NON-BLOOD

SPECIMENS PART 2
FECES
TRUE OR FALSE?
The absorption of Nutrients and minerals occur in the stomach.
Answer: FALSE

The absorption of Water occurs mainly in the small intestines.

Answer: yes, that is false.

Normally, feces is acidic in nature.

Answer: False
FECES
•Examination of fecal specimens is helpful in
evaluation of gastrointestinal disorders.
•Evaluated for the presence of:
• Intestinal parasites and their eggs.
• Fat content
• Urobilinogen content
• Bacteria such as C. defficile and salmonella in Culture
• Viruses
• Occult blood: Guaiac test
DIGESTION
Final break down and reabsorption of ingested
proteins, carbohydrates and fates takes place in the
small intestine where they are also reabsorbed.
Digestive enzymes are secreted by the pancreas into
the small intestine
Bile salts help in fat digestion, are provided by the liver
Any deficiencies of these substances will result to
maldigestion or malabsorption
The excess undigested or unreabsorbed material will appear in feces
DIGESTION
The large intestine is capable of absorbing ~
3000 ml of water
When bowel movement is too rapid, less water is
absorbed=diarrhea
When fecal material stays too long in the large
intestine, more water is absorbed=constipation
Brown color of feces results from the
intestinal oxidation of stercobilinogen to
Stercobilin
FECES
Diarrhea: Increased stool weight above
200g with increased water content and
frequency of more than three times per day.
Steatorrhea: increase in stool fat that
exceeds 6 grams per day
Due to pancreatic insufficiency
Feces appear to be pale, greasy, bulky, spongey, or
pasty in consistency and has a very strong odor
SPECIMEN COLLECTION AND
HANDLING
Collect in a clean container and transfer to the laboratory container
Specimens must not be contaminated with urine or toilet water

Types of specimens:
Random: collected in a plastic or glass containers and suitable for
qualitative testing of blood and microscopic examination of leukocytes,
muscle fibers, and fecal fats.
FOBT: material is collected o physicians’ glove and applied to filter paper
in occult blood testing (Fecal Occult Blood)
3 day or 72 hr collection: collected in large containers for
quantitative fecal fat testing
FOBT: FECAL OCCULT BLOOD
TEST
Most frequently used screening test for fecal blood
Mass screening procedure for the early detection
of Colorectal cancer
 Recommended by the American cancer society, particularly
for those above 50 years old
NORMAL PHYSICAL
EXAMINATION OF FECES
Quantity: 100 to 200g per day
Color: light to dark brown
Consistency: light to well formed
Odor: foul to offensive
pH: 7.0 to 8.0
RECAP:
FOBT is a mass screening test for the detection of:_______________
Answer: colorectal cancer

Defined as increase in stool fat that exceeds 6 grams per day:

__________
Answer: Steatorrhea

The brown color of stool is attributed to the presence of: ___________

Answer: Stercobilin
BY THE WAY CLASS…
The normal yellow color of urine is attributed to
the presence of: __________
Answer: Urobilin
CSF
TRUE OR FALSE?
CSF is an ultrafiltrate of plasma
Answer: False
Next
Collection of CSF is done routinely by Phlebotomist
Answer: False
Identify:
CSF is produced by the: ____________
Answer: Choroid plexus
CSF
It is not an ultrafiltrate of plasma

It is formed by mechanisms of selective filtration

under hydrostatic pressure and active transport
secretion

Chemical composition of CSF does not resemble an

ultrafiltrate of plasma
CSF
Functions: PSR
 Produces a mechanical barrier to cushion the brain and
spinal cord
 Supply nutrients to nervous tissue
 Removes metabolic wastes
CSF
It is produced by the Choroid Plexuses
 Approx: 20 ml of CSF is produced every hour, total CSF
volume is replaced every 5 to 7 hours
 Adults: 90 – 150 ml
 Neonates: 10 – 60 ml

Flows through the subarachnoid space

Reabsorbed back to the blood capillaries in the
arachnoid villi/granulations at a rate equal to its
production
CSF COLLECTION AND
HANDLING
Methods of collection:
LUMBAR PUNCTURE:
Between the 3rd and 4th lumber vertebrae in ADULTS
Between the 4th and 5th lumbar vertebrae in CHILDREN
Patient is in FETAL POSITION or LATERAL DECUBITUS POSTION
Up to 20 ml of CSF may be removed safely

OTHER METHODS: VCL

Ventricular puncture, cisternal puncture, lateral cervical puncture
ORDER OF COLLECTION C-
M-C/H
Tube #1: Chemistry
 Least affected by blood or bacteria introduced by spinal tap
 Tested for glucose and proteins

Tube #2: Microbiology

 To avoid contamination of specimen from skin flora
 Cultured for bacteria that caused meningitis

Tube #3: Cytology/Hematology

 Least likely to contain cells introduced by spinal tap
TRAUMATIC TAP
EH PANO KUNG MAY 4 TH
TUBE?
Send to Microbiology section for better exclusion of skin
contamination or;

Send to Serology section for additional Serological test

EH PANO KUNG ISA LANG NA
TUBE NA-COLLECT?
Don’t panic, eto tatandaan:
Ready ka na?

MICROBIOLOGY>HEMATOLOGY>CHEMISTRY/SE
ROLOGY

MHC
CSF
Excess fluid should not be discarded and should be
frozen until no further use for it
Tests are preformed on a STAT basis, if not, preserve the
specimen:
Tube #1: FROZEN (-15 TO -20˚C)

Tube #2: ROOM TEMPERATURE (19 – 26 ˚C)

Tube #3: REFRIGIRATED (2 – 8 ˚C)

NORMAL VALUES FOR CSF
Color: COLORLESS
Viscosity: SAME WITH WATER
Clarity: CRYSTAL CLEAR
Specific gravity: 1.006 – 1. 008
pH: 7.30 – 7.45
RECAP:
pH range of CSF is__________
Answer: 7.30 – 7.45

Tube #3 is stored at what temperature?

Answer: 2 – 8 ˚C

If there is only one tube containing CSF, the order for testing is:
Microbiology > Hematology > Chemistry/Serology
SEMEN
TRUE OR FALSE
Seminal fluid is normally basic in pH
Answer: True

Seminal fluid has a distinct bleach-like odor

Answer: True

Seminal fluid contains Glucose as the major nutrient source for

spermatozoa
Answer: False
CLINICAL SIGNIFICANCE
DIPSF
Investigation of the causes of infertility in marriages
Determination of the effectiveness of vasectomy
Paternity cases
Sperm donor evaluation
Forensic analysis to determine presence of semen
SPECIMEN CONSTITUENTS
5% SPERM CELLS

60 – 70% SEMINAL VESICLE FLUID

20 – 30% PROSTATE FLUID

5% BULBOURETHRAL GLAND FLUID

SPECIMEN COLLECTION
Sexual Abstinence Period: at least 2days, but not
more than 7 days
 Prolonged abstinence period: Higher volume,
decreased sperm motility, and increased Flavin giving
the semen a yellowish color.

Complete collection is ESSENTIAL:

 the first portion of the ejaculate contains the highest
concentration of sperm
SPECIMEN COLLECTION
EMPTY THE BLADDER BEFORE EJACULATION
 Urine is toxic to sperm cells affecting their motility

Time of collection is preferably in the MORNING

Laboratory should provide patient with warm
sterile glass or plastic containers
If collected at home, specimen must be kept at
room temperature and delivered to the lab within
1 hour
METHODS OF COLLECTION
Self-Production: preferred method
Coitus interruptus: withdrawal method
 Not reliable means because the first portion of the ejaculate may
be lost, and the acidity of the vaginal fluid may affect motility
Vaginal vault aspiration: aspiration of seminal fluid from
the vaginal vault after coitus
Condom method: only non-lubricant-containing rubber or
polyurethane condoms should be used
 Ordinary condoms are not acceptable because it contains
spermicidal agents
SPECIMEN HANDLING
ALL SEMEN SPECIMEN ARE POTENTIAL RESERVOIRS FOR HIV
AND HEPATITIS VIRUSES
Standard precautions must be observed at all times during analysis
Specimens discarded as biohazardous wastes
Culture is performed prior to continuing with the semen analysis
PRESERVATION

Keep the specimen at body temperature if needed to be

transported
 Under the arm pit, between thighs, or in the breast inside the bra

Specimen must be kept at room temperature while awaiting

analysis
For artificial insemination, it can be preserved in frozen state
and stored for 1 year at -85 ˚C
Specimens Fructose levels should be tested within two hours
or frozen to prevent fructolysis.
NORMAL VALUES FOR
SEMEN
Macroscopic:
Color: grayish white to pearly white
Transparency: translucent
Volume: 2 – 5 mL/ejaculation
Odor: Fishy, Distinct, “Bleach-like,” musty
Viscosity: pours in droplets
pH: 7.2 – 8.0