CLINICAL MICROSCOPY Bilirubin: Only conjugated, B1, Direct bilirubin is detected.
IMPORTANT DETAILS: ✓ Diazo Reaction is the principle.
Protein: Buffered to pH 3 (constant pH due to the presence of citrate buffer
that maintains). Orthostatic proteinuria is a benign condition.
✓ Orthostatic proteinuria is determined by 1st morning urine and
random urine in the afternoon.
✓ Positivity (+) for protein indicates the presence of cast = usually an
indication of renal disease accompanied with increase BUN and
creatinine.
✓ Protein as protein error of indicator or Sorensen’s error of
indicator. The indicator that is present in reagent strip specifically
changing its color not because of the changes (increasing or
decreasing) in pH but due to the presence of certain ions possess
by the albumin, unlike others that changes its color due to PH (e.g.
litmus paper.) The reagent strip only changes its color when there
is a presence of albumin specifically, since it is more sensitive to it,
even if there are presence of other proteins it will only change its
color if the albumin is present. The protein is utilized if there is an
orthostatic proteinuria, where there is an increase renal vein
pressure due to tumor or pregnancy or weak vein. During the day
(afternoon) the result is usually positive or trace urine protein,
upon waking up the 1st morning specimen from a supine position
for several hours the result will be negative.
Glucose: More sensitive & specific than Reduction Method (Benedict’s
Test).
✓ Double Sequential Enzymatic reaction is the principle.
✓ Reagent strip is for confirmatory as it uses the glucose-oxidase
principle coupled with peroxidase.
✓ Glucose-oxidase only yield false positive if there is a presence of
oxidizers and unclean tubes/ container.
✓ Benedict’s test is prone to false positive result, as other sugar will
be present in the urine such as maltose, lactose, fructose (sucrose
is a non-reducing sugar and under normal circumstances it will not
be present in the urine.)
✓ Benedict’s test is utilized only as screening test but not as
confirmatory.
pH: Significant Acid-base Balance in management of Urinary tract Infection
and Renal Stones/ Renal lithiasis
✓ Double Indicator System: Methyl Red and Bromothymol Blue
✓ Renal Stones- usually found in acidic environment coupled with
urine stasis
✓ Infection- basic urine.
✓ If there is renal lithiasis, a probability hematuria.
Ketones: Most sensitive to Acetoacetic Acid/ Diacetic acid. Less sensitive to
Acetone. Doesn’t react with Beta-hydroxyburate.
✓ Sodium Nitroprusside is the principle
✓ Acetone only reacts when there is a presence of glycine.
Ketone Glucose
+ + Diabetes
Mellitus
+ - Crush Dieting,
Starvation,
Vomiting
- + Hyperglycemia/
Pregnancy
✓ Why is glucose associated with pregnancy: The normal renal
threshold for glucose is 160-180 mg/dl where glucose is not
excreted in the urine but if it goes beyond its renal threshold then
glucose will spill in the urine (glycosuria). During pregnancy there
is an increase renal vein pressure with increased pressure in renal
tubules that will lead to decrease to glucose renal threshold
becoming 100-120 mg/dl that is why there is hyperglycemia.
Specific gravity (SG): Only measures IONIC solute. Not affected by urea,
glucose, radiographic contrast media, plasma expanders. Not always same
as SG by Refractometer.
✓ Principle is pkA a change in the polyelectrolyte pad/ Dissociation
constant change in polyelectrolyte pad.
✓ Radiographic contrast media is usually seen in intravenous
pyelogram (increase), and the presence of radiographic contrast
media will yield a SG of >1.040 using the total solid meter/ or
known as Refractometer.
✓ SG reagent strip also depend to a certain protein as affected by
protein.
✓ 0.001 as increment with a sensitivity to 1.000-1.030.
✓ As conjugated is the only water-soluble type.
✓ Yellow foam in urine if bilirubin is present.
✓ Bilirubin is increase if there is liver disease and biliary duct
obstruction.
✓ In biliary duct obstruction the urobilinogen is decreased while an
increase in bilirubin that will be detected in the urine
Blood: Uniform: Myoglobin & Hemoglobin (Lysed RBCs, Hemolysis, Ghost
cells if there is a diluting factor that causes alkalinity to the urine) versus
speckled: Hematuria
✓ Pseudo peroxidase activity of heme is the principle.
✓ Myoglobin associated to muscle disease, crush injuries other
diseases that will cause myoglobinuria.
✓ Hematuria associated to renal lithiasis
✓ Hematuria is the release of intact RBCs.
✓ Blondheims test is used to differentiate myoglobinuria and
hemoglobinuria where the usage of ammonium sulfate where
hemoglobin precipitates while myoglobin does not.
Urobilinogen: Reagent strip don’t detect absence of urobilinogen, only
Increased levels.
✓ Principle is Erlich’s with the use of PDAB (para-
dimethylaminobenzaldehyde)
✓ Utilize the presence of BDO (decreased or not detected/ Normal)
and Liver disease(positive); increased in cases of intravascular
hemolysis associated with pre-hepatic jaundice.
✓ Measured at certain 2pm – 4pm frame, which referred to as
alkaline time.
✓ Urobilinogen is very sensitive and it functions optimally if the pH is
basic or alkaline.
✓ In the 1st morning urine, there is an instance that urobilinogen is
falsely negative, since it is acidic.
Nitrite: 1ST morning specimen is best. Increased sensitivity when urine in
bladder at least 4 hours
✓ First morning urine since function best accumulate at acidic
environment.
✓ Greiss reaction principle.
✓ 4 hrs requirement.
✓ Contact time between bladder that contains bacteria (>4hrs).
✓ In order to avoid false negative, diet rich in nitrate must have to
convert the nitrite that is being measured.
✓ There are some bacteria that causes bacteriuria but negative in
nitrite since they are non-nitrate reducing
✓ No contaminate cause a false positive.
✓ Nitrite testing a very good screening test for UTI together with
leukocyte esterase.
✓ Culture is for the confirmatory test.
✓ Urea-splitting organism is P. mirabilis.
Leukocyte esterase: Detects intact and lysed grans and monos, not
lymphocytes. Can be used with nitrite to screen urines for culture.
✓ Leukocyte esterase reaction.
✓ Can cause false positive result in the presence of T. vaginalis
✓ Can be false positive in the presence of histiocytes.
✓ If WBCs are lysed then it can cause positive result.
✓ There is leukocyturia with bacteriuria- most common case.
Associated with enterics.
✓ There is leukocyturia without bacteriuria- common cause in cases
of Renal interstitial nephritis which is associated increased
eosinophilia from drug induced. Another reason is when there is
Candida infection/ yeast infection or inflammatory infection that
affects the renal tubules.
✓ Utilized as a stain is urine eosinophils stain, the Hansel stain.
✓ To differentiate eosinophils from other renal epithelial cells is
Toluidine blue.
  Highly pigmented urine (False positive): BLU (Bilirubin, Leukocyte PREGNANCY TEST: BIOLOGIC
esterase, Urobilinogen)
• Highly pigmented means highly colored urine due to the presence 1) Friedman: Mature Virgin Female rabbit; Marginal ear vein
of other elements (diet, drugs). injection: hyperuremic uterus with corpora hemorrhagia

 Highly buffered alkaline urine (False positive): Protein
 Increased protein (False positive): Specific Gravity (SG)
• If SG is increased the protein is false positive (>8.0), if protein is
increased SG is false positive.
2) Galli-Mainini: Male frog (Rana pipens or Rana clamitans), leopard
or grass frog: Subcutaneous: spermatogenesis.
3) Aschheim Zondek: Immature Female mice: Subcutaneous
Formation of hemorrhagic follicles and corpora lutea.

 Improperly preserved specimen (False positive): PN (Ph, Nitrite) 4)
• If sample is improperly preserved there will be an increase
bacterium the urea will be acted by the urease coming from
urease-producing bacteria cause the formation of ammonia 5)
increasing the PH.
• In nitrite, if there is nitrate converted to nitrite due to bacteria.
Frank Berman: Immature Female rats: Subcutaneous ovarian
hyperemia
Kuppermann: Female Rat: Intraperitoneal: ovarian hyperemia
Cells, casts, and Crystals: Other important details:

 Improperly preserved specimen (False Negative): BUGK (Bilirubin,  May form syncytia (clumps): unable to form casts Renal
Urobilinogen, Glucose, Ketone) transitional cells or urothelial cells, characterize by a caudated tail
• Bilirubin once exposed to light as it is light sensitive it will
decrease.  Reduced by collecting midstream clean-catch specimens:
• The urobilinogen once exposed air and light, and undergo Squamous epithelial cells
oxidation converted into urobilin.
• The glucose a nutrient for bacteria consuming it.  RTE that forms Maltese crosses: Oval Fat bodies
• In ketone, exposure to air will be volatilized • Renal tubular epithelial cells with lipid-filled vacuole, mostly seen
in Nephrotic syndrome and crush syndrome. Maltese crosses is
associated with Babesia.
 Acid runover from protein square (False Negative): PH
• PH has 2 indicators which is Methyl red (Acid) and Bromothymol
 Only needle form seen in alkaline urine: Calcium phosphate.
blue (Basic).
Needle form that is a physiologic crystal, considered the 2nd most
• In protein strip has a citrate buffer which maintain the pH of level
frequent cause of renal calculi. Most common cause of renal
of 3
calculi is the calcium oxalate, seen in urine of neutral acidic,
alkaline urine. If it is needle like in an acidic urine then it is
 Antibiotics (False Negative): NL (Nitrite, Leukocytes)
tyrosine.
• Antibiotics decreasing the bacterium
CHANGE CAUSE
 Must differentiate from uric acid. Doesn’t polarize light: Cystine.
Turbidity (↑) Increase Multiplication of bacteria, precipitation of Polarization of light is uric acid which cystine can’t.
amorphous crystals A pathologic crystal.
pH (↑) Increase Conversion of urea to ammonia (Alkalotic Cystine is the least cause of calculi.
urine) by bacteria
Glucose (↓) Decrease Metabolism by bacteria  Cystine is confirmed by: Cyanide Nitroprusside Test
Ketones (↓) Decrease Volatilization of acetone, breakdown of
acetoacetate by bacteria  Most fragile cast: RBC Cast
Bilirubin (↓) Decrease Oxidation to biliverdin
Urobilinogen (↓) Decrease Oxidation to urobilin  Transitional and Squamous cells aren’t seen in cast
WBCs, RBCs, (↓) Decrease Lysis in dilute or alkaline urine
casts  A cast shown to imply unfavorable signs: Waxy cast- the final
degenerative form of cast. Seen in extreme urine stasis and in
 Microalbumin (Micral Testing) testing samples: early stages of renal disease.
i. 24-hr urine sample -for (enzyme) immunoassays
ii. Random sample – for ACR (Albumin Creatinine ratio)  Cast with maltase cross formation: Fatty cast together with oval
fat bodies, that is very common in nephrotic syndrome, lipiduria.
 SSA (Sulfosalicylic acid in Protein) False assays (2). Contains also increase cholesterol.
1. False positive: radiographic dyes, tolbutamide, some antibiotics
(amikacin), turbid urine.  Formed in dilated distal tubules and collecting ducts: Broad casts.
• Radiographic dye can increase the turbidity of the solution Renal failure casts- seen in patients in end stage renal disease. No
2. False negative: Highly buffered alkaline urine urination for >3 mos. Seen in extreme urine stasis with
• SSA is considered as confirmatory test for the presence of protein dehydration. Urine is acidic.
in urine.
• SSA is based on the reporting of turbidity, flocculation,  May be sign of sexual abuse in child: Sperm
precipitation.
• Tolbutamide is considered hypoglycemic agent and it an anti-  May be mistaken for hyaline cast: Mucus
diuretic agent; certain type of medication for diabetic patient. This • Mistaken due to low refractive index. Assume a tubular shape,
drug can able to cause precipitation. rounded.
• Amikacin; drug that can cause damage in cranial nerve that can • Mucus is made up of uromodulin/ Tamm Horsfall protein.
cause turbidity.
• Most common in the Philippines as of now is PT

 Used to detect galactosemia in children <2 years old: cataracts;

best detected with Clinitest.
• Galactosemia, one of common type of hereditary/acquired cases
of metabolic disease.

 Acetest is most sensitive to: Acetoacetic acid/ Diacetic acid

• Principle of Sodium Nitroprusside

MICROALBUMIN: Not detected by most urine dipstick 50-200mg/hr or

ACR >2-8 for males, >2.0 for females predictive of diabetic nephropathy,
as also the complication of hypertension, DM. with correlation to Acute
Coronary Syndrome, Retinopathy.
 Renal Disorder • The differentiation between bacterial, viral, mycobacterial and
 Inflammation and damage to glomeruli: (Acute) fungal meningitis
Glomerulonephritis (AGN) Bacterial Viral Mycobacterial Fungal
Increase (↑) Increase (↑) Increase (↑) Increase (↑)
 Acute glomerulonephritis considered as one of the Streptococcus WBC
Differential PMNS Lymphs Lymphs, Monos Lymphs, Monos
pyogenes infections that starts with sore throat together with (Neutrophils
rheumatic heart fever. Protein Marked Increase (↑) Moderately Marked
Increase Increase (↑↑) Increase
 Increased glomerular permeability: Nephrotic syndrome (↑↑↑) (↑↑↑)
Glucose Marked Normal Marked Normal
 Loss of shield of negativity. Increase in (metabolism) Increase in (metabolism)
 The specific negative charge will be loss and eventually the glucose glucose or Increase
reduction of that specific negative charge from proteins will not metabolism metabolism (↑) Marked
(↑↑↑) Increase in
happen. Proteins will flow out towards of the urine filtrate Decrease in glucose
Decrease in glucose level metabolism
 Kidney infection: (Acute) Pyelonephritis – will become chronic glucose level (↓) (↑)
(↓)
depends on the situation if UTI is not treated. Decrease in
 Associated with cast (WBC cast, WBC free, WBC clumps) glucose level
 There is also a presence of bacteria and bacterial casts (↓)
Lactate Marked Normal Increase (↑) Increase (↑)
Increase >25mg/dl
 Bladder infection: Cystitis (↑↑↑)
 With the presence of WBC (WBC free, WBC clumps), note that >35mg/dL
there is no cast formation. Other Pos gram stain, Weblike clot or Pos india ink
bacterial pellicle and or latex
 Just an in inflammation urinary bladder. antigen agglutination
 Can be seen with bacteria but without bacterial cast. test with
 Specific type of infection without cast: Lower UTI (encapsulated)
Cryptococcus
neoformans
Reagent strip notable reactions:
 Abnormal accumulation of fluid in body cavity. Classified as
 Associated with protein or blood: AGN transudate or exudate: Effusion
 Associated with the presence of red cells and RBC casts. • Transudate considered as clear, non-clotting characteristic seen in
 The presence of hyaline casts, coarsely granular cast, finely Congestive heart failure, Hepatic cirrhosis, Nephrotic syndrome.
granular cast = Chronic Glomerular Nephritis (CGN) • Exudate is similar in lesion formation and turbid, clot. Associated
with Inflammation, Malignancy (neoplasm), Infection.
 Associated with protein, leukocyte esterase, nitrite:
Pyelonephritis  Fluid in abnormal cavity: Peritoneal fluid
• The presence of coarsely granular cast, finely granular cast=
Chronic Pyelonephritis (CPN)  Fluid surrounding heart: Pericardial fluid

 Protein (large amount): Nephrotic syndrome (NS)
• In NS there is >3.5g / day of protein, coupled with increased oval
fat bodies, cholesterol crystals, fatty cast.
• The increase of lipids is a compensatory of the liver to produce
more protein which also links with increase production of lipids,
and those lipids will be increase in the serum and will be flushed
out in the urine.
 Leukocyte esterase, nitrite: Cystitis
 The first clinical bioassay for HCG: Ascheim Zondek
• Results of the test:
a. Enlargement & Luteinization of the follicles in the
female mice.
Same results were noted when Zondek made use urine from
women with: Choriocarcinoma & ovarian cancer
 And to men with: Testicular cancer
 Fluid contained in pericardial, peritoneal & pleural cavities: Serous
Fluid
• If it does not accumulate it is serous but once it accumulates, it is
effusion.
 Fluid surrounding lungs: Pleural fluid
 Fluids in joints: Synovial fluid
• Synovial fluid is normally viscous because of hyaluronate
polymerization.
 Synovial fluid poor viscosity (decrease): Inflammatory lesions/
Effusions, Crystal induce condition, hemorrhagic events, Infection.
 RA and lupus (addition of gouty arthritis- associated with
monosodium urates/ Pseudo gout- associated with calcium
pyrophosphate dihydrate) type of synovial effusion: Inflammatory
effusions

Other Body fluids  Clear synovial fluid: Normal & Non-inflammatory

 Normal cells in CSF: Lymphocyte, Neutrophils, Monocytes,
ependymal cells, choroid plexus cells
• Increase lymphocyte if taken in adults and increase monocytes if
taken in child/infants.
• In WBC count 0-5/ul in adults, and 0-30/uL for infants.
 Siderophages are seen with Subarachnoid hemorrhage.
 Blast cells are seen with leukemia.
 Nucleated RBCs may be seen due to Bone marrow contamination.
 Perform cell count within 30 minutes of collection.
 Cloudy and turbid synovial fluid: Infectious & Inflammation
 Pink to red-brown synovial fluid: Hemorrhagic
 Yellow when long axis of crystal is parallel to slow wave of red
compensator, blue when perpendicular: Monosodium urates
 Blue when long axis of crystal is parallel to slow wave of red
compensator, yellow when perpendicular: Calcium
Pyrophosphate dihydrate
 Seen in chronic effusions (rheumatoid arthritis): Cholesterol
crystals

 Differential of CSF cells on stained smear following concentration:  Post vasectomy testing time: 2 months after the vasectomy
Cytocentrifugation procedure- Done until 2 successive samples show no sperms.
• Associated with the usage of albumin.
 Not critical for post vasectomy testing: Time & Temperature

 For sperm motility, 50-60 % of sperm should show at least fair

motility.
• It must be tested within 1 hr., and tolerable within 3 hours.
  FLM (Fetal Lung Maturity) test:
1) LIS ratio- >2.0
2) Lamellar body count-cells structure that determine the
production of surfactants, an increase level means increase
lung maturity.
3) Foam Stability Index- >0.48 – the child has a mature lung
4) Phosphatidyl glycerol- increase when the lung is already
mature.
 Amount of urine used for the refractometry: 1ml
• 1 drop (1-2 drops)
• 25ml
• 10ml
• The principle of refractometry is refractive index.
• Refractometer is also referred to as total solids; requires
calibration and correction in the presence of glucose and protein.
No temperature correction since it is been compensated.

 FLM reference: LIS ratio • Urinometer: 10-15 ml

• Urinometer is considered as the hydrometer form of machinery;
 Last surfactant to rise: Phosphatidyl glycerol requires calibration and also requires correction, protein, glucose
and temperature.
 NTD (Neural Tube defects) test: Alpha feto-protein (AFP)
• If the AFP is increase associated with NTD such as Anencephaly & • Reagent strip:
Spina bifida. • Dips smear is utilized, 1 dip is enough. No requirement for
• For the confirmation of NTD the best is the: Acetylcholinesterase. correction but requires control as compensation.
• If AFP is decreased associated with down syndrome.
• What is the sperm count given the following values: 5RBCs, 1:20
FERRIC CHLORIDE TESTS dilution, 5ml volume of ejaculate, 100 sperms.
Phenylketonuria Blue-green • 500 million
Tyrosyduria Transient green • 50 million
Alkaptonuria Transient blue • 10 million
Melanuria Gray-blue • 25 million
•
MSUD Green-gray 100 𝑥 20 2000
Solution: 0.2 𝑥 0.1 = 0.02 = 100,000/𝑢𝐿
Indicanuria Violet-blue with chloroform • Since it is in Ul convert into ml first, 100,000 x 1000 =
5` HIAA Blue-green 100,000,000/ml = sperm concentration.
• 5` HIAA (5-Hydroxyindolacetic acid)- considered as a metabolite of • Sperm count= 100,000,000 x 5 = 500,000,000 million
serotonin in the consumption of pineapple, banana, and oxidizing • Sperm concentration- the number of cells per ml of ejaculate
agents. • Sperm count- the number of cells per ejaculate
• Neubauer counting chambers; cell count:
 What cells are found in the normal CSF? 𝑁𝑜.𝑜𝑓 𝑐𝑒𝑙𝑙𝑠 𝑐𝑜𝑢𝑛𝑡𝑒𝑑 𝑥 𝑑𝑓
• Formula:
a. Neutrophil 𝑁𝑜.𝑜𝑓 𝑠𝑞𝑢𝑎𝑟𝑒𝑠 𝑐𝑜𝑢𝑛𝑡𝑒𝑑 𝑥 0.1
•
𝑁𝑜.𝑜𝑓 𝑐𝑒𝑙𝑙𝑠 𝑐𝑜𝑢𝑛𝑡𝑒𝑑 𝑥 𝐷𝐹
b. Lymphocyte- if adult Formula for sperm concentration: 𝑁𝑜.𝑜𝑓 𝑠𝑞𝑢𝑎𝑟𝑒𝑠 𝑐𝑜𝑢𝑛𝑡𝑒𝑑 𝑥 0.1/ Ul
c. Eosinophil- least or not found • Sperm concentration unit is ml.
d. Monocyte- if infant • 1ml = 1,000uL
• 1L = 1,000,000uL
 Membrane cassette tests for pregnancy determination are one- • If the result is UL to convert into ml just multiply by 1000 or add 3
step: Solid Phase Enzyme Immuno Assay (SPEIA)/ Solid phase 0’s (000). If Ul to convert into liter just add 6 0’s (000,000) or
Sandwich Immunochromatographic assay (SPSICA) multiply by 1,000.
• Usually, EIA. • Formula for sperm count: sperm concentration x volume of semen
• If it is complete with everything, reagent it is SPSICA.
• In the EIA of micral test. • Dilution factor is the reciprocal of dilution.
• The 0.1 is constant.
 In normal pregnancy HCG can be detected in as early as 7 days • For no. of squares counted for
following conception. large squares (RBCs, WBCs) = 1
• 7 days is usually rise in pregnancy. small squares if WBC =
𝑛𝑜
• In the cassettes used it has greater or more sensitivity as early as 16
𝑛𝑜
14 days. small squares if RBC =
25
• In 7-14 days, it is in the 10th day that is usually detected.
WBC WBC

 The concentration doubles every 1.3 to 2 days. RBC

WBC WBC
 Levels of HCG reach a peak of approximately 200,000Miu/ml at the
end of the first trimester. • Above is the hemocytometer, each of the WBC square is composed
of 16 smaller squares and the RBC square in the middle is
 If the cassette for EIA in HCG testing contains all the necessary composed of 25 smaller squares.
reagents, this is called as: Immunochromatography • Dilution converting to Dilution factor depending on the type of
• In immunochromatography, the test band region is precoated with pipet that has been utilized (WBC diluting pipet).
anti-alpha HCG antibody to trap HCG as it moves through the • 2 ways of using the WBC pipet: the pipet will suck the fluid until
membrane caused by capillary action; an antigen- antibody the 0.5 mark and suck the diluent until 11th mark, providing a 1:20
reaction wherein the sample must possess the antigen and the converting into 20 DF. The other the pipet will suck the fluid until
cassette reagent has specific antibody. 1.0 mark and suck the diluent until the 11th mark, providing a 1:10
• When the patient specimen is added, it reconstitutes anti-beta converting into 10 DF.
HCG antibody, which is complexes to colloidal gold particles. • If the RBC pipet is utilized: suck fluid until 0.5 and suck the diluent
• This complex is trapped by the anti-alpha HCG and forms a until 101 mark, providing a 1:200 converting into 200 DF. Suck until
colored complex in the test region. 1.0 mark and suck the diluent until 101 mark, providing a 1:100
• This may be in the form of a straight line or a plus sign. converting into 100 DF.
• For the WBC count: 98 WBCs, suck WBC fluid 0.5 and ended in 11th
 A positive test results if a minimum concentration of mark, make use of 2 Large WBCs, and make use 4 small WBCs. The
approximately 25 Miu/ml is present. (Specific least sensitivity) problem is what is the cell count?
• WBC = per Liter = 𝑋 109 /𝐿
 If the string test is 6cm long: • RBC = per Liter = 𝑋 1012 /𝐿
a. Low, abnormal • PLT = per Liter =𝑋 109 /𝐿
1
b. Abnormal • 1uL =
1,000,00𝐿
c. Normal. • :
𝑁𝑜.𝑜𝑓 𝑐𝑒𝑙𝑙𝑠 𝑐𝑜𝑢𝑛𝑡𝑒𝑑 𝑥 𝑑𝑓
:
98 𝑥 20
=
1960
= 8711/𝑢𝐿
d. High, abnormal 𝑁𝑜.𝑜𝑓 𝑠𝑞𝑢𝑎𝑟𝑒𝑠 𝑐𝑜𝑢𝑛𝑡𝑒𝑑 𝑥 0.1 2.25 𝑥 0.1 0.225

• String test is performed in synovial fluid, uses the Pasteur pipet.
• Normal is 4-6cm
• Is the synovial fluid having low viscosity it is associated with IgE
inflammation.
• 8,711 Ul convert into L add 6 0’s so 8,711,000,000, since it is WBC
move the decimal point from right to left 9x.
• The answer is 8.711 𝑋 109 /𝐿
• NV is= 3-11/ 3.5 x 11 𝑋 109 /𝐿
o If there is a question for smallest RBC: in the 25 small square of
RBCs there are still 16 smallest RBCs, total of the smallest square of
the RBC square is 400

 What odor does the urine exude in the presence of the breakdown
product of the urea:
a. Fruity
b. Sweaty feet
c. Mousy
d. Pungent.
• Urea is acted by urease that will produce ammonia is a little bit
pungent.
• Pungent odor is caused by prolonged exposure of certain sample
on environmental air and urease producing bacteria will act on
urea and convert it to ammonia
 Best sample for urine crystal determination:
a. 1st morning- acidic; most concentrated
b. 2HPP (2-hrs Post prandial)- considered accompanying
test to blood sugar measurement. Also known as 2-hrs
Post prandial urine sugar (2HPPUS)
c. 1-hr after meal- not that effective, 1-2-hr after meal
becomes alkaline. Alkaline type is associated with
urobilinogen. Alkaline type is better seen after 2-4hrs of
heavy meal
d. 24-hr- for diurnal substances. In the morning the
increase of ACTH, prolactin, cortisol, while during the
afternoon the increase of catecholamines, electrolytes,
as well as iron decrease in afternoon.
• Urine crystal determination is very important if there is a
pathologic cause, and usually acidic (ph: 5-6).
• In glucose testing in urine, can make use of the 2nd specimen; the
specimen taken after a period of fasting, take right after the 1 st
morning specimen.
 Inorganic substance that has the highest concentration in urine?
Chlorine (but not in the choices)
a. Urea
b. Creatinine
c. Sodium.
d. Phosphate
• If inorganic Cl> Na> K> PO4
• If organic Urea> Creatinine> Ammonia> Uric Acid
 Seminal-fluid interpreted as “gel-like” (0-4)
a. 0- watery
b. 4
c. 10
d. 5
 False-positive levels of 5`-HIAA (associated with serotonin) is
caused by ingestion of:
a. Brown rice
b. Banana (tomatoes, pineapples)
c. Beef
d. cassava
 Elevated in Congenital Erythropoietic Porphyria
a. Leucine
b. Valine
c. Uroporphyrin III cosynthase
d. Uroporphyrin.
• Leucine, Isoleucine, valine increased in the urine with MSUD
• FEP: Free erythrocyte Protoporphyrin screening test for lead
poisoning.
 What is the corrected S.G. if the refractometer result is 1.030
temperature is 30°C; protein 2g/dl?
a. 1.038
b. 1.031
c. 1.032
d. 1.024.
• Refractometer there is a certain type of correction in protein and
glucose. Per 1g of protein the correction is minus 0.003 from S.G.,
per gram 1g of glucose or carbohydrate is minus 0.004.
• In the problem there is 2g of protein so 2 x 0.003 = 0.006.
• The refractometer reading is 1.030 – 0.006 = 1.024.
• There is no need for temperature correction since it has been
compensated already into a 16-38°C.
• If in the case of urinometer/hydrometer then there is a correction
for temperature. The result for S.G is 1.036, 1g of glucose and 2g of
protein, the specific temperature which is calibrated to 20°C, and
the test was did on the 14°C. The problem is what is the corrected
S.G.?
• Per increase 3°C in the calibrated temperature (20°C) add 0.001,
and per decrease of 3°C minus 0.001.
• 1g of glucose – 0.004
2g of protein - 0.006
Temperature is 20°C- 14°C = 6°C / 3 = 2(0.001) = 0.002.
Total the 0.004 + 0.006 + 0.002 = 0.012.
1.036 – 0.012 = 1.024
 Collection of urine D-xylose absorption test in adults’ is done with
a 5-hr urine container with Refrigerated.
a. 24-hr urine in a container with 10ml Hac
b. 24-hr urine in a container with 10ml NaOH
c. 6-hr urine in a container with 10ml HCl.
d. 12-hr urine in a container with 20ml NaOH
• D-xylose testing done in order to differentiate pancreatic
insufficiency and malabsorption.
The D-xylose test us used to distinguish pancreatic insufficiency from
intestinal malabsorption.
The test requires a blood sample taken 2-hours after oral administration
of 25g of D-xylose and a 5-hour timed urine sample.
B
 Gold standard for measuring GFR: when it comes to clearance
testing the gold standard is the inulin clearance test, the most
frequently performed is the creatinine clearance, but with high
sensitivity is Cystatin C.
 Drug specimen requirement:
▪ There must be a certain bluing agent to avoid adulteration, if there
is no bluing agent make use of waterless urinals.
▪ Chain of Custody
▪ Container capacity must be 60ml and the amount of urine must be
30-45 ml.
▪ Specific temperature 32.5-37.7°C for 4 minutes within collection.
▪ A person that submitted its urine is a donor not a patient.
• drug specimen requirement is to measure the presence of
tetrahydrocannabinol (marijuana) and methamphetamine
(shabu).
 The recommended capacity of container for routine urinalysis:
50ml, wide mouth, wide base and flat
 LABORATORY CORRELATIONS IN URINE TURBIDITY
Acidic urine Amorphous urates, radiographic contrast media.
Alkaline urine Amorphous phosphates, carbonates (Calcium
carbonate that tend to produces gas with dumbbell
appearance)
Soluble with heat Amorphous urates, uric acid crystals
Soluble in dilute acetic acid RBCs, Amorphous phosphates, carbonates
Insoluble in dilute acetic WBCs, bacteria, yeast, spermatozoa
acid
Soluble in ether Lipids, lymphatic fluid, chyle
• SSA can show false-positive by a urine turbidity.

Nota Bene:
 This is the actual harr question and answer:
Which type of urine sample is needed for D-xylose absorption test
on an adult patient?
a. 24-hr urine sample collected with 20ml of 6 NHCl
b. 2-hr timed postprandial urine preserved with boric acid
c. 5-hr timed urine kept under refrigeration.
d. Random urine preserved with formula vanillylmandelic
acid (VMA), metanephrines, cortisol, and estriol
The D-xylose absorption test is used to distinguish pancreatic insufficiency from
intestinal malabsorption. The test requires blood sample taken 2 hours after oral
administration of 25 g of D-xylose is absorbed without the aid of pancreatic
enzymes, and is not metabolized by the liver. Therefore, deficient absorption • Formalin is excellent in ADDIS count.
(denoted by a plasma level <25mg/dl and urine excretion of<4g/5 hours) points to
malabsorption syndrome. Test requiring a 24-hr urine sample included
 Urinometer calibrations: 1.000 water, as well as refractometer,
catecholamines.
if it is 5% NaCl it is 1.002 ± 0.001 (1.021 – 1.023)
3% NaCl it is 1.015 ± 0.001 (1.014 – 1.016)
 Least affected by long standing urine (or non-preservation)
9% sucrose it is 1.034 ± 0.001 (1.033 – 1.035)
a. Bilirubin
Usually, potassium sulfate solution can also be utilized.
b. PH
c. Albumin.
 Rifampin, phenolphthalein, phenindione, and phenolthiazines
d. Glucose
produces: Red coloration.
 The major disadvantage of urinometer usage: The amount of
 Phenazopyridine/ Pyridium: produces orange color.
urine of testing as it requires 10ml
 Which of the following is affected by long standing urine or non-
 Foam colors: if it is a red/pink foam it can be myoglobin or
preservation.
hemoglobin, if it is a white foam; protein, yellow foam; bilirubin
▪ Protein – Non affected (NA)
▪ Ketones - Decreased
 Vomiting and RTA (Renal Tubular Acidosis):
▪ Blood – Variable (depends on a specific characteristic, if it is
lysed it is increased,
▪ Glucose - Decreased
▪ SG - Decreased
▪ Nitrite - Increased
▪ PH - Increased
▪ Bilirubin - Decreased
▪ LE - Variable

 The following fluids produced by a fetus contributes to amniotic

fluid volume EXCEPT:
a. Urine
b. Amniotic fluid
c. Bone marrow.
d. Lung fluid

 A portion of the fluid arises from the fetal respiratory tract, fetal
Urine, the Amniotic membrane and the umbilical cord.
• As would be expected, the chemical composition of the amniotic
fluid changes when fetal urine production begins. The
concentrations of creatinine, urea, and uric acid increase, whereas
glucose and protein concentration decreases.
• Concentrations of electrolytes, enzymes, hormones, and metabolic
end products also vary but are of little clinical significance.
• Measurement of amniotic fluid creatinine has been used to
determine fetal age.
• Prior to 36 weeks’ gestation, the amniotic fluid creatinine level
ranges between 1.5 and 2.0 mg/dl. It then rises above 2.0 mg/dl,
thereby providing a means of determining fetal age greater than
36 weeks.
 Preservative that preserves formed elements and does not
interfere with routine analysis:
a. Thymol
b. Formalin
c. Boric Acid
d. Refrigeration.
• Urease producing bacteria such as; Proteus.
• UTI drugs are acidic.
 Which factor is usually present with positive glucose seen in
Candida albicans infection:
a. Acidic Ph.
b. Alkaline PH
c. Low SG
d. Presence of bacteria
• Candida albicans has increased WBCs that indicates leukocyturia,
without bacteremia, a positive in glucose occur in an acidic PH
urine. A certain type of yeast that consume more glucose,
decrease renal threshold that is associated with DM.
• Ketosis in some cases.
 Yeast cells, primarily Candida albicans, are seen in the urine of
diabetic patients, immunocompromised patients (AIDS), and
women with vaginal moniliasis.
• The acidic, glucose containing urine of patients with diabetes
provides an ideal medium for the growth of yeast.
• As with bacteria, a small amount of yeast entering a specimen as a
contaminant multiplies rapidly if the specimen is not examined
while fresh.
• A true yeast infection should be accompanied by the presence of
WBCs
  Resorcinol:  What is the underlying condition given the following results:
a. Black (+) sugar, (+) protein, (+) nitrite
b. Orange. a. Kidney cancer- no abnormal cells or blastic cells
c. Blue b. Multiple myeloma- no Bence jones proteins
d. Green c. Diabetic acidosis- it could not be since there is no
• Resorcinol test is done in seminal fluid, performed for fructose ketones
determination that is >13umol/ ejaculate (pertaining to the d. Acute UTI – screening form for the probability of UTI
viability of the sperm cell
• The test is composed of HCl- in order to produce the color orange.  The nitrite test also can be used to evaluate the success of
antibiotic therapy and to periodically screen persons with
recurrent infections, patients with diabetes (prone to infection;
bacteria, yeast), and pregnant women, all of whom are considered
to be at high risk for UTI.
 Positive protein is due to post renal proteinuria in lower UTI –
occurs after the kidney phase.

 Glucose color in potassium iodide: Green to brown (green is the

lowest result and brown is the highest, yellow is negative).
• If it utilizes the tetramethylbenzidine the result is yellow to green.

 Urobilinogen azo coupling (Diazo) pad and result (chemstrip):

White to pink

 Urobilinogen PDAB (para-Dimethylaminobenzaldehyde) with result

(Multistix): Light pink to dark pink

 Pink colored azo dye (Nitrite testing; Greiss reaction; reaction

from Sulfanilamide & para-arsanilic acid): • Sudan III, instead can also use Oil Red O.
• Galactosemia; Clinitest.
 Purple azo dye: Leukocyte esterase (LE) with the use of diazonium
salt.  A patient’s urine appears hazy and had a reddish color. The urine
dipstick showed a homogenous blue color for blood. The S.G is
 Reflectance photometry uses the principle that light reflection 1.010 (diluted urine causing swelling of RBC; lysis; release
from the test pads decreases in proportion to the intensity of hemoglobin- result in dipstick is homogenous color blue indicating
color produced by the concentration of the test substance. a ghost cell, could either be myoglobinuria or hemoglobinuria)
TEST PARAMETER RESULTS and 5-10 ghost cells.
Bilirubin PINK TO TAN-VIOLET a. Hematuria- speckled or spotted
Glucose GREEN/ BROWN
b. Chronic bladder inflammation- there must be WBC
Ketone PURPLE
clumps, free WBCs, no cast and no ghost cells.
Specific gravity LOW= BLUE / HIGH= YELLOW GREEN/GREEN
PH LOW= ORANGE / HIGH= BLUE/GREEN
c. Nephrotic syndrome - >3.5 g/ day, OFB, fatty casts and
Protein VARIOUS SHADES OF GREEN TO BLUE, YELLOW= NEGATIVE cholesterol crystals.
UBG RED d. Hemoglobinuria.
Blood GREEN OR BLUE/ UNIFORM • If the result is speckled it is an intact RBC indicating hematuria.
Nitrite UNIFORM PINK
LE PURPLE  CASE STUDY: 20-year-old female patient with the following
urinalysis result:
*Nitrite-negative
*Protein-negative
*Leukocyte esterase-positive
*WBC:3-5
*RBC:0-1
*Bacteria: moderate
*Epithelial cells: few (lesser contamination)
▪ What is discrepant: Nitrite
▪ What should you do:
A. Repeat nitrite
B. Repeat protein
C. Report
D. Repeat strip
▪ What is the probable disease: Acute UTI

 Flash point grading

a. A to D
b. ABC
c. 0-4
 Prior to the development of current reagent strips methods that
d. 0-100
are specific for albumin, detection of microalbuminuria required
collection of a 24-hr urine specimen. Specimens were tested using
 Degree of hazard/ Symbol for poison (toxic/deadly) skull with an x
quantitative procedures for albumin. Results were reported in mg
a. xxv
of albumin per 24 hours or as the albumin excretion (AER) in
b. xox
ug/min. with these methods, microalbumin is considered
c. 0-4
significant when 30-300 mg of albumin is excreted in 24 hours of
d. 10
the AER is 20-200 ug/min:
SIGNIFICANT MICRAL TEST if 30-300 mg of albumin is excreted in
24 hours of the AER is 20-200 ug/min
  Primary reason (clinical significance) for the presence of
eosinophils: Acute Interstitial Nephritis (certain inflammation on
renal interstitial) – drug induced mechanism.
• >1% Eosinophils
• If there is a presence of neutrophils, associated with Acute UTI.

 Secondary reasons (small numbers): Renal transplant rejection,

UTI

 Epithelial cells casts are usually differentiated from WBCs

through:
1) Stain by toluidine blue
2) Phase contrast Microscopy
• Sternheimer-Malbin can also be used as stain

Uric acid (may faceted) crystals occur at low PH (5-5.5) and are seen in a variety of
shapes, including rhombic or four-sided flat plates, prisms, oval forms with
pointed ends (lemon-shaped), wedges, rosettes, and irregular plates. Most are
typically yellow or reddish brown. Rarely, they are colorless and hexagonal,
resembling cystine. Unlike cystine, they show birefringence with polarized light.
Biurates (found in the (alkaline urine) PH of 7.5 to 8.0); when exposed to acetic
acid will turn into uric acid.

 Which is TRUE of pre-eclampsia:

The first procedure to standardize the quantitation of formed elements
in the urine microscopic analysis was developed by Addis in 1926. The
Addis count, as it is called, used a hemocytometer to count the number
of RBCs, WBCs, casts, and epithelial cells present in a 12-hour specimen.
Normal values have a wide range and are approximately 0 to 500,000
RBCs, 0 TO 1,800,000 WBCs and epithelial cells, and 0 to 5,000 hyaline
casts.
Preservative is formalin.
a. 4+ glucose- associated with diabetes (Type I)
b. 4+ nitrite- UTI
c. Hematuria- injury, renal stones, renal lithiasis
d. Albuminuria.
• Pre- eclampsia; occurs wherein increase blood pressure and
increase constriction of the veins associated with other vessels of
the body. Increases the painful delivery that may cause death to
mother and fetus.
• Eclampsia associated with secondary syndrome; Sheehan’s
syndrome- can also be shock and decrease production of all
anterior pituitary gland hormones coming from the mother.

 Protein that can be seen macroscopically:

a. Bence jones- can be seen through precipitation by
heating.
b. Tamm-Horsfall- forms mucus and casts.
c. Globulin- not seen macroscopically
d. Albumin (seen as white foam)

 Lipid stains dye fats as colored: Red or Orange-red -with the use of
Oil Red O and Sudan III

 First structure observed when the urine is examined under LPO:

Squamous epithelial cell -as contaminant, improper collection.
• If increased transitional cells may be injury, friction, may be
associated with neoplasm if the transitional cell is irregular.
• If increased RTE cells has a clinical significance, may be associated
with Acute Tubular necrosis or Nephrotic syndrome.

 Clinically significant squamous cells: RTE cells >2/HPF

• Prostatic fluid can cause trace or positive protein result in the

urine, must require repeat collection, if it has sperm presence with
negative protein, accept the specimen, evaluate the presence and
note their presence

 RTE cells are reported as:

a. Average number/HPF.
b. Rare, few, moderate, may/HPF
c. Rare, few, moderate, may/LPF
d. Average number/LPF

 Group of crystals that can be found in the urine with a PH of 7

(neutral) and below (acidic):
a. Calcium phosphate, amorphous phosphate, calcium
carbonate. (>7)
b. Calcium oxalate (>7 / <7 / 7), amorphous urates (<7),
uric acid (<7)
Exposure to heavy metals (mercury, lead), drug-induced toxicity (acetaminophen- c. Uric acid (<7), amorphous urates (<7), calcium carbonate
affecting the liver, and can also nephrotoxic at times, mefenamic acid), (>7)
hemoglobin and myoglobin toxicity, viral infections (Hepatitis B), pyelonephritis, d. Uric acid (<7), amorphous urates (<7), amorphous
allergic reactions (uncontrolled anaphylactic reaction, hypersensitivity type III:
biurates (>7)
associated with immune complex deposition), malignant infiltrations, salicylate
poisoning, and acute allogenic transplant rejection are reasons ACUTE TUBULAR
NECROSIS (ATN) for which shows increase incidence of BUBBLE CELLS -Represent  Which protein is found in renal disease in reagent strip protein
injured cells in which the endoplasmic reticulum has dilated prior to cell death. a. None (should be ALBUMIN)
Presenting an odorless urine. b. Tamm-Horsfall
Bubble cells are RTE with non-lipid vacuoles, >2/HPF c. Bence Jones
Oval fat bodies are RTE cells that has lipid vacuoles. d. Globulin
 Which is an ABNORMAL constituent of feces:  What is the principle in automated slide-less microscopy for
a. RBCs -if increased associated with Lower GIT bleeding, bacteria
fresh bright blood, associated with hemorrhoids, polyps a. Reflectance photometry
increase Carcinoembryonic antigen; colorectal cancer. If b. Fluorometry – for antigen-antibody
in increased Hemoglobin due to lysis of RBC the color of c. Turbidometry
the fecal is tarry or black associated to Upper GIT d. Micro-particle histogram- for cells.
bleeding; due to Ulcer.
b. Bacteria- biggest load  How many weeks after gestation should you test for Down
c. Electrolytes syndrome
d. Water a. 15-18 weeks
• The normal fecal specimen contains bacteria, cellulose, undigested b. 22-25 weeks
foodstuffs, GI secretions, bile pigments, cells from the intestinal c. 10-15 weeks
walls, electrolytes and water. d. 30 weeks

 Standard time for gastric fluid collection

a. 2 hours after lunch/ a meal
b. 1 hour before/ after lunch
c. 1 hour after breakfast
d. Fasting/ 1 hour -for 15 minutes interval
• If through nose- Levine, if through mouth Rehfuss.
• Tube less gastric analysis; Diagnex; make use of Azure A (blue)

 Low glucose in Peritoneal fluid

a. Bacterial peritonitis -bacteria consumes glucose
>50mg/dl
b. Diabetes insipidus - >3000ml/day, ADH deficiency.
c. Appendicitis- associated with amylase and ALP increase
d. Pancreatitis- amylase increase as well as lipase and
trypsin.

 Serotonin metabolism will produce

a. Mucopolysaccharide
b. Bilirubin
c. 5-HIAA.
d. All of these
• Argentaffinoma or chromaffin cell malignancy

 Amniocentesis is indicated later in the pregnancy (20 to 42 weeks)

to evaluate:
I. Fetal lung maturity
II. Fetal distress
III. HDN caused by Rh blood type incompatibility
IV. Infection -sepsis that may be caused by S. agalactiae, L.
monocytogenes

 For quantitative fecal fat determination (confirmatory test for

steatorrhea as well as patient with Giardiasis), stool sample must
be collected for how many days:
a. 2
b. 3-day collection or the Van de Kamer titration
c. 4
d. 5

• For quantitative testing such as for fecal fats, timed specimens

• Miliary TB; associated with ADA. are required.
• Because of the variability of bowel habits and the transit time
 Which of the following is NOT DISPOSED in a biological hazard required for food to pass through the digestive tract, the most
waste: representative sample is a 3-day collection.
a. Stool and urine • These specimens are frequently collected in large containers to
b. Urine sample -flushed down in the drain followed by accommodate the specimen quantity and facilitate emulsification
copious amounts of water. before testing.
c. Pleural fluid • Care must be taken when opening any fecal specimen to slowly
d. Serum release gas that has accumulated within the container.
• Patients must be cautioned NOT to contaminate the outside of
 A freshly voided urine with pungent (ammoniacal; increase the container.
number of bacteria) odor is most probably indicative of:
a. Isovaleric acidemia
b. Bacteriuria
c. Phenylketonuria
d. Acidemia

 According to the new guidelines established by DOH/DOTS (Direct

Observed Treatment Short Course) in DSSM, how many sputum
samples are to be collected:
a. 1
b. 2
c. 3
d. 4

 If molecular testing: Gene Expert

  Crystal found together with bilirubin in liver disease: Tyrosine
(Colorless needles), Leucine (oily spheres with radial striation)
• The come together Bili (B2) yellow brown granules

 Negative result for HCG testing: Only 1 band is present.

• Even though it is faint pink reported as positive but for
confirmation repeat after 2 weeks.

 Microscope which provides 3D images: Layer by layer Imaging

Modulation type: Hoffmans
Differential type: Nomarksi
All in all, they are referred as Interference Contrast Microscopy.

*Gauge RTE/ Bubble cells >2/HPF

for Odorless urine
Acute *Disorder causing ischemic ATN include shock, trauma (such as
Tubular crushing injuries), and surgical procedures.
Necrosis “Shock” is a general term indicating a severe condition that decrease
the flow of blood throughout the body.
*Examples of conditions that may cause shock are cardiac failures,
sepsis involving toxigenic bacteria, anaphylaxis, massive hemorrhage,
and contact with high-voltage electricity (electrocution).

 Cholesterol crystal appearance: Stair-step/ Stairway pattern /

Notched corners increased in lipiduria, lipidemia, crush injuries,
nephrotic syndrome.

 OFB is a product of: RTE With lipid vacuole seen in lipiduria,

lipidemia, crush injuries, nephrotic syndrome.

 Nocturia is defined as: >500ml of urine per night. Seen in diabetes

mellitus and early pregnancy.

 How frequent is the centrifuge disinfected:

a. Frequently
b. Every 6 hours
c. Daily- clean
d. Once a week.
• Calibrated every 3 months.

 Struvite or MAP stones, usually formed by ensuing Proteus

infection are formed through alkalinization.
• Struvite is triple phosphate also referred as magnesium
ammonium phosphate

 Granuloma producing inflammation of the small blood vessels of

primarily the kidney and respiratory system: Wegener’s
granulomatosis associated with ANCA
• AABMA- lungs
• AGBMA- kidney
• Both is associated with Good Pasture Syndrome

 Patients with serotonin-producing carcinoid tumors often have

marked increases in urinary 5-HIAA excretion. Ingestion of
serotonin-rich foods such as bananas, chocolate, plums or walnuts,
or medications containing guaifenesin may produce false positive
elevations

 In newborn screening, testing for many substances is now

performed using MS/MS (Tandem Mass Spectrometry); double
quantification. It is capable of screening the infant blood sample
for specific substances associated with particular IEMs.

Melanin reacts with ferric chloride, sodium nitroprusside

(nitroferricyanide), and Ehrlich reagent. In the ferric chloride tube test, a
gray or black precipitate forms in the presence of melanin and is easily
differentiated from the reactions produced by other amino acid products.
The sodium nitroprusside test provides an additional screening test for
melanin. A red color is produced by the reaction of melanin and sodium
nitroprusside. Interference due to a red color from acetone and
creatinine can be avoided by adding glacial acetic acid, which causes
melanin to revert to green-black color, whereas acetone turns purple,
and creatinine becomes amber.

 The most well aminoaciduria

Amniotic fluid for fetal lung maturity (FLM) tests should be placed in ice
for delivery to the laboratory and refrigerated up to 72 hours prior to
testing or kept frozen and tested within 72 hours
1. In the urinalysis laboratory the primary source in the chain of infection would be:

A. Patients

B. Needlesticks

C. Specimens

D. Biohazardous waste

2. The best way to break the chain of infection is:

A. Hand sanitizing

B. Personal protective equipment

C. Aerosol prevention

D. Decontamination

3. The current routine infection control policy developed by CDC and followed in all
health-care settings is:

A. Universal Precautions

B. Isolation Precautions

C. Blood and Body Fluid Precautions

D. Standard Precaution