Fundamentals of Urine and Body Fluid Analysis

461 Pages·2012·53.27 MB·English

Fundamentals
of
Urine &
Body FlUid
Analysis
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Third Edition
Fundamentals
of
Urine &
Body FlUid
Analysis
CM
Nancy A. Brunzel, MS, MLS(ASCP)
Assistant Professor
University of Minnesota
Minneapolis, Minnesota
3251 Riverport Lane
St. Louis, Missouri 63043
FUNDAMENTALS OF URINE AND BODY FLUID ANALYSIS, ISBN: 978-1-4377-0989-6
THIRD EDITION
Copyright © 2013, 2004, 1994 by Saunders, an imprint of Elsevier Inc.
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Notices
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Library of Congress Cataloging-in-Publication Data
Brunzel, Nancy A.
Fundamentals of urine & body fuid analysis / Nancy A. Brunzel.—3rd ed.
p. ; cm.
Fundamentals of urine and body fuid analysis
Urine & body fuid analysis
Urine and body fuid analysis
Includes bibliographical references and index.
ISBN 978-1-4377-0989-6 (pbk. : alk. paper)
I. Title. II. Title: Fundamentals of urine and body fuid analysis. III. Title: Urine & body fuid
analysis. IV. Title: Urine and body fuid analysis.
[DNLM: 1. Urinalysis. 2. Body Fluids—chemistry. QY 185]
616.07′566—dc23
2012005517
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C O N T R I B U T O R S A N D R E V I E W E R S
CONTRIBUTOR
Charlotte Janita, MT(ASCP)
Clinical Pathology Operations Manager
Regions Hospital
St. Paul, Minnesota
REVIEWERS
Donna Marie Duberg, MA, MS, MT(ASCP)SM, CLS(NCA)
Assistant Professor
Saint Louis University
St. Louis, Missouri
Debbie Heinritz, MS, MLS(ASCP)CM
CLT Instructor
Northeast Wisconsin Technical College
Green Bay, Wisconsin
Joel D. Hubbard, MT(ASCP), PhD
Associate Professor
Texas Tech University Health Sciences Center
Lubbock, Texas
Michele B. Zitzmann, MHS, MT(ASCP)
Associate Professor
LSUHSC Department of Clinical Laboratory Sciences
New Orleans, Louisiana
vii
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P R E FA C E
This book is designed as a teaching and reference text identifcation of urine sediment elements. Chapter 9
for the analysis of urine and body fuids. The intended completes the study of urine with a discussion of the
audience is students in clinical/medical laboratory science clinical features of renal and metabolic disorders and
programs and practicing laboratory professionals. their associated urinalysis results.
However, other health care professionals—physicians, Chapters 10 through 16 are dedicated to the study of
physician assistants, nurse practitioners, and nurses— body fuids (other than urine) frequently encountered in
can also beneft from the information provided. the clinical laboratory. Each chapter describes the physi-
As with previous editions, the task of achieving a ology, normal composition, and clinical value associated
balance in depth and breadth of content to meet all needs with laboratory analysis of the fuid. Preanalytical factors
is challenging. I believe that to gain a true understanding in specimen collection and handling are discussed along
of a subject requires more than the mere memorization with the signifcance of specifc tests that provide clini-
of facts. Therefore, a guiding principle in the format and cally useful information. Note that laboratory tests rou-
writing of this book was to present comprehensive infor- tinely performed on one body fuid may not have clinical
mation in a manner that arouses interest, enhances learn- value when analyzing another body fuid.
ing, and facilitates understanding and mastery of the Chapter 17 provides a snapshot of automation cur-
content. Although the content is comprehensive and rently available for the analysis of urine and body fuids.
detailed, educators can easily adapt it to the level of Because of the robust and dynamic nature of laboratory
content desired. instrumentation, the content of this chapter will quickly
outdate. However, the intent is to provide an under-
standing of the analytical principles used in semi- and
ORGANIZATION
fully automated instruments. In this regard, the basic
The organization is similar to previous editions, with a analytical principles for chemical (refectance photome-
couple of minor changes: the Urine Sediment Image try) and microscopic (digital microscopy, fow cytome-
Gallery has been centralized for easy access and two try) analyses have stood the test of time and will endure.
new chapters are present. As in previous editions, the Future improvements in the application of these analyti-
frst two chapters cover general topics that are important cal techniques for the analysis of urine and body fuids
in laboratories that perform urine and body fuid analy- will undoubtedly bring to the marketplace new analyzers
ses, namely microscopy, quality assurance, and safety. and manufacturers.
Chapter 1 describes various types of microscopy, proper For a variety of reasons, manual cell counts of body
microscope handling and care, including important do’s fuids using a hemacytometer persist today. Chapter 18
and don’ts, as well as step-by-step instructions for prop- and Appendix C are resources for the preparation of
erly adjusting a binocular microscope for optimal viewing dilutions and the performance of manual body fuid cell
(i.e., Kohler illumination). Chapter 2 reviews quality counts. Pretreatment solutions and a variety of diluents
assurance and safety concerns that apply to laboratories for body fuids are discussed, as are step-by-step instruc-
that perform urine and body fuid analyses. tions and calculations for performing manual cell counts.
Chapters 3 through 9 focus on the study of urine— This chapter ends with a discussion of cytocentrifuga-
preanalytical considerations, analysis, and the role uri- tion and the preparation of slides for a leukocyte
nalysis plays in the diagnosis and monitoring of disorders. differential.
Chapter 3 provides a thorough discussion of urine speci- Three appendices are provided to complement the
men collection, handling, and preservation; chapters 4 chapters. As previously stated, Appendix C Body Fluid
and 5 review the anatomy and physiology of the urinary Diluent and Pretreatment Solutions supplements Chapter
system. Together, these chapters set the stage for an in- 18 by providing detailed instructions for the preparation
depth discussion of the three components of a complete and use of diluents and pretreatment solutions. Appen-
urinalysis, namely the physical examination (Chapter 6), dix A, Reagent Strip Color Charts, supplements the
chemical examination (Chapter 7), and microscopic chemical examination of urine (see Chapter 7) by provid-
examination (Chapter 8). Located between Chapters 8 ing fgures of manufacturer color charts used to manu-
and 9 is a Urine Sediment Image Gallery containing ally determine reagent strip results. These fgures are a
more than 100 urine sediment photomicrographs to be useful reference and assist in highlighting differences in
used as a teaching tool and reference for the reagent strip brands such as physical orientation of strip
ix