PRINCIPLES OF MEDICAL

LABORATORY SCIENCE PRACTICE 1

MODULE 5

UNIT 3:
UNIT 3: THE CLINICAL
MICROSCOPY SECTION
Unit 3 – THE CLINICAL MICROSCOPY SECTION
Unit Objectives:
1. Identify and differentiate the
microscopic, chemical and
physical examination of
urine.

2. Enumerate historical events and

figures that contributed to the
development routine
urinalysis.
OUTLINE
01 INTRODUCTION

BRIEF HISTORICAL BACKGROUND OF

URINALYSIS

ROUTINE WORK IN THE CLINICAL

MICROSCOPY SECTION
 INTRODUCTION

CLINICAL MICROSCOPY 05
Clinical microscopy involves the
performance of scientific analysis on
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body fluids other than blood: seminal
fluid, spinal fluid, serous fluids,
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synovial fluid, amniotic fluid, and
URINE, which is considered as the most 02
readily available and easily collected
indicator of the body’s many metabolic
functions.
 INTRODUCTION

CLINICAL MICROSCOPY 05
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 INTRODUCTION

CLINICAL MICROSCOPY 05
The Clinical and Laboratory Standards
Institute (CLSI) defines urinalysis as “the
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testing of urine with procedures
commonly performed in an expeditious,
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reliable, accurate, safe, and cost-
effective manner.” 02
According to CLSI, the main reasons for
performing urinalysis include aiding in the
diagnosis of disease, screening
asymptomatic populations for undetected
disorders, and monitoring the progress of
disease and the effectiveness of therapy
(Strasinger, 2014).
BRIEF HISTORICAL BACKGROUND OF
URINALYSIS

a. Hippocrates (5th 05
century)
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Wrote a book in “uroscopy”
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b. Rufus of Ephesus (50
AD)
- Made the first description of
hematuria as the presence of blood in
the urine
 BRIEF HISTORICAL BACKGROUND OF
URINALYSIS

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c. Isaac Judaeus (900 AD)
- Considered as one of the founders of the origins of
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nephrology
- In his book Kitab al Baul (Book of Urine), detailed the
concepts of urine formation, urinary sediments, and urine
characteristics in relation to diseases. 02
 BRIEF HISTORICAL BACKGROUND OF
URINALYSIS

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d. Middle Ages
- Physicians concentrated their efforts very
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intensively on the art of uroscopy, receiving
instruction in urine examination as part of
their training
- 1140: Color charts had been developed that 02
described the significance of 20
different colors
- Chemical testing of urine involved “ant
testing” and “taste testing” for glucose

- “Pisse prophets”, charlatans without

medical credentials, began offering health-
related predictions of patients using their
urine samples
 BRIEF HISTORICAL BACKGROUND OF
URINALYSIS

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e. Thomas Bryant (1627) 04
- Published a book that exposed the scam offered by the
“pisse prophets”
- Revelations uncovered in his book inspired the passing
of the first medical licensure laws in England 02
 BRIEF HISTORICAL BACKGROUND OF
URINALYSIS

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f. Jean Baptiste van Helmont 04
- Introduced the gravimetric analysis of urine by
weighing a number of 24-hour urine specimens.
No significant conclusions were derived from his
measurements.
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g. Frederik Dekker (1694)
- Discovered albuminuria by boiling urine;
Observed that proteins in the urine
precipitated when boiled with acetic acid
 BRIEF HISTORICAL BACKGROUND OF
URINALYSIS

h. Thomas Addis (1926) 05

- First attempt to standardize the quantitation of
formed elements in urine microscopic
analysis
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- Addis count: used a hemocytometer to count
the number of RBCs, WBCs, casts and
epithelial cells present in a 12-hour urine
sample
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i. Richard Bright (1827)
- Introduced the concept of urinalysis as part of
a doctor’s routine patient examination
- Revealed the presence of albumin in heated
urine samples
- Studied renal diseases and clearly established
the overall correlation of edema,
albumin in urine, and diseased kidneys
observed after death
 BRIEF HISTORICAL BACKGROUND OF
URINALYSIS

j. 1930s 05
- Number and complexity of the tests performed
in a urinalysis had reached a point of
impracticality, and urinalysis began to disappear
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in routine examinations

k. Reagent Strips (Urine Test Strip)

- Rescued routine urinalysis by making chemical
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and physical examination of urine
samples easier
- 1950s: Urine test strips were first made on
industrial scale and offered commercially
- 1964: The company Boehringer Mannheim
(today Roche) launched its first Combur
test strips
 ROUTINE WORK IN THE CLINICAL
MICROSCOPY SECTION
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Accurate urinary results greatly depend on the quality of 04
the specimen collected.
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With this in mind, laboratories routinely request patients to
collect urine samples using the 02
MIDSTREAM CLEAN-CATCH METHOD. Urine
samples collected via midstream clean-catch
method are less contaminated by epithelial cells
and bacteria.
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ROUTINE URINALYSIS
a. Physical Examination of Urine 04
i. Color
▪ To examine urine color, examine the specimen under a good light
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source, looking down through the container against a white
background
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▪ Normal urine color: straw, pale yellow, yellow, dark yellow, & amber
(relatively dehydrated states)
▪ Normal urine pigments responsible for coloration:
a. Urochrome: Responsible for the YELLOW color of urine
b. Uroerythrin: a PINK pigment most evident in REFRIGERATED
SPECIMENS as a result of amorphous urates precipitation
c. Urobilin: Imparts an ORANGE-BROWN color to urine samples that are
not fresh
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ii. Clarity
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▪ Refers to the TRANSPARENCY / TURBIDITY of a urine
specimen 03
▪ Amount of turbidity will correspond to the amount of
material observed 02
during microscopic examination
▪ To examine clarity, visually examine the specimen in a
clear container while holding it in front of a light source.
▪ Reporting:
• Clear: No visible particulates, transparent
• Hazy: Few particulates, print easily seen through urine
• Cloudy: Many particulates, print blurred through urine
• Turbid: Print cannot be seen through urine
• Milky: May precipitate or be clotted
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b. Chemical Examination of Urine
- Chemical parameters (and specific gravity) of urine 04
samples are routinely assessed using reagent strips
(urine strips) 03
Reagent Strips (Urine Strips)
o Consist of chemical-impregnated absorbent pads
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attached to a plastic strip
o A color-producing chemical reaction takes place when
the absorbent pad comes in contact with urine
o Reactions are interpreted by comparing the color
produced on the pad with a chart supplied by the
manufacturer
 ROUTINE WORK IN THE CLINICAL
MICROSCOPY SECTION

o Parameters in Reagent Strips

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1. Specific gravity (physical property)
2. pH 04
Normal Urine pH
Random: 4.5 to 8.0 03
First Morning urine samples: 5.0 to 6.0
With normal protein diet: 4.5 to 6.5 02
3. Protein
4. Glucose
5. Ketones
6. Blood
7. Bilirubin
8. Urobilinogen
9. Nitrite
10. Leukocyte esterase
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THANK YOU