CLINICAL MICROSCOPY UNIT

PRETEST
Cobas 6500 Urine Analyzer The cobas 6500 urine analyzer series is a fully automated
urine work area that can handle up to 240 samples per hour
and therefore fulfills the needs of high throughput laboratories.
Due to its modular design the cobas® 6500 urine analyzer
series can be used as a stand-alone strip analyzer, a stand-
alone microscopy analyzer or together as a fully automated
urine work area.The cobas 6500 urine analyzer series
significantly improves productivity and efficiency of urine
testing in the laboratory by reducing manual tasks to a
minimum.

Cobas 6500 is divided into two different areas:

 cobas u 601 urine analyzer automates all manual steps and

provides high quality results by proven unique reagent strip
technology based on more than 50 years of experience in
urine strip analysis and innovation and minimizing operator
intervention while providing confidence in results.

 cobas u 701 microscopy analyzer improves the gold

standard2 (manual microscopy) in urine microscopy by
standardization and automation of all manual steps, removing
operator variability and significantly reducing operator
intervention while increasing efficiency.
Microscope A microscope is an instrument that can be used to observe
small objects, even cells. The image of an object is magnified
through at least one lens in the microscope. This lens bends
light toward the eye and makes an object appear larger than it
actually is. It is used to microscopically identify cellular cast
and elements in the urine sample and other body fluids.
Cobas u 411 Urinalysis Analyzer The cobas u 411 urinalysis analyzer is a semi-automated,
bench top analyzer which is designed to read Chemstrip 10
UA (Combur10 Test M) test strips for urinalysis for the
measurement of bilirubin, blood, glucose, ketones, leukocytes,
nitrite, pH, protein, specific gravity, urobilinogen and color (if
selected). These measurements are useful in the evaluation of
renal, urinary and metabolic disorders. These measurements
are useful in the evaluation of renal, urinary and metabolic
disorders.
Centrifuge A centrifuge is a laboratory device that is used for the
separation of fluids, gas or liquid, based on density. Separation
is achieved by spinning a vessel containing material at high
speed; the centrifugal force pushes heavier materials to the
outside of the vessel. This apparatus is found in most
laboratories from academic to clinical to research and used to
purify cells, subcellular organelles, viruses, proteins, and
nucleic acids.
Laboratory Oven Laboratory ovens, also referred to as laboratory furnaces, are
used to sterilize biohazard waste, dissecting instruments or
media/reagents for aseptic assays.

They are also used for drying, heating, testing environmental

stresses, such as changes in temperature, light and humidity.
 Laboratory ovens can be used in various laboratories, such as
a diagnostic laboratory to dry microscope slides, a research
laboratory to test products at different temperatures for
stability, or an industrial lab using a walk in autoclave to
sterilize a large piece of equipment.
RBC Pipette An RBC PIPETTE is a calibrated pipet used to draw a very
small sample of blood from a finger prick, dilute it with a
specialized fluid, then apply a droplet of it to a special
calibrated microscope slide (hemocytometer) so one could
count the RBCs while looking through the microscope.
WBC Pipette WBC PIPETTE to dilute blood with a reagent. A devise offering
a simplified technique for counting white blood cells, employing
only a small quantity of reagent.
Hemocytometer The hemocytometer (or haemocytometer or counting chamber)
is a specimen slide which is used to determine the
concentration of cells in a liquid sample. It is frequently used to
determine the concentration of blood cells (hence the name
“hemo-“) but also the concentration of sperm cells in a sample.
Chemical Fume Hood Chemical fume hoods, when used properly, are one of the
most reliable engineering controls in the laboratory. They
protect workers by:
* Containing vapors, dusts, gases, and fumes generated within
the hood, and removing them as air flows into the hood and
then out via the laboratory exhaust system
* Contributing to laboratory ventilation as air flows through the
hood
* Shielding the worker with a clear sliding window, called a
sash, that contains aerosols and prevents injury from
splashes, fires, or minor explosions that may occur inside the
hood.
Mortar and Pestle A mortar and pestle are used to grind up solid chemicals into a
fine powder and crush solids into smaller pieces. The mortar's
interior is unglazed for more effective grinding. The rims have
integrated pouring spouts. The mortar is a bowl, typically made
of hardwood, ceramic, or stone. Commonly used in stone
analysis.

INTRODUCTION
This unit performs scientific analysis of non-blood body fluids such as urine, semen, stool, peritoneal fluid, ascitic
fluid, cerebrospinal fluid, etc. The tests included here are Routine Urinalysis, Pregnancy Test, Urinary Stone
Analysis, Bence Jones Protein Test, Routine Fecalysis, Fecal Occult Blood Test, Scotch Tape Swab, Helicobacter
pylori Antigen Test, Clostridium difficile Toxin A and B Test, Wet Smear (for Trichomonas), Seminal Fluid Analysis,
Other Body Fluid Analysis (Total Cell Count, Differential Count, Chemical Analysis).

LECTURE
Clinical Microscopy Supervisor Mr. Noel Sobrevilla, RMT
Clinical Microscopy Assisstant supervisor Ms. Roxana Mendoza, RMT
Required volume At least 3 ml
When receiving the spx check the ff  patient’s demograhic
 time of collection
 dater (2hrs from time collected)
Prior to processing Log the spx in the receiving logbook
Applied for uring spx Continous numbering
Before transferring to the tube Mix first
How to use Cobas 6500 Urine Analyzer 1. Indicate sample ID using YY/MM/DD-spx number
 2. Use the number at the rght side corner of the rack as RACK
ID
3. Numbers engraved on the rack is use as RACK POSITION
4. Place the rack on the machine, most likely it takes 3-5 mins
to view the result
5. 15 picures are taken in different fiel that is validated by a
registered medical technologist
Special Test
For special test, pregnancy test 1. use a number with “S” for numbering spx
2. Put 2 drops of urine an read after 3 mins
Special fluid
CSF, pleural, peritoneal, ascitic fluid 1. Label the spx using a number with “S”
2. Indicate the ff: Total Volume, Color, Transparency
3. Use the reagent strip for pH and Specific gravity
WBC and RBC count Dilution for WBC – Acetic Acid
Dilution for RBC – Hayem’s
Thoma pippet – 11 (WBC), 0.5 mark blood
1. Discard 5 drops before charging. Slowly charge the spx t the
counting chamber
2. Centrifuge for 5 mins
3. After 5 mins, decant and make a smear
4. Let it dry
3-5 dips in methanol
30 dips for eosin
30 dips for methylene blue
5 dips for phosphate buffer
5. Let it dry
6. Microscopic analysis is done by the registered medical
technologist
Fecalysis
Required spx Pea sized stool
Prior to processing Log the spx to the receiving book
For stool spx Circled number is used
Steps Make a smear for microscopic analysis
Make a smear using 1 drop of NSS and small size of stool
Microscpic analysis and validation is done by a registered
medical technologist

ACTIVITY 1
An unlabeled specimen was brought to the laboratory Inform the ward to recollect a new specimen.
by the nursing attendant. The nursing attendant asked
you to write the patient’s demographics on the
specimen bottle. What will you do?
a) Inform the ward to recollect a new specimen.
b) Ask your co-intern to write the patient’s
demographics on the urine bottle.
c) All answers are correct.
d) Write the complete patient’s demographics on
the urine bottle.
You received a light brown colored urine. The Tell the staff on duty that the specimen maybe
MedTech staff on duty asked you to read the specimen contaminated. Then inform the ward for recollection
before she do. You noticed some artifacts present in
the examination that may be found in stool samples.
What will you do?
a) Continue to read the specimen and report all
 artifacts that are present.
b) Ignore the specimen.
c) Tell the staff on duty that the specimen maybe
contaminated. Then inform the ward for
recollection.
d) Proceed the test.
The Attending Doctor called the laboratory to relay the Inform the MedTech staff on duty about the phone
laboratory results of the patient, as a Medical call.
Technology Intern what will you do?
a) Relay the results without the permission of the
MedTech staff.
b) Ignore the phone call.
c) All choices are correct.
d) Inform the MedTech staff on duty about the
phone call.
A urine specimen was submitted to the laboratory for Inform the doctor to collect a new specimen for the
routine urinalysis. After processing the test, you urine CS and GS.
received a phone call from the doctor telling that there
would be additional urine culture and sensitivity (CS)
and gram stain (GS) test for the same specimen. What
will you do?
a) Both of the choices are correct.
b) Both of the choices are incorrect.
c) Inform the doctor to collect a new specimen for
the urine CS and GS.
d) Accept the additional request/test.
A urine specimen was brought to the laboratory for Reject the specimen and inform the ward for
routine urinalysis. While checking the integrity of the recollection.
specimen you noticed that the specimen is collected
3hrs prior to the submission of the specimen to the
laboratory. What will you do?
a) Reject the specimen and inform the ward for
recollection.
b) Try to coordinate with the patient’s doctor if
they will proceed the test.
c) Accept the specimen.
d) Change the time of collection.

ACTIVITY 2
Describe the transparency of the urine sample below: Clear
Clear
Slightly Turbid
Turbid
Describe the transparency of the urine sample below: Clear
Turbid
Slightly Turbid
Clear

What is the color of the urine sample below:

Light Yellow
Colorless
Amber
Yellow
Dark Yellow

What is the color of the urine sample below: Light Yellow

Amber
Yellow
Dark Yellow
Light Yellow
Colorless

What is the color of the urine sample below: Amber

Yellow
Dark Yellow
Amber
Light Yellow
Colorless

Describe the transparency of the urine sample Slightly Turbid

below:
Turbid
Slightly Turbid
Clear

Describe the transparency of the urine sample below: Turbid

Turbid
Clear
Slightly Turbid

What is the color of the urine sample below: Amber

Colorless
Yellow
Amber
Dark Yellow
 Light
Yellow

Describe the transparency of the urine sample below: Slightly Turbid

Clear
Slightly Turbid
Turbid

What is the color of the urine sample below: Light Yellow

Light Yellow
Dark Yellow
Amber
Colorless
Yellow

ACTIVITY 3
Dypilidium caninum

Plasmodium falciparum

Giardia lamblia

Enterobius vermicularis

Chilomastix mesnilli
Balantidium coli

Capillaria philippinensis

Taenia solium

Trichuris trichiura

Wuchereria bancrofti
 Hymenolepis diminuta

Trichinella spiralis

Taenia saginata

Fasciola hepatica

SHIFTING EXAM
Ketones in urine may indicate: All of the above
a) Nausea
b) All of the above
c) Starvation
d) Diabetes
Determine at what pH would the following crystals 1. Triple phosphate - Alkaline
appear: 2. Ammonium biurate -Alkaline
1. Triple phosphate 3. Amorphous urates -Acid
2. Ammonium biurate 4. Tyrosine -Acid
3. Amorphous urates 5. Amorphous phosphate - Alkaline
 4. Tyrosine 6. Calcium oxalate - Acid
5. Amorphous phosphate 7. Uric Acid - Acid
6. Calcium oxalate 8. Cystine - Acid
7. Uric Acid 9. Bilirubin crystals - Acid
8. Cystine 10. Leucine- Acid
9. Bilirubin crystals
10. Leucine
What substance is present in high concentrations in Urea
urine, but not in serum?
a) Urea
b) Albumin
c) Erythrocyte
d) Glucose
Volume requirement for urinalysis is 3ml. False
True
False
Bence-Jones protein is usually present in: Multiple myeloma
a) Multiple myeloma
b) Porphyria
c) Gonorrhea
d) Typhoid fever
In alkaptonuria, exposure to air turns the urine: Black
a) Green
b) Pink
c) Black
d) Purple
Pre label specimen container are acceptable. False
True
False
Also known as “ENVELOPE CRYSTAL” Calcium oxalate
a) Triple phosphate
b) Calcium oxalate
c) Amorphous urates
d) Uric acid
Stool that is contaminated by urine is acceptable. False
True
False
The early stage of malarial parasites in the red cells is Ring stage
called:
a) Schizont
b) Schizoite
c) Ring stage
d) Segmenter
In receiving the urine specimen, time of collection True
should always be indicated.
True
False
Which of the following animals acts as a reservoir of Pig
infection of Balantidium coli?
a) Sheep
b) Dog
c) Pig
d) Cattle
The flukes and tapeworm parasitic in man belong to Platyhelminthes
the phylum:
a) Arthropods
b) Platyhelminthes
 c) Protozoa
Schuffner’s dots are more frequent and abundant in True
erythrocytes with Plasmodium ovale than in those with
Plasmodium vivax.
True
False
Hematuria: Pathologic in male urine
a) Pathologic in female urine
b) Not clinically significant
c) Gives a red color urine
d) Pathologic in male urine
Which of the following could cause a false positive All of the above
pregnancy test?
a) Hormones produced by tumors
b) All of the above
c) Menopause
d) Pituitary tumors
Crystal that is NOT found in acid urine: Calcium carbonate
a) Calcium carbonate
b) Calcium oxalate
c) Uric acid
d) Amorphous urates
In receiving of specimen complete name including True
middle name is needed.
True
False
In CSF Analysis, bottle number 1 is for cell count and False
differential count.
True
False
Lung fluke: Paragonimus westermani
a) Fasciola hepatical
b) Paragonimus westermani
c) Fasciola buski
d) Clonorchis sinensis
Cobas 6500 is divided into 2 different machines the True
chemical test machine and microscopic area.
True
False
Pea sized stool is acceptable for fecalysis. True
True
False
The egg resembles an old-fashioned electric bulb: Clonorchis sinensis
a) Clonorchis sinensis
b) Fasciolopsis buski
c) Fasciola hepatica
d) Paragonimus westermani
Bacteria would likely interfere with which two test? Glucose and PH
a) Glucose and ketones
b) Glucose and protein
c) Glucose and PH
d) Protein and PH
Medical technology interns are the one who validates False
the result.
True
False
Which of the following crystals are NOT normally found Tyrosine and sulfa
in urine?
a) Tyrosine and sulfa
b) Calcium oxalate
c) Cysteine and triple phosphate
d) Amorphous urates and phosphate
Enterobius vermicularis is best diagnosed by: Scotch tape swab
a) Scotch tape swab
b) None of the above
c) Zinc sulphate flotation
d) Formalin ether concentration
To determine if a 24 hr urine collection is complete, Creatinine
which of the following determination may be helpful?
a) Creatinine
b) Uric acid
c) BUN
d) Osmolality
When a large amount of porphyrin is present in the Port wine red
urine it is often colored:
a) Pale yellow
b) Port wine red
c) Dark brown
d) Pink
Thick blood smear taken at night shows microfilaria
larvae with well developed sheaths.
a) Onchocerca volvulus
b) Plasmodium sp.
c) Wuchereria bancrofti
d) Loa loa
Match the following vectors to its corresponding
disease.

Kissing bug Chaga’s Disease

Tse tse fly African trypanosomiasis
Aedes mosquito Dengue fever
Rat flea Bubonic plague
Culex mosquito Bancroft’s filariasis
Phlebotomus sand fly Leishmaniasis
Dog flea Dipylidiasis
Human flea Pulex irritans
Black fly Onchocerciasis
Tabanus sp. Anthrax