Fundamentals of Urine and Body Fluid Analysis

461 Pages·2022·56.223 MB·English

by  Nancy A. Brunzel

QUICK GUIDE TO URINALYSIS FIGURES BLOOD CELLS
Cell Type Figures Image Gallery #
CASTS Red blood cells 7.13, 7.14, 7.15, (7.16, 7.24, 3, 9, 10, 13, 69,
7.27, 7.28A, 7.33, 7.47, 7.61) 73, 76, 82, (86,
Image
87, 89)
Type Figures Gallery #
Dysmorphic RBCs 7.14, 7.15, Table 7.5
Broad 7.37 31
White blood cells 7.6, 7.9, 7.13, 7.16, 7.17, 7.18, 1, 5, 11, 12, 13,
Hyaline 7.35, 7.36, 7.38, 7.42, 7.43, 33-35 (38)
7.19, 7.20, 7.22, 7.23, (7.24, (66)
7.51, 7.59, (7.72, 7.117),
7.26), 7.61, (7.62, 7.63), 7.64
(18.12)
Macrophages 7.23
Granular 7.37, 7.39, 7.45, 7.48, 27-32
7.51, 7.52, 7.57
Cellular:
EPITHELIAL CELLS
RBC 7.46, 7.47 (21), 22-24
Cell Type Figures Image Gallery #
WBC 7.49 20, 21
Renal epithelial cell 7.50, 7.58 16-18, (19, 26) Squamous 7.4, 7.10, (7.16), 7.25, 7.26, 7.27, 7.67, 7.68 (11), 65-67
Mixed cell 7.41 15, 21, 22 Clue cells 7.67, 13.4 65
Waxy 7.12, 7.37, 7.39, 7.40, 36-40 Transitional 7.28, 7.29 67-71
7.44, 7.45, 7.59, 18.21 Renal 7.5, 7.21, 7.31, 7.32, 7.33 71-73, 77
Fatty 7.53, 7.54 19, 25, 26, Decoy cells 7.30
74,75, 79
Crystalline 7.55, 7.56
FAT
Figure numbers in parentheses indicate that the element is present but it is
not the predominant element in the image.
Element Figures Image Gallery #
Free fat globules 7.11 (74-75, 79)
Fatty casts—
CRYSTALS – ALSO SEE TABLE 7.14
See Casts
Image Oval fat bodies 7.7, 7.24, 7.34, 7.74, 7.75, (7.105A) 26, 75-80
pH* Crystal Figures Gallery #
<5.7 Uric acid 7.78A, 7.80, (51), 61-64
7.81, 7.82, 7.83, MICROORGANISMS (ALPHABETICAL
7.84, 7.85 ORDER)
<5.8 2,8-Dihydroxyadenine 7.104
Organism Figures Image Gallery #
≤7 Urates, amorphous 7.78
Bacteria 7.8, 7.61 68, 81-82, (86, 94)
Urate, monosodium 7.79 60
Giardia lamblia 7.70
Bilirubin 7.100 43
Pinworm eggs 7.69
Cholesterol 7.105, 7.106, 7.107 48
Schistosoma haematobium 7.71
Leucine 7.103
Trichomonads 7.65, 7.66, 13.7 83-85
Tyrosine 7.102
Yeast and/or pseudohyphae (7.13, 7.16, 7.17), 50, 86-89
Ionic radiographic media 7.108
7.62, 7.63, 7.64
Ampicillin (medication) 7.110
Sulfa drugs (medication) 7.112, 7.113 50-51
5-8 Calcium oxalate (7.56), 7.86, 7.87, 45-47
MISCELLANEOUS ELEMENTS
7.88, 7.89, 7.90,
7.91, 7.92 Element Figures Image Gallery #
Cystine 7.101 49
Air bubbles Table 7.15 1-2
(6)-8 Phosphate, calcium 7.95, 7.96, 7.97 56-59
Fibers 7.60, 7.116, 7.117, Table 7.15, 7-8
Acyclovir (medication) 7.109 18.12
Indinavir sulfate (medication) 7.111 52 Fungal spores Table 7.15
≥7 Phosphate, amorphous 7.93 Glass fragments --- 5
Phosphate, triple 7.94 53-55 Hemosiderin 7.76 90-91
Carbonate, calcium (7.96), 7.99 44 Mucus (7.25, 7.35, 7.36, 7.38, 7.42), 92
Ammonium biurate (7.96), 7.98 41-42 7.72, (18.12)
Plastic fragments --- 3-4
*Approximate pH value or range.
Pollen grains 7.116, Table 7.1
Sperm 7.77 (79), 93-94
Starch 7.114, 7.115 4
Talc 7.116 6
Fundamentals of
Urine &
Body Fluid
Analysis
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Fundamentals of
FIFTH EDITION
Urine &
Body Fluid
Analysis
Nancy A. Brunzel,
MS, MLS(ASCP)CM
University of Minnesota Medical Center,
Minneapolis, Minnesota
Elsevier
3251 Riverport Lane
St. Louis, Missouri 63043
FUNDAMENTALS OF URINE AND BODY FLUID ANALYSIS, ISBN: 978-0-323-71197-5
FIFTH EDITION
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Previous editions copyrighted 2018, 2013, 2004, 1994.
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CHES® Professor
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Farmingdale State College SUNY Findlay, Ohio
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Bachelor of Health Science, (ASCP) MT School of Health Sciences
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Medical Laboratory Technology Waterloo, Iowa
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Faculty University of Tennessee Health Science Center
Medical Laboratory Technology/Allied Health Professions Memphis, Tennessee
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Columbus, Ohio Michele B. Zitzmann, MHS, MLS(ASCP)
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vi
P R E FA C E
As stated in the preface of the first edition (1994), “the pur- sediment (Chapter 7). In contrast with previous editions,
pose of this textbook is to present the fundamental principles the in-depth discussion of specific gravity has been localized
of urine and body fluid analysis” and “to serve as a straightfor- to a single chapter (Chapter 5), with pertinent callouts pro-
ward, in-depth teaching and reference text”. As with previous vided in other chapters when necessary. In Chapter 6, the
editions, the task of achieving a balance in depth and breadth commercial reagent strips as well as the principles, sensitiv-
of content to meet all needs is challenging. I still believe that ity, and specificity for each chemical test has been updated.
to gain a true understanding of a subject requires more than In Chapter 7, several new tables with embedded thumbnail
the mere memorization of facts. Therefore a guiding principle images have been added. These include a table for the iden-
in the format and writing of this book is to present basic and tification of urine crystals based on shape and pH, a table of
comprehensive information in a manner that arouses interest, urine contaminants, and one specific for urine drug crystals.
enhances learning, and facilitates understanding and mastery Each is unique, useful, and serves as a resource for training
of the content. A foundation knowledge of each body fluid or reference.
in health is established before pathologic conditions are dis- New photomicrographs have been added to the Urine
cussed. This enables readers to build their skills in interpret- Sediment Image Gallery, which is located between Chapters
ing and correlating test results with disease states. 7 and 8. This unique gallery provides alternate views of urine
The intended audience is practicing laboratory profes- sediment elements to assist in their proper microscopic iden-
sionals—medical laboratory scientists, medical laboratory tification, especially in those specimens that are not ‘picture
technicians—as well as faculty of undergraduate and gradu- perfect’. Minor formatting and organization changes were
ate educational programs in medical laboratory science. In also made to enhance navigation within the image gal-
the medical laboratory, this text is useful as a training guide lery. Chapter 8 completes this section on the formation and
and reference. Note that other healthcare professionals, such analysis of urine with a discussion of the clinical features of
as physicians, physician assistants, nurse practitioners, and renal and metabolic disorders and their associated urinalysis
nurses can also benefit. Although the content can be compre- results.
hensive and detailed, educators can easily adapt it to the level
Part III: Other Body Fluids
desired for their students.
Chapters 9 through 15 are dedicated to the study of other
ORGANIZATION ‘non-blood’ body fluids that are frequently encountered in
the medical laboratory. Each chapter has been updated and
This, the revised fifth edition, is organized into 4 sections describes the physiology, normal composition, and clinical
that contain 18 chapters. Throughout the text, content has value associated with laboratory analysis of the body fluid.
been updated, figures added, and numerous tables have been Preanalytic factors in specimen collection and handling are
revised or added (see sections below for more details). In discussed along with the significance of specific tests that pro-
addition, the five appendices continue to provide reference vide clinically useful information. Note that laboratory tests
intervals, tabular summaries, as well as resource methods and routinely performed on one body fluid may not have clinical
materials for all body fluids discussed in an easily accessible value when analyzing another body fluid.
location. To facilitate learning and quick access to desired In this edition, take note of the following enhancements.
photomicrographs, Quick Reference Guides are available on Chapter 9, Cerebrospinal Fluid, is updated with several new
the inside front and back covers. figures, expanded discussion of hemorrhagic events and the
morphologic transitioning of monocytes to macrophages,
Part I: Quality Assessment and Safety
and thumbnail images added to several tables. In Chapter 10,
Chapter 1 provides an overview of quality assessment and Pleural, Peritoneal, and Pericardial Fluids, discussion of the
safety protocols that are specifically required in medical labo- nucleated cell differential has been enhanced, new figures
ratories in the United States. However, these are key compo- added, and a table with embedded images created to assist in
nents found in laboratories throughout the world. the microscopic differentiation of monocytes, macrophages
and mesothelial cells.
Part II: Urinalysis
Part IV: Laboratory Techniques and Tools
Chapter 2 provides a thorough discussion of urine specimen
collection, handling, and preservation, whereas Chapters The three chapters in this section cover the laboratory tech-
3 and 4 review the anatomy and physiology of the urinary niques, manual and automated, that can be used to analyze
system. Together, these three chapters set the stage for an urine and other ‘non-blood’ body fluids. Chapter 16 pro-
in-depth discussion of the three components of a com- vides a snapshot of automation currently available for their
plete urinalysis—namely, the physical exam (Chapter 5), analysis. Because of the robust and dynamic nature of labora-
chemical exam (Chapter 6), and microscopic exam of urine tory instrumentation, the content of this chapter can change
vii
viii PREFACE
dramatically and quickly outdate. However, the intent is to sensitivity and specificity of each test. Appendix C serves as a
provide an understanding of the analytic principles used handy resource and single location for the Reference Intervals
in automated instruments. In this regard, the basic analytic of the body fluids that are provided in the various chapters.
principles for urine chemical (reflectance photometry) analy- As previously stated, Appendix D, Body Fluid Diluent and
sis have stood the test of time and continue to endure. The Pretreatment Solutions, supplements Chapter 17 (manual
arena of automated microscopic analysis of urine is broad- hemacytometer counts) by providing detailed instructions
ening with three alternatives: digital flow microscopy, flow for the preparation and use of diluents and pretreatment
cytometry, and cuvette-based digital microscopy. Future solutions. Last, Appendix E provides information for the
developments in the analysis of urine and body fluids will performance of manual and historic methods of interest.
undoubtedly bring to the marketplace new analyzers and These methods are valuable tests that are no longer routinely
manufacturers. performed in some regions, are used only under rare circum-
For a variety of reasons, manual cell counts of body fluids stances, or are of historical interest. Note that this section
using a hemacytometer persist today. Therefore Chapter 17 provides detailed information that enables test performance,
and Appendix D are provided as resources for the prepara- including specifics for reagent preparation.
tion of dilutions and the performance of manual body fluid This text concludes with two additional sections, the
cell counts. Pretreatment solutions and a variety of diluents Answer Key and a Glossary. The Answer Key provides the
for body fluids are discussed; step-by-step instructions and answers and explanations (when necessary) to the end-of-
calculations for performing manual cell counts are included. chapter study questions and cases in a convenient, readily
This chapter closes with a discussion of cytocentrifugation accessible location. The glossary includes the key terms that
and the preparation of slides for a nucleated cell (or white are bolded in each chapter as well as additional clinical and
blood cell) differential. scientific terms that may be new to readers.
Last, but definitely not least is Chapter 18, Microscopy. The
importance of familiarity with and the ability to optimize TEXTBOOK FEATURES
a microscope cannot be overemphasized. These skills are
required because the detection and proper identification of Each chapter has the following pedagogical features to
microscopic elements are adversely affected when a micro- enhance mastery of the content:
scope is not properly adjusted. In many laboratory settings • Learning Objectives at three cognitive levels (Recall, Ap-
globally, automation isn’t available or financially feasible, plication, Analysis).
but microscopes are. Chapter 18 describes various types of • A Chapter Outline that provides an overview and quick
microscopy, including their uses and their advantages. Proper content location guide.
microscope handling, care, and important do’s and don’ts • Key Terms that are bold in the chapters and defined in the
are included. Step-by-step instructions are provided (1) to Glossary
properly adjust a brightfield microscope for optimal view- • Many Tables that capture, summarize, and enhance the
ing using Köhler illumination (Box 18.1) and (2) to convert content
a brightfield microscope for polarizing microscopy includ- • Numerous high-quality Figures and photomicrographs in
ing directions for synovial fluid crystal analysis (Box 18.3, full color
Fig. 18.18). Tables and photomicrographs are provided of • Study Questions at the end of each chapter that correlate to
polarizing microscopy, with and without a red wave compen- the learning objectives. Note that most are in the multiple-
sator, as well as variations in birefringence intensity. choice format used on certification examinations.
• Case Studies at the end of pertinent chapters, which assist
APPENDICES the reader in applying the content to real-life situations.
The five appendices provided complement the chapters. EVOLVE INSTRUCTOR RESOURCES
Appendix A, Reagent Strip Color Charts, supplements the
chemical examination of urine (see Chapter 6) by provid- Downloadable instructor content specific to this text is avail-
ing figures of manufacturer color charts used to manually able on the companion Evolve Resources site (http://evolve.
determine reagent strip results. These figures are a useful elsevier.com/Brunzel). The site includes the following ancil-
reference and assist in highlighting differences in reagent lary material for teaching and learning:
strip brands, such as physical orientation of strip to chart • PowerPoint presentations for all chapters to aid in lecture
and variations in result reporting. Appendix B, Comparison development
of Reagent Strip Principles, Sensitivity, and Specificity, gath- • Test Banks that tie exam questions directly to book con-
ers the information for each chemical reaction discussed in tent, making exam development easier and faster
Chapter 6 into one location. Here, a table summarizes the • Image Collection that includes all illustrations in the
test principles employed on reagent strips from three popu- book, offering a closer look at hundreds of microscopic
lar brands. Similarly, a tabular comparison is provided of the slides