MALIGNANT CELLS – primary adenocarcinoma
fluid formation & reabsorption. & small-cell carcinoma, metabolic carcinoma
MICROORGANISMS ASSOCIATED W/ PLEURAL
EFFUSIONS:
CAUSES OF EFFUSIONS 1. Staph. Aureus
↑ hydrostatic pressure Congestive failure 2. Enterobacteriaceae
↓ oncotic pressure Hypoproteinemia 3. Anaerobes
↑ capillary permeability inflammation and 4. Myobacterium tuberculosis
infection FREQUENTLY PERFORMED TESTS:
Lymphatic obstruction tumors 1. ANA – Antinuclear antibody
2. RF – rheumatoid factor
3. CEA – tumor marker carcinoembryonic antigen
SPECIMEN COLLECTION • Provides valuable diagnostic info. In
• 100 ml - usual amount by needle aspiration effusions of malignant origin
• THORACENTESIS – pleural Source
• PERICARDIOCENTESIS – pericardial ➢ Thoracic Cavity (around Lungs)
• PARACENTESIS – peritoneal
• EDTA tube – used for cell counts & differential Appearance
count. ➢ Turbid – white cells, bacteria
• Heparinized (green-top evacuated tubes) – for ➢ Bloody – trauma, malignancy
chemical serologic, microbial & cytologic ➢ Milky – chylous fluid
LAB TESTS-CLINICAL SIGNIFICANCE (Pleural Fluid)
analysis.
1. CELL COUNTS
• Specimens for pH must be maintained
• ↑ Red Cells = trauma, malignancy
anaerobically in ICE.
• ↑ Neutrophils = bacteria
• Chemical exams on serous fluids are compared • ↑ Lymphocytes = tuberculosis,
with plasma. malignancy
o CLEAR PALE YELLOW – normal 2. GLUCOSE
o TURBID – microbial infection (TB) • ↓ Tuberculosis, rheumatoid
o BLOODY – hemothorax, hemorrhagic inflammaton, malignancy
effusion 3. PH
o MILKY – Chylous material from thoracic • ↓ Tuberculosis, malignancy,
duct leakage esophageal rupture
o PSEUDOCHYLOUS form chronic 4. AMYLASE
inflammation • ↑ Pancreatitis
5. CEA
GENERAL CLASSIFICATION OF THE CAUSE OF EFFUSION • ↑ Malignancy

TRANSUDATES
➢ From because of a systemic disorder that
disrupts the balance in the regulation of fluid PERICARDIAL FLUID
filtration & reabsorption.
➢ Testing the transudates is not usually necessary. ➢ About 10-50 ml of fluid is normally found bet. the
pericardial serous membranes
EXUDATES ➢ Effusion are primarily the result of changes in the
➢ Produced by conditions that directly involve permeability of the membranes due to infection
the membranes of the particular cavity, ➢ ↑ neutron – indicative of bacterial endocarditis
including infections & malignancies ➢ Malignant cells – metastatic lung or breast
carcinoma
• Determines exudates or transudates
PLEURAL FLUID o Fluid-to-serum protein
o Lactic dehydrogenase ratio
➢ Obtained from the pleural cavity, located
between the parietal pleural membrane lining the Source
chest wall & the visceral pleural membrane ➢ Pericardial Cavity (around Heart)
covering the lungs.
➢ Pleural fluid cholesterol & fluid - toserum Appearance
➢ Turbid – infection, malignancy
cholesterol ratio >60mg/d ↑ or >0.3 ↓ = fluid is an
➢ Bloody – tuberculosis, tumor, cardiac puncture
exudate
➢ Milky – chylous fluid
➢ pH lower than 7.3 – may indicate the need for ➢ Green – bile
chest-tube drainage, in addition to administration LAB TESTS-CLINICAL SIGNIFICANCE (Pericardial Fluid)
of antibiotics in cases of pneumonia
4
 1. CELL COUNTS ▪ Wooden shaft- toxic to
• ↑ Red Cells = tuberculosis, tumor, Chlamydia trachomatis
cardiac puncture ▪ Calcium alginate can inactive
• ↑ Neutrophils = bacterial endo cartitis the herpes simplex virus (viral
2. GLUCOSE cultures)
• ↓ Bacterial infection • Properly labeled specimens should be placed
3. CEA in a biohazard bag with the requisition and
• ↑ Malignancy transported to the laboratory as soon as
possible
▪ The requisitions must include:
PERITONEAL FLUID → The patient’s name
→ Unique identifier
▪ Patient medical history that should
ASCITES – accumulation of fluid in the peritoneal cavity &
include:
the fluid is referred to as ascitic fluid
→ menstrual status
CIRRHOSIS – are frequent causes of ascitic transudates → use of vaginal creams, lubricants,
and douches
PERITONITIS – bacterial infection, is a result of intestinal → recent exposure to sexually
perforation or a ruptured appendix & malignancy are the transmitted diseases
most frequent causes of exudative fluids.

PERITONEAL LAVAGE – a sensitive test for the detection of COLOR AND APPEARANCE
intraabdominal bleeding in blunt trauma cases (RBC count Normal White with a flocculent
= <100000/ul) (using normal saline) Note: results of the RBC discharge predominance of
count are used to aid in determining the need for surgery large, rod shape, gram positive
RBC counts greater than 100000/l are indicative of blunt lactobacilli Squamous epithelial
cells.
trauma infection
Menstruating WBC AND RBC
Source Bacterial vaginosis Thin, homogenous white-to-gray
➢ Peritoneal Cavity (around Abdomen) Candida infections White “cottage-cheese”
T. vaginalis Yellow-Green
Appearance C. trachomatis Yellow, opaque
➢ Turbid – peritonitis, cirrhosis
• Bloody – trauma
• Milky – chylous fluid DIAGNOSTIC TESTS
• Green – bile pH
LAB TESTS-CLINICAL SIGNIFICANCE (Peritoneal Fluid) • Performed before placing the swab into saline
1. CELL COUNTS or KOH solutions.
• ↑ Red Cells = trauma • Commercial pH test paper with narrow pH
• ↑ Neutrophils = peritonitis range – recommended to accurately evaluate
2. GLUCOSE pH in the 4.5 range
• ↓ Tubercular peritonitis, malignancy • Helps to differentiate the causes of vaginitis
3. AMYLASE
• ↑ Pancreatitis, GI perforation ➢ 4.5 pH
4. ALKALINE PHOSPHATASE ▪ Bacterial vaginosis
• ↑ Intestinal perforation ▪ Trichomoniasis
5. UREA/CREATININE ▪ Desquamative inflammatory vaginitis
• ↑ Ruptured bladde (DIV)
▪ Atrophic vaginitis
• Lactobacilli is predominant in a normal vaginal
flora and produces:
VAGINAL SECRETIONS ▪ Lactic Acid
o Provides an acidic vaginal
INRTRODUCTION:
environment with a pH value
➢ Diagnose: infection, complications of pregnancy, between 3.8 – 4.5
forensic testing (sexual assault) o Acidity suppresses overgrowth
➢ Vaginitis: common condition especially pregnant of:
women → Mobiluncus
➢ Characterized (in abnormality): odor, pruritus, → Prevotella
vaginal irritation, dysuria, and dyspareunia → Gardnerella vaginalis
▪ Hydrogen peroxide
SPECIMEN COLLECTION AND HANDLING o Toxic to pathogens
• Vaginal secretions are collected during pelvic o Helps keep the vaginal pH
examination acidic
• Collected during pelvic examination o Provide protection from
• Speculum moistened with warm water is used urogenital infections
to visualize vaginal fornices and lubricants may MICROSOPIC PROCEDURES
contain antibacterial agents and must not be • Usually diagnoses vaginal infections
used. • Screening tests:
• The specimen is collected by swabbing the o Saline wet mount
vaginal wall and vaginal pool (to collect o KOH mount
epithelial cells along with vaginal secretions) • Confirmatory test:
o Gram stain
NOTE: • Reported per
▪ Cotton swabs should not be o hpf – wet mount examinations
used because cotton is toxic o OIO field – Gram stains
to Neisseria gonorrhoeae

5
 1. WET MOUNT EXAMINATION 4. POINT OF CARE TESTS
• Cover slip is placed on specimen to exclude air • Proline aminopeptidase activity
bubbles • OSOM Trichomonas Rapid Test
• Examined using low power (10x) and high dry o Positive result: visible blue line
power (40x) using bright-field microscope and red internal control line
• Even distribution of the ff. is scanned in LPO and • OSOM BVBLUE test
HPO: o Detects vaginal fluid sialidase
→ Cellular components o Takes 1 min. to perform
→ Types and numbers of epithelial cells o Result:
→ Clumping of epithelial cells - blue/green – positive
→Presence of budding yeast or pseudohyphae - yellow – negative
• COMMERCIAL TESTS:
Typical Constituents of Vaginal Fluid Wet Mounts: o Used to measure elevated
• Squamous epithelial cells vaginal ph and presence of
• WBCs and RBCs amines
• Clue cells o Identifies bacterial vaginosis
• Parabasal cells and trichomonas
• Basal cells
• Bacteria and Yeasts
• Trichomonas vaginalis VAGINAL DISORDERS
• Hyphae/Pseudohyphae
BACTERIAL VAGINOSIS
2. KOH PREPARATION AND AMINE TEST ➢ Most common cause of vaginitis
• KOH slide is prepared and Amine (Whiff) test is ➢ Affects 40% - 50% of women of childbearing age;
performed by placing a drop of saline ➢ It occurs when there is an imbalance in the ratio
specimen prepared of normal vaginal bacteria flora
• Swab onto a properly labeled clean slide ➢ Associated with a new or multiple sex partners,
• Add a drop of 10% KOH solution frequent douching, use of intrauterine devices,
• After amine test, place a cover slip over the pregnancy and lack of the protective lactobacilli;
specimen ➢ Treatments:
• Allow KOH prep to rest for 5 mins. to dissolve o Metronidazole (Flagyl)
epithelial and blood cells
o Metronidazole gel
• Heat can be applied to speed the dissolving
o Clindamycin cream
process
• 10% glycerin prevents specimen deterioration TRICHOMONIASIS
• Examined under: LPO (10x magnification) – for
➢ Caused by parasitic protozoon T. vaginalis
presence of yeast pseudohyphae
➢ transmitted by sexual intercourse and causes
vaginitis in women and sometimes urethritis in
RESULT:
• Presence of "fishy odor" – positive men;
• Absence of "fishy odor"- negative ➢ MOST men are asymptomatic carriers;
OTHER DIAGNOSTIC TESTS ➢ Treatments:
1. GRAM STAIN o Metronidazole
• Gold standard in identifying the o Patients with allergy = tinidazole
causative organisms for bacterial
vaginosis CANDIDIASIS
• Provides permanent record of the px ➢ Caused by an infection with the yeast Candida;
specimen ➢ Common cause of vaginitis, and nearly 75% of
• Results: adult women have at least one yeast infection in
o Score of 0-3 – normal vaginal their lifetime;
flora ➢ Candida is part of the normal vaginal flora
o Score of 4-6 – intermediate ➢ Occurs when there is a change in the vaginal
o Score of 7 or more – bacterial environment
vaginosis ➢ Conditions that causes change in the vaginal
2. CULTURE
environment:
• Gold standard test for detecting yeast&
o Use of broad-spectrum antibiotics:
Trichomonas
• More time consuming and requires up o Oral contraceptives or oral estrogen
to 2 days for a result replacement therapy
• Diamond’s medium – T.vaginalis o Hormonal changes that occur with
detection pregnancy
• Specimen must be inoculated into the o Ovulation
pouch within 30 minutes of collection o Menopause
and; ➢ Treatments:
• Incubated for 5 days @ 37°C in a CO2 o Butoconazole
atmosphere o Clotrimazole
3. DNA TESTING o Tioconazole
• Identifies causative pathogen for o Miconazole.
vaginitis
• Diagnosis of:
DESQUAMATIVE INFLAMMATORY VAGINITIS
o G. vaginalis
o Candida spp. ➢ A syndrome characterized by profuse purulent
o T. vaginalis vaginal discharge, vaginal erythema, and
• Results are available in 1 hour with a sensitivity dyspareunia.
of 95% ➢ It also occurs secondary to atrophic vaginitis in
• More sensitive than wet mount microscopy postmenopausal women as a result of decreased
• Most accurate estrogen.

6
 ➢ Treatment:
o 2% clindamycin
o Hormone replacement therapy is
effective for patients with DIV secondary
to atrophic vaginitis.

ATROPHIC VAGINITIS
➢ a syndrome found postmenopausal women.
➢ caused by thinning of the vaginal mucosa
because of reduced estrogen production and
decreased glycogen production.
➢ As a result, the vaginal environment changes and
the balance of normal flora is altered.
➢ Clinical symptoms include:
o vaginal dryness and soreness
o dyspareunia
o inflamed vaginal mucosa
o and purulent discharge.

AMNISURE TEST
➢ A new method to diagnose a rupture of the fetal
membrane by detecting the placental alpha-
microglobulin-1 (PAMG-1) in cervicovaginal fluid.
➢ It quickly identifies patients with fetal membrane
rupture, and appropriate intervention can take
place.
o 1 line = Negative (-)
o 2 lines = Positive (+)
➢ A qualitative rapid test that uses an Advantages of Automation
immunochromatographic device ✓ Online computer capability with LIS interface
✓ Bar coding
PAMG-1
✓ Manual entry of color, clarity, and microscopic
➢ A normal level of PAMG-1 in the pregnant women
results to be included on the printed report
ranges from 0.05 to 0.22 mg/mL
✓ Flagging abnormal results
➢ 3 mg/mL when vaginitis is present
✓ Storing patient and control results
➢ Fetal membrane ruptures cause increased
✓ Minimal calibration, cleaning and maintenance
concentrations of amniotic fluid in the vaginal
secretions. It can raise the PAMG-1 levels to 2,000
AUTOMATED INSTRUMENTS
to 25,000 mg/mL
➢ Semi-automated instruments
o Depend on operator for specimen
AUTOMATION OF URINE AND OTHER mixing, test strip dipping, and microscopic
BODY FLUIDS results input.
o Following test can be performed:
AUTOMATION • Leukocyte
➢ Used not only to assist the laboratory’s test • Nitrite
performance but also to process and transport • Protein
the specimens, to load the specimens into • Blood
automated analyzers, to assess the test results • Glucose,
obtained, and to store and archive the • Ketone
specimens. • Bilirubin
GOAL • Urobilinogen
➢ Improve reproducibility and color discrimination • pH
while increasing productivity and standardization • specific gravity
for reporting urinalysis results. • color
➢ Note: Color readings depend on the accuracy of • creatinine
the timing. • protein-to creatinine ratio
o Self-calibrating and some instruments
REFLECTANCE PHOTOMETRY perform automatic checks (auto-checks)
➢ Principle: Light reflection from test pads decreases to identify strip type and humidity
in proportion to the intensity of color produced by exposure
concentration of the test substance.
➢ Automated urine cell analyzers
EQUIPMENTS EXAMPLES o Mix, aspirate, dilute, and stain urine to
classify urine sediment particles.

➢ Fully automated chemistry analyzer

o Tubes of urine are placed on rack or
carousel and moved automatically
through the instrument
o For a high-volume urinalysis laboratory
with user walk-away capability

7
 o The various instruments have the ability to The instrument also can be used for body fluid cell counts
load many samples on a carousel or rack by adding the body fluids software module.
at one time with the capability to insert a
STAT specimen during the run. It can be used independently or integrated with an
o DRY PAD TEST – measure results, which automated urine chemistry analyzer to create urinalysis
uses Reflectance Photometry to detect system.
color change and takes readings at the
right time and wavelength for each test.
o Color – measured by Reflectance
Photometry or Spectrophotometry
o Specific Gravity – measured by Refractive
Index methodology

ANALYTES BEING MEASURED

o Leukocytes
o Ketones
o Protein
o Glucose AUTO PARTICLES RECOGNITION (APR)SOFTWARE
o Nitrite ➢ Preclassifies urine particles in the photographs
o Blood based on size, shape, texture and contrast into 12
o Urobilinogen categories.
o Ph ➢ Particle identification is confirmed, or flagged and
o Bilirubin checked by the user before release.
➢ Results are sent to an operator screen or
INTEGRATED BAR-CODED SAMPLE IDENTIFICATION compared with user-defined auto-release
Used by the instruments which allow abnormal ranges to parameters.
be selected so that the sample that require microscopic ➢ If results are within the defined criteria they are
examination or confirmatory testing can be identified and sent directly to the LIS.
flagged ➢ The software allows the user to subclassify 27
additional categories.
AUTOMATED MICROSCOPY
Assists in decreasing labor costs and increasing The sedMAX
productivity in the urinalysis laboratory. They eliminate ➢ Performs automated microscopy with digital
observer-associated variation, reduce the need for imaging.
manual microscopy review, and offer results similar to ➢ The instrument uses newer technology.
those of manual microscopy. ➢ Requires a minimum of 2 mL of urine that is
Provide efficient standardized results in less than 1 minute centrifuged in a special cuvette to produce a
as compared with approx. 6 minutes using manual monolayer of urine sediment.
method ➢ Sediment is analyzed by a bright-field microscope
and digital camera to capture and categorized
15 particle images based upon size and shape
Sysmex UF-1000i using image-processing software.
Uses a laser-based flow cytometry that measures forward
light scatter, side scatter, fluorescence staining AUTOMATED URINALYSIS SYSTEM
characteristics, and adaptive cluster analysis to identify ➢ Combining automated urine chemistry analyzers
stained urine sediment particles and automated urine cell analyzers to create
completely automated urine analysis systems has
Main Particles Enumerated significantly improved turnaround times for
o Red Blood Cells urinalysis.
o White Blood Cells ➢ Using similar sample racks and moving on a
o Epithelial Cells conveyor system, samples are easily transferred
o Hyaline Casts from one instrument to the next, providing a
o Bacteria complete walkaway capability with minimal
specimen handling from sampling through results.
The results are displayed as scatter diagrams. ➢ By interfacing with the LIS, bar-coded samples are
These parameters are directly reportable without automatically identified and processed
technologist intervention and may be auto-validated. according to the requested tests.

Latex particle quality system monitors performance, and THE CLINITEK ATLAS
quality control records can be viewed on instrument ➢ An automated urine chemistry analyzer and
screen in a Levy-Jennings graph. Sysmex UF-1000i, an automated urine cell
Analyzers store 10,000 patient results analyzer, have been integrated to develop the
CLINITEK AUWi system which performs a
Can be used independently or integrated with an completely automated urinalysis.
automated urine chemistry strip reader to create a ➢ A minimum of 5 mL of urine is required in the
complete urinalysis system iQ 200 automated mode.
➢ the bar-coded tubes are racked and placed on
Uses digital imagining and APR to automatically analyze to the system.
and preclassify urine particles in uncentrifuged urine ➢ The rack advances to the ATLAS analyzer, where
based on size and shape. the specimen is identified, mixed, aspirated, and
tested for physical and chemical components.

8
 ➢ The sample then travels across a connecting ➢ Other Common condition related to anatomic
bridge to the UF-1000i for microscopic analysis. changes in UT
➢ The instrument automatically reflexes samples o Benign prostatic hyperplasia
requiring sediment analysis, reducing the time
associated with manual microscopic analysis. INFECTIONS OF THE LOWER URINARY TRACT
➢ Results are automatically verified and integrated 1. URINARY TRACT INFECTIONS (UTI)
into a complete urinalysis report to be sent to the o common cause for an outpatient visits to
LIS or printed. a physician or for nosocomial infections
o may be symptomatic or asymptomatic
THE IRICELL AUTOMATED URINALYSIS SYSTEMS • Pregnant women often have
➢ Consist of the iChem VELOCITY urine chemistry asymptomatic UTIs
analyzer and the iQ 200. o Men have less UTIs than Women, but both
➢ A minimum of 4 mL of urine is required. suffer from them as they age
➢ The bar-coded tubes are placed into the 10- • Common for elderly person
position rack and are moved to the iChem o In children, UTIs occur as many as 3-5% of
VELOCITY. female children and 1% of male children
➢ Upon completion of the physical and chemical o Infections can arise in either both ways
analysis, the rack moves across the connecting o Arise in the lower urinary tract via the
bridge to the iQ 200 for microscopy testing. urethra and ascend the urinary tract
➢ Samples can be reflexed to urine microscopy (More common)
based upon urine chemistry results. o Arise through infections in the
➢ Results for a complete urinalysis are transmitted to bloodstream seeding the kidney with
the LIS or printed. organisms deposited in the upper urinary
tract and descend the urinary tract.
BODY FLUIDS ANALYSIS AUTOMATION o Factors increasing risk of UTI:
➢ Neubauer Hemocytometer • Obstruction
o Used to perform body fluids cell counts • Foreign bodies
and differential • Presence of catheters
➢ Automation 2. UPPER UTIS (PYELONEPHRITIS)
o Brings quality control and precision to a o treated more aggressively as there is risk
method that previously was uncontrolled. of permanent kidney damage
➢ Manual Differential o Examining evidences of UTIs
o Use for body fluids with low cell count or • If white blood cell (WBC) casts
malignant cell using a stained cytospin are present, this is an indication of
smear. kidney infection rather than a
bladder infection, as casts are
ADVIA212Oi (Siemens) formed in the nephron.
➢ Count red and white blood cells and perform a 3. UROLITHIASIS (KIDNEY STONES)
WBC differential o Most common cause of upper urinary
➢ Uses flow cytometry, light scatter, and tract obstruction
absorbance o Common site of stone formation is in the
➢ Provide a rapid automated diagnostic test for kidney
fetal lung maturity by counting lamellar bodies in o Men are affected more commonly than
amniotic fluid women
o Different types of crystalline stones may
Symex XE 5000 form:
➢ newest generation hematology analyzer that • Calcium oxalate/calcium
includes a dedicated body fluid mode. phosphate
➢ the body fluid mode has extended cell counting • Magnesium ammonium
to increase precision in samples with small phosphate
numbers of cells • Uric acid
➢ body fluids can be analyzed without sample • Cystine stones
preparation or pretreatment. o Pain is the major manifestation of this
➢ only nonmalignant fluid be analyzed on the condition
XE5000iQ200 (Beckman Coulter, inc.) o Urinalysis
➢ fully automated method for the analysis of red • done to provide information
blood cell (RBC) count and nucleated cell count related to hematuria, urine pH,
in cerebrospinal, synovial and serous fluid and crystals that may be present
in the urine that may contribute
to stone formation.
URINARY TRACT DISORDERS
DISEASES OF THE KIDNEY
Anatomical Variations Affecting the UT 1. KIDNEY FAILURE
➢ Congenital Problems of the kidney and UT o Other means of replacing kidney
o Arise during fetal development functions such as dialysis or transplant are
o There may be abnormalities of the parts needed to cleanse the system. (declining
of the urinary tract’s shape and sizes. such replacements may shorten life)
➢ Anatomical conditions that arise prior to birth o According to a survey done in the U.S,
o Duplicate sets of ureters diseases that contribute to kidney
o Horseshoe kidney diseases includes:
o Vesicoureteral reflux • Chronic diseases
❖ Diabetes
9
 ❖ Hypertension ▪ Following only serum creatinine level is not
❖ Autoimmune disease a precise way to estimate GFR
• Metabolic disorders • Older Creatinine Clearance test
• Genetic disorders ▪ Involves collecting a blood sample for
o Kidney disease affects the quantity of fluids in the serum creatinine and a 24-hour urine
body such as: collection and urine volume
• Sodium ▪ Results are reported in mL/min or mL/min.
• Potassium body surface area
• Chloride • Newer Estimated GFR (eGFR)
• Bicarbonate ▪ Determined using the patient’s serum
• Phosphate creatinine and a formula that includes;
• Magnesium age, race, and sex
o Kidney diseases also often causes changes in • GFR remains within the normal range until
urinalysis results that help the physician diagnose extensive kidney damage has occurred.
and monitor patients • Urine microalbumin
▪ Generally, urine microalbumin levels are
COMMON DISEASES OF THE KIDNEY assessed by comparing the amount of
1. VASCULAR DISEASE microalbumin to the urine creatinine level
• Due to high blood pressure/hypertension in a single urine sample.
• If blood vessels of the kidneys are ▪ Healthy kidneys will yield large amounts of
damaged, the kidneys may stop creatinine but almost no microalbumin.
removing nitrogenous waste and excess
fluids from the body. DISEASE AFFECTING THE GLOMERULUS
• Laboratory tests can assist in determining 1. GLOMERULAR DISEASE
whether high blood pressure has • include those that present with nephritic
damaged the kidneys. syndrome and those that present with
▪ Measuring nitrogenous waste nephrotic syndrome
levels (measuring serum 2. GLOMERULAR DISEASE CAUSES AND MECHANISMS
creatinine) • Numerous immune complexes,
❖ Too much creatinine in immunological processes, and
blood is a sign of kidney nonimmunological processes can result in
damage various glomerular diseases. They may
❖ Used to measure main develop from primary kidney illness, have
kidney function called hereditary reasons, or have systemic
glomerular filtration rate disease origins.
(GFR) 3. ACUTE GLOMERULONEPHRITIS DISEASE
i. Can also be • Glomerulonephritis is a sterile,
done with inflammatory condition affecting the
creatinine glomerulus, resulting in protein, blood,
clearance test and casts in the urine. One type of
ii. Proteinuria - glomerulonephritis may change into
Associated with another types over time and may
hypertension, become chronic or lead to nephrotic
heart disease, syndrome.
and blood 4. ACUTE POSTSTREPTOCOCCAL
vessel level GLOMERULONEPHRITIS
2. DIABETES • an autoimmune condition that may arise
• Small blood vessels of the body are after a Streptococcus pyogenes infection
injured of the throat or skin.
• When kidney blood vessels are injured, 5. RAPID PROGRESSIVE (CRESCENTIC)
the kidneys cannot cleanse the blood GLOMERULONEPHRITIS
properly • a form of acute kidney disease that
• The body retains water and salt, which causes damage to the glomeruli and
can result in weight gain and ankle progressive loss of kidney function over
swelling (Edema) weeks to months.
• Protein may also be present in the urine 6. GOODPASTURE SYNDROME
• May cause nerve damage (may cause • An autoimmune disease with cytotoxic
difficulty in emptying bladder) autoantibodies to collagen that are
▪ May cause urine backup called anti-glomerular basement
▪ Development of infection from membrane antibodies and with
bacterial growth subsequent complement activation
• Measuring urinary protein levels, producing glomerular capillary
especially microalbumin can help detect destruction.
diabetic kidney damage. 7. MEMBRANOUS GLOMERULONEPHRITIS
• Screening of Diabetes: • Membranous nephropathy is caused by
▪ Diabetic and hypertensive patients pronounced thickening of the glomerular
should be regularly screened for kidney basement membrane.
diseases with two key tests: GFR (or 8. MEMBRANOPROLIFERATIVE GLOMERULONEPHRITIS
estimate GFR(eGFR)) and Urine • a kidney disorder arising from
microalbumin inflammation and resulting changes in
• Creatinine rises as GFR falls the microscopic structure of kidney cells
and peripheral capillaries. This is also
10
 known primarily as mesangiocapillary phosphorus, sodium, and
glomerulonephritis type potassium in the urine
9. CHRONIC GLOMERULONEPHRITIS ▪ can be caused by faulty genes,
• advanced stage of several kidney or it may result later in life due to
disorders, resulting in inflammation and kidney damage, or the cause
slowly worsening destruction of glomeruli, may be unknown
with progressive loss of kidney function ▪ Common causes of Fanconi
10. IMMUNOGLOBIN A NEPHROPATHY (BERGER syndrome in children are genetic
DISEASE) inborn errors of metabolism.
• patients chronically show increased • Nephrogenic Diabetes Insipidus
serum levels of IgA and immune ▪ a disorder in which a defect of
complexes containing IgA are deposited the nephron results in the
on the glomerular membrane. passage of large volumes of urine
11. DIABETIC NEPHROPATHY (KIMMELSTIEL- WILSON ▪ may be present at birth as a result
DISEASE) of an inherited defect that
• In diabetes, the blood vessels of the usually affects men, although
kidney are damaged. women can pass the gene on to
12. MISCELLANEOUS DISEASE RELATED TO their children
GLOMERULONEPHRITIS AND NEPHRON DAMAGE ▪ involves a defect in the kidney
• A variety of systemic and vascular tubules which affects the ability
diseases are also associated with of the kidneys to respond to
glomerular lesions and nephron damage. antidiuretic hormone
13. NEPHROTIC SYNDROME AND RELATED DISORDERS (vasopressin), which normally
• Nephrotic syndrome may occur over time instructs the kidneys to make the
as a complication of glomerulonephritis urine more concentrated
as mentioned above, or it may arise from ▪ Factors:
circulatory shock with a decrease of ❖ drugs such as lithium,
blood flow to the kidney and decreased demeclocycline, and
pressure in the glomerulus amphotericin,
14. FOCAL SEGMENTAL GLOMERULOSCLEROSIS electrolyte disorders,
• caused by scar tissue that forms in areas and urinary blockage
of the glomeruli • Renal Tubular Acidosis
▪ a group of primary or secondary
TUBULAR DISORDERS (ACUTE AND HEREDITARY) disorders characterized by the
1. ACUTE TUBULAR DISORDER impaired ability to secrete
• disorder involving damage to the tubule hydrogen ions in the distal tubule
cells of the kidneys, resulting in acute or to reabsorb bicarbonate ions
kidney failure in the proximal tubule leading to
• Acute tubular necrosis chronic metabolic acidosis.
▪ a condition with rapid onset ▪ resulting chronic metabolic
caused by lack of oxygen to the acidosis causes potassium
kidney tissues (ischemia of the depletion and wasting, muscle
kidneys) or by exposure to weakness that can lead to
materials that are nephrotoxic. paralysis, calcium loss in bone,
▪ internal structures of the kidney, elevated urine calcium loss,
particularly the tissues of the kidney stones, and renal failure.
kidney tubule, are damaged or • Renal Glycosuria
destroyed. ▪ the reabsorption of glucose
▪ one of the most common causes ▪ this disorder is inherited as an
of kidney failure in hospitalized autosomal recessive trait
patients. ▪ Patients have increased urine
levels of glucose with normal
Findings of this disorder: blood glucose levels.
o increased blood urea nitrogen (BUN) and serum
creatinine levels TUBULOINTERSTITIAL DISEASE
o altered excretion of sodium and of urea ➢ This term is used for infections and inflammatory
o kidney biopsy may show acute tubular necrosis conditions that affect both the interstitium and the
o urinalysis may show casts, kidney tubular cells, and tubules, which are in close proximity.
red blood cells
o urine specific gravity and osmolarity may indicate ACUTE AND CHRONIC PYELONEPHRITIS
dilute urine ➢ Pyelonephritis is an infection of the kidney and the
2. HEREDITARY AND ACQUIRED METABOLIC TUBULAR ducts that carry urine away from the kidney
DISORDERS (ureters)
• Fanconi Syndrome ACUTE INTERSTITIAL NEPHRITIS
▪ a tubular disorder in which ➢ Interstitial nephritis is a kidney disorder in which the
certain substances normally spaces between the kidney tubules become
reabsorbed into the bloodstream inflamed.
by the nephrons are released
into the urine instead RENAL FAILURE
▪ results in the accumulation of ➢ inability of the kidneys to perform excretory
various amino acids, glucose, function leading to retention of nitrogenous waste
products from the blood.
11
 ➢ can occur rapidly or over time which poses a
serious and even life-threatening risk to the
patient.
➢ in renal failure situation, it would require measures
such as dialysis or kidney transplant for the body
to be able to get rid of toxic nitrogenous wastes.

ACUTE RENAL FAILURE

➢ Acute (sudden) kidney failure is the sudden loss of
the ability of the kidneys to remove waste and
concentrate urine without losing electrolyte
➢ Transfusion Reaction
➢ CAUSES OF ACUTE RENAL FAILURE:
• Decreased Blood Flow
• Acute Tubular Necrosis
• Infections (pyelonephritis or septicemia)
• Obstructive Uropathy
• Autoimmune Kidney Disease (interstitial
nephritis or acute nephritic syndrome)
HEPATORENAL SYNDROME
➢ occurs with fulminant hepatitis or advanced
cirrhosis of the liver with ascites fluid buildup and
has an acute onset in these patients with severe
liver disease.
➢ characterized by a progressively intense
vasoconstriction which leads to oliguria, elevated
BUN and creatinine, and renal failure.
➢ The kidneys are still able to produce a smaller
amount of hypertonic urine in which this urine is
very low in sodium due to hyperaldosteronism.
➢ In this case, if the hepatic function can be
restored the kidney function can also improve.
CHRONIC RENAL FAILURE
➢ A condition characterized by a gradual loss of
kidney function over time.
➢ The rate of chronic renal failure progression from
several months to years
➢ CHRONIC RENAL FAILURE PROGRESSION STAGES:
1. Diminished Renal Reserve – Glomerular
filtration rate (GFR) drops to about 50% of
normal.
2. Renal Insufficiency – Glomerular filtration rate
(GFR) drops from 20 to 50% following the
beginning of azotemia, anemia, and
hypertension.
3. Renal Failure – Glomerular filtration rate (GFR)
is less than 20% where kidneys cannot
regulate volume and solute concentration
and development of metabolic acidosis,
edema, and hyperkalemia arises.
4. End Stage Renal Disease - Glomerular filtration
rate (GFR) is less than 5% of the normal where
dialysis or transplantation may be required for
survival. In this case, critical renal functions are
lost.

END STAGE RENAL DISEASE-DIABETES

➢ most common cause of end stage renal disease
are currently the diabetes mellitus and related
diabetic nephropathy (Kimmelstiel-Wilson
disease).
➢ Presence of microalbuminuria is important for
early detection of diabetic nephropathy in
diabetic patients.
➢ Control of blood sugar and blood pressure is
critical for patients with diabetes to control
damage of the kidney

12