Common Laboratory Tests:

Body Fluids
PHR 327.1
ZTG
Fall 2019

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 Overview

• Urinalysis
• Cerebrospinal Fluid
• Pleural Fluid
• Ascitic fluid

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 Urinalysis: Description
• Routine urinalysis, one of the most widely
ordered laboratory procedures, is used
for basic screening purposes.
• It is a group of tests that evaluate the
kidneys’ ability to selectively excrete and
reabsorb substances while maintaining
proper water balance.
• The results can provide valuable information
regarding the overall health of the patient
and the patient’s response to disease and
treatment
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 Urinalysis
• Specimen: Urine about 30 ml
 
• collected in a clean plastic collection container.
• sufficient sample is required for accurate results
• At least (~15 mL)

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Urinalysis

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 When is it ordered?
• Determine the presence of a genitourinary
infection or abnormality or help diagnose
and/or monitor several diseases and
conditions, such as kidney disorders

• If patient complains of symptoms, such as

abdominal pain, back pain, frequent or painful
urination, pregnancy check-up, hospital
admission, or pre-surgical work-up

• Routine screening
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 Screens for
• Urinalysis comprises a series of tests including a:
– description of the color and appearance of urine
– measurement of specific gravity and pH
– measurement of protein, glucose, ketones,
urobilinogen, bilirubin, hemoglobin, nitrites etc..
• Urine sediment may also be examined for the
presence of crystals, casts, renal epithelial cells,,
squamous epithelial cells, white blood cells
(WBCs), red blood cells (RBCs), bacteria, yeast,
sperm, and any other substances excreted in
the urine that may have clinical significance
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 Screens for.. Urine pH

• pH: 4.5-8 (average, 6)

• Urine pH is an indication of the kidneys’ ability to
help maintain balanced hydrogen ion concentration
in the blood.
• The urine is usually slightly acidic, about pH 6, but can
range from 4.5-8.

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 Screens for ..Urine pH
• Protein: absent
– Present in benign/
diabetic nephropathy

• Usually Urine protein is the most

common indicator of renal disease

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 Screens for ..Urine Specific Gravity

• Specific gravity: 1.005 to 1.030

–increased: dehydration diarrhea
, fever, vomiting,
–Urine specific gravity is a measure
of urine concentration.

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 Screens for .....Normal values

• Ketones: absent.
• Glucose: absent.
• Occult blood: absent
• Bacteria: Absent
• Very low WBCs
 Screens for .....Bilirubin

• Bilirubin: absent.

• Bilirubin is used to assist in the detection of

liver disorders: cirrhosis, hepatitis.

• The results of this test will be considered along

with the result of urobilinogen.

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 Screens for .....

• Urobilinogen is normally present in urine in

low concentrations.
• High urobilinogen indicates hepatic
or hematopoietic conditions.

• When urine urobilinogen is low or absent in a

person with urine bilirubin and/or signs of
liver dysfunction, it can indicate the presence
of hepatic or biliary obstruction.

• Nitrites and leukocytes are used to test for

sources of urinary tract infections (UTIs).
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 Normal appearance
• The color of normal urine ranges from
light yellow to deep amber.
• The color depends on the patient’s state
of hydration, diet, medication regimen,
and exposure to other substances that
may contribute to unusual color or odor.
• The appearance of normal urine is clear.
• Normal specific gravity is 1.005 to 1.030.

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 Unusual Color analysis
• Deep yellow: Riboflavin
• Red: Beet pigment, hemoglobin
• Brown: Bilirubin, metronidazole
• Smokey: Red blood cells

• Abnormal Findings:
– Bacteria
– Pus
– RBCs
– Etc.

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 Pleural fluid
• Thoracentesis (pleural Tap): Fluid is
withdrawn from the pleural cavity by needle
insertion and tested for therapeutic /
diagnostic purposes.

• Appearance: clear, light yellow

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 DESCRIPTION:
• The pleural cavity and organs within it
are lined with a protective membrane.
• Normally only a small amount of fluid is
present between the membranes
– abnormal conditions can result in the buildup of
fluid within the pleural cavity.

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 When is it used:
• Therapeutic uses: to relieve pain, dyspnea, and
other symptoms of pleural pressure. Removal
of this fluid also permits better radiographic
visualization of the lung.
• Diagnostic uses: to obtain and analyze fluid to
determine the cause of the pleural effusion
• Pleural fluid is classified according to transudate
or exudate _ very helpful differentiation in
determining the cause of the effusion.
 Pleural fluid Classification

• Transudates: fluid pushed through the

capillary due to high pressure within
the capillary
– Congestive heart failure, cirrhosis etc.

• Exudates: fluid that leaks around the cells

of the capillaries caused by inflammation,
infections, neoplasm.
 Abnormal findings
• Empyema
• Pneumonia
• Tuberculosis
• Tumors
• Etc.
• pH 7.1–7.2 indicates need for
immediate drainage of fluid
– Empyema (infection, pus)
• Normal pH: 7.6-7.64
 Cerebrospinal Fluid (CSF) Analysis
• CSF (~1 to 3 mL) collected in three or four
separate plastic conical tubes for
– chemistry and serology testing
– microbiology
– cell count and
– miscellaneous testing.
• Specimens for analysis are most
frequently obtained by lumbar puncture
– Lumbar puncture can also have therapeutic uses,
including injection of drugs and anesthesia.
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CSF

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 DESCRIPTION:
• Cerebrospinal fluid (CSF) circulates in the
subarachnoid space and mainly protects the
brain and spinal cord from injury

• A CSF analysis: tests to evaluate substances

in CSF in order to diagnose conditions
affecting the brain and spinal cord
– evaluation for the presence of blood, bacteria,
and malignant cells, along with quantification
of the amount of glucose and protein present.
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 When to order a CSF analysis:
• Diagnosis/detection of
– intracranial hemorrhage
• Diagnosis of diseases such as
– multiple sclerosis, meningitis or encephalitis
– neurosyphilis and chronic central nervous system infections
• Detect:
– obstruction of CSF circulation due to hemorrhage, tumor,
or edema
– any condition decreasing the flow of oxygen to the brain
• Monitor for metastases of cancer into the CNS
• Monitor severe brain injuries 29
 Abnormal Findings
• Presence of malignant cells, brain abscess,etc.
• Elevated WBC count: significant increase  infection or
inflammation of the central nervous system.
• Glucose:
– Higher than normal: Meningitis etc.
– Lower than normal: Bacterial infection
• Complications:
– headache: can happen from persistent CSF leak after puncture
– Introduction of bacteria causing meningitis

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 Other considerations:
• Cefotaxime and dexamethasone can decrease
or increase CSF protein/ glucose levels
• RBC count may be falsely elevated with
a traumatic spinal tap.
• Contraindications:
– This procedure is contraindicated if infection
is present at the needle insertion site
– If patient is anticoagulated
• Risk of haemorrhage
– Patients with increased intracranial pressure
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 Peritoneal Fluid/Ascitic Fluid

• Peritoneal Fluid: Lubricant liquid in

the abdominal cavity.
• Found in small quantities (generally 5-20 mL)
– abnormal conditions can result in the buildup
of fluid within the peritoneal cavity.
• Fluid is withdrawn from the peritoneal cavity
by inserting needle and removal of ascitic fluid
(paracentesis) for diagnostic and therapeutic
purposes.
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Ascites

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Ascitic Fluid

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 When is this test used:
• Therapeutic uses: to remove large amounts
of fluid from the abdominal cavity.

• Diagnostic uses: to obtain and analyze fluid

to determine the cause of the peritoneal
effusion.
– Peritoneal fluid is classified as a transudate or
exudate. This differentiation is very helpful in
determining the etiology of the effusion.

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 Description
• Transudates: form as a result of a systemic
disorder that disrupts the regulation of fluid
balance. Eg: congestive heart failure,
cirrhosis, peritoneal dialysis etc.

• Exudates: caused by conditions involving

the tissue of the membrane itself, such as
an infection or malignancy eg. infectious or
malignant conditions. Additionally,
gastrointestinal diseases, trauma, and drug
hypersensitivity also may cause an
exudative effusion
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 Abnormal findings:
• Carcinoma
• Tuberculosis
• Cirrhosis
• Congestive heart failure

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