Urinalysis and Body Fluids

311 Pages·2009·43.45 MB·English

Urinalysis

and Body Fluids

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©2008 F. A. Davis

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©2008 F. A. Davis

Urinalysis
and Body Fluids

Fifth Edition

Marjorie Schaub Di Lorenzo, BS,
MT(ASCP)SH

Adjunct Instructor
Division of Laboratory Sciences
Clinical Laboratory Science Program
University of Nebraska Medical Center
Omaha, Nebraska
Phlebotomy Program Coordinator
Health Professions
Nebraska Methodist College
Omaha, Nebraska

Susan King Strasinger, DA, MT(ASCP)
Faculty Associate
The University of West Florida
Pensacola, Florida

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©2008 F. A. Davis

F. A. Davis Company
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Library of Congress Cataloging-in-Publication Data
Strasinger, Susan King.
Urinalysis and body fluids / Susan King Strasinger, Marjorie Schaub Di Lorenzo ; photography by Bo Wang …
[et al.] ; illustrations by Sherman Bonomelli. — 5th ed.
p. ; cm.
includes bibliographical references and index.
ISBN 978-0-8036-1697-4 (alk. paper)
1. Urine—Analysis. 2. Body fluids—Analysis. 3. Diagnosis, Laboratory. I. Di Lorenzo, Marjorie Schaub,
1953- II. Title.
[DNLM: 1. Urinalysis—methods. 2. Body Fluids—chemistry. QY 185 S897u 2008]
RB53.S87 2008
616.07’566—dc22
2007017271

Authorization to photocopy items for internal or personal use, or the internal or personal use of specific
clients, is granted by F. A. Davis Company for users registered with the Copyright Clearance Center (CCC)
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Drive, Danvers, MA 01923. For those organizations that have been granted a photocopy license by CCC, a
separate system of payment has been arranged. The fee code for users of the Transactional Reporting Service is:
8036-1698/08 � $.10.

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©2008 F. A. Davis

To Harry, you will always be my Editor-in-Chief

SKS

To my husband, Scott, and my children,
Michael, Christopher, and Lauren

MSD

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©2008 F. A. Davis

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©2008 F. A. Davis

As will be apparent to the readers, the fifth edition of Urinal-
ysis and Body Fluids has been substantially revised and
enhanced. However, the objective of the text—to provide
concise, comprehensive, and carefully structured instruction
in the analysis of nonblood body fluids—remains the same.
This fifth edition has been redesigned to meet the
changes occurring in both laboratory medicine and instruc-
tional methodology.
To meet the expanding technical information required
by students in laboratory medicine, all of the chapters have
been updated. Chapter 1 is devoted to overall laboratory
safety and the precautions relating to urine and body fluid
analysis. Chapter 7 addresses quality assessment and man-
agement in the urinalysis laboratory. Preanalytical, analytical,
and postanalytical factors, procedure manuals, current regu-
latory issues, and methods for continuous quality improve-
ment are stressed. In Chapter 8 the most frequently
encountered diseases of glomerular, tubular, interstitial, and
vascular origin are related to their associated laboratory tests.
To accommodate advances in laboratory testing of cere-
brospinal, seminal, synovial, serous, and amniotic fluids, all
of the individual chapters have been enhanced, and addi-
tional anatomy and physiology sections have been added for
each of these fluids. Appendix A provides coverage of the
ever-increasing variety of automated instrumentation avail-
able to the urinalysis laboratory. Appendix B discusses the

analysis of bronchioalveolar lavage specimens, an area of the
clinical laboratory that has been expanding in recent years.
This fifth edition has been redesigned to include exten-
sive multiple choice questions at the end of each chapter for
student review. In response to readers’ suggestions, the num-
ber of color slides has been significantly increased, and the
slides are included within the text to increase user friendli-
ness. The text has been extensively supplemented with tables,
summaries, and procedure boxes, and many figures are now
in full color. Case studies in the traditional format and clini-
cal situations relating to technical considerations are included
at the end of the chapters. Answers to the study questions,
case studies, and clinical situations are also included at the
end of the book. Terms in bold italics appear in the Glossary;
abbreviations in bold are listed in Abbreviations. Additional
support is provided to adopting instructors in the form of
accompanying test-generating software, an instructor’s man-
ual with criticial thinking exercises for each chapter, and
PowerPoint presentations.
We have given consideration to the suggestions of our
previous readers and believe these valuable suggestions have
enabled us to produce a text to meet the needs of all users.

Susan King Strasinger

Marjorie Schaub Di Lorenzo

vii

Preface

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©2008 F. A. Davis

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©2008 F. A. Davis

Ellen P. Digan, MA, MT(ASCP)
Professor of Biology
Coordinator of Medical Laboratory Technology Program
Manchester Community Tech College
Department of Math, Science, and Health Careers
Manchester, Connecticut

Brenda L. M. Franks, MT(ASCP)
Point of Care Testing Coordinator
Methodist Hospital Pathology
Omaha, Nebraska

Stephen M. Johnson, MS, MT(ASCP)
Program Director
Medical Technology
Saint Vincent Health Center
Erie, Pennsylvania

Rhoda S. Jost, MSH, MT(ASCP)
Faculty Program Director
Medical Laboratory Technology
Florida Community College at Jacksonville
Jacksonville, Florida

Pam Kieffer, MS, CLS(MCA), MT(ASCP)
Program Director
Clinical Laboratory Science
Rapid City Regional Hospital
Rapid City, South Dakota

Cynthia A. Martine, MEd, MT(ASCP)
Assistant Professor
Department of Clinical Laboratory Sciences
University of Texas Medical Branch
School of Allied Health
Galveston, Texas

Ulrike Otten, MT(ASCP)SC
University of Nebraska Medical Center
Division of Laboratory Sciences
Clinical Laboratory Science Program
Omaha, Nebraska

Kathleen T. Paff, MA, CLS(NCA), MT(ASCP)
Program Director
Medical Laboratory Technology
Kellogg Community College
Battle Creek, Michigan

Kristy Shanahan, MS, NCA, MT(ASCP)
Associate Professor
Medical Laboratory Technology
Oakton Community College
Des Plaines, Illinois

Amber G. Tuten, MEd, CLDir(NCA), MT(ASCP)
Program Director
Medical Laboratory Technology
Okefenokee Technical College
Waycross, Georgia

ix

Reviewers

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©2008 F. A. Davis

Many people deserve credit for the help and encouragement
they have provided us in the preparation of this fifth edition.
Our continued appreciation is also extended to all of the peo-
ple who have been instrumental in the preparation of previ-
ous editions.
The valuable suggestions from previous readers and the
support from our colleagues at The University of West
Florida, Northern Virginia Community College, The Univer-
sity of Nebraska Medical Center, Methodist Hospital, and
Creighton University Medical Center have been a great asset
to us in the production of this new edition. We thank each
and every one of you.

We extend special thanks to the individuals who have
provided us with so many beautiful photographs for the text
over the years: Bo Wang, MD; Donna L. Canterbury, BA,
MT(ASCP)SH; Joanne M. Davis, BS, MT(ASCP)SH; M. Paula
Neumann, MD; Gregory J. Swedo, MD; and Scott Di Lorenzo,
DDS. We also thank Sherman Bonomelli, MS, for contribut-
ing original visual concepts that became the foundation for
many of the line illustrations.
We also appreciate the help and understanding of
our editors at F. A. Davis, Christa Fratantoro, Elizabeth
Zygarewicz, and Deborah Thorp.

xi

Acknowledgments

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©2008 F. A. Davis

Chapter 1. Safety in the Clinical
Laboratory, 1

Biological Hazards, 2

Personal Protective Equipment, 4

Handwashing, 4

Disposal of Biological Waste, 5

Sharp Hazards, 5
Chemical Hazards, 6

Chemical Spills, 6

Chemical Handling, 6

Chemical Hygiene Plan, 6

Chemical Labeling, 6

Material Data Safety Sheets, 7

Radioactive Hazards, 7
Electrical Hazards, 7
Fire/Explosive Hazards, 8
Physical Hazards, 8

Chapter 2. Renal Function, 11

Renal Physiology, 12

Renal Blood Flow, 12

Glomerular Filtration, 13

Tubular Reabsorption, 14

Tubular Secretion, 17

Renal Function Tests, 18

Glomerular Filtration Tests, 18

Tubular Reabsorption Tests, 22

Tubular Secretion and
Renal Blood Flow Tests, 24

Chapter 3. Introduction
to Urinalysis, 29

History and Importance, 29
Urine Formation, 31
Urine Composition, 31

Urine Volume, 31
Specimen Collection, 32
Specimen Handling, 33

Specimen Integrity, 33

Specimen Preservation, 33

Types of Specimens, 34

Random Specimen, 34

First Morning Specimen, 34

Fasting Specimen (Second Morning), 34

2-Hour Postprandial Specimen, 35

Glucose Tolerance Specimens, 35

24-Hour (or Timed) Specimen, 36

Catheterized Specimen, 36

Midstream Clean-Catch Specimen, 36

Suprapubic Aspiration, 36

Prostatitis Specimen, 36

Pediatric Specimen, 37

Drug Specimen Collection, 37

Chapter 4. Physical Examination
of Urine, 41

Color, 42

Normal Urine Color, 42

Abnormal Urine Color, 43

Clarity, 44

Normal Clarity, 44

Nonpathologic Turbidity, 44

Pathologic Turbidity, 45

Specific Gravity, 45

Urinometer, 46

Refractometer, 47

Harmonic Oscillation Densitometry, 48

Clinical Correlations, 48

Odor, 49

xiii

Contents

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©2008 F. A. Davis

Chapter 5. Chemical Examination
of Urine, 53

Reagent Strips, 54

Reagent Strip Technique, 54

Handling and Storage of Reagent Strips, 55

Quality Control of Reagent Strips, 55

pH, 56

Clinical Significance, 56

Reagent Strip Reactions, 56

Protein, 57

Clinical Significance, 57

Prerenal Proteinuria, 57

Renal Proteinuria, 58

Postrenal Proteinuria, 58

Reagent Strip Reactions, 58

Reaction Interference, 59

Glucose, 61

Clinical Significance, 62

Reagent Strip (Glucose
Oxidase) Reactions, 62

Reaction Interference, 63

Copper Reduction Test, 63

Comparison of Glucose
Oxidase and Clinitest, 64

Ketones, 64

Clinical Significance, 64

Reagent Strip Reactions, 65

Reaction Interference, 65

Blood, 65

Clinical Significance, 66

Hematuria, 66

Hemoglobinuria, 66

Myoglobinuria, 66

Hemoglobinuria Versus Myoglobinuria, 67

Reagent Strip Reactions, 67

Reaction Interference, 67

Bilirubin, 68

Production of Bilirubin, 68

Clinical Significance, 68

Reagent Strip (Diazo) Reactions, 68

Ictotest Tablets, 68

Reaction Interference, 69

Urobilinogen, 69

Clinical Significance, 70

Reagent Strip Reactions and Interference, 70

Reaction Interference, 70

Ehrlich Tube Test, 70

Watson-Schwartz Differentiation Test, 71

Hoesch Screening Test
for Porphobilinogen, 71

Nitrite, 72

Clinical Significance, 72

Reagent Strip Reactions, 72

Reaction Interference, 73

Leukocyte Esterase, 73

Clinical Significance, 73

Reagent Strip Reaction, 74

Reaction Interference, 74

Specific Gravity, 74

Reagent Strip Reaction, 75

Reaction Interference, 75

Chapter 6. Microscopic
Examination of Urine, 81

Macroscopic Screening, 82
Preparation and Examination
of the Urine Sediment, 82

Commercial Systems, 82

Specimen Preparation, 83

Specimen Volume, 83

Centrifugation, 83

Sediment Preparation, 83

Volume of Sediment Examined, 83

Examination of the Sediment, 83

Reporting the Microscopic Examination, 84

Correlation of Results, 84

Sediment Examination Techniques, 84

Sediment Stains, 85

xiv
CONTENTS

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