Quality Control and QA Part of the Institutional

Programs Continuous Quality Improvement and

Total Quality Management
Designed to maintain an established
level of quality
Designed to develop methods to
continually improve the quality of
healthcare
Pre-Examination Variables Test requests
Patient preparation
Timing
Specimen Collection
Handling
Storage
Examination Variables Reagents
Instrumentation and Equipment
Testing Procedure
QC
Preventative maintenance
Access to procedure manuals
Competence of personal performing
the tests
Post Examination Variables Reporting of results
Correct interpretation of data
The most widely used plan for
quality improvement
Defines as the amount of time
required from at which a test is
ordered by the health-care provider
until the results are reported to
the health-care provider
The laboratory can then monitor the
TATs to determine areas in the
process that need improvement
Time of receipt of the specimen in

1 Clinical Microscopy – Coaching Notes| JBCRMT

 the laboratory to reporting of
results to a patient care area or
into a data information system
Time from when they write the order
for the test until the result is
communicated to them for action
Time that elapses from actual
specimen collection until the
results are communicated to them
Handwashing procedure 1. Wet hands with warm water
2. Apply anti-microbial soap
3. Rub from a lather, create
friction, and loosen debris.
4. Thoroughly clean between
fingers, including thumbs,
under fingernails and rings,
and up to the wrist, for at
least _________________
5. Rinse hands in a downward
position
6. Dry with a paper towel
7. Turn off faucets with a clean
paper towel to prevent
recontamination
Chemical labeling Hazardous chemicals should be
labeled with a description of their
particular hazard, such as
Poisonous, Corrosive, Flammable,
Explosive, Teratogenic, or
Carcinogenic
NFPA Developed the Standard System For
The Identification Of The Fire
Hazard of Materials
Health Hazard 4 Deadly
3 Extreme Danger
2 Hazardous
1 Slightly Hazardous
0 Normal material
Fire Hazard 4 Below 73F
3 Below 100F
2 Below 200F
1 Above 200F
0 Will not burn

2 Clinical Microscopy – Coaching Notes| JBCRMT

Reactivity 4 May deteriorate
3 Shock and heat may deteriorate
2 Violent chemical change
1 Unstable if heated
0 Stable
Specific Hazard OXY
ACID
ALK
COR
USE NO WATER
RADIATION
Biohazard Label
All biologic waste must be
placed in appropriate
containers labeled with
biohazard symbol
Sodium hypochlorite dilutions
stored in plastic bottles
The capillaries retain blood cells
and serum proteins, whereas smaller
molecules with a Molecular Weight
_________ and water filter into
Bowman’s space

Substance to be
reabsorbed combine with a
Active
carrier protein contained
transport
in the membranes of the
renal tubular cells

Moves molecules across a

Passive membrane based on
transport concentration gradient or
electrical potential

The most frequently used

formula for Estimated
Glomerular Filtration Rate
Cockcroft-Gault Formula Serum Creatinine
Age
Sex
Body Weight
MDRD Age

3 Clinical Microscopy – Coaching Notes| JBCRMT

 Race
Gender
Serum Creatinine

Variables include ethnicity, BUN,

Serum albumin
Greatest source of error
in any clearance procedure
Complex polysaccharide produced by
certain plants and has been widely
registered as the GOLD STANDARD for
measuring GFR
Does not Precipitates Prevents bacterial
interfere with amorphous growth for 24 hours.
chemical tests crystals
Raises
specific
gravity by
hydrometer
Thymol Preserves Interfere
glucose and with acid
sediments well precipitation
testfor
protein
Boric Preserves May Keeps pH at 6.0
acid protein and precipitate Bacteriostatic at
formed elements crystals when 18g/L
well used in large
Does not amounts
interfere with Interferes
routine analysis with drug and
other than pH hormone
Prevents analyses
bacterial growth
and metabolism
Formalin Excellent Acts as Can also be used for
sediment reducing cytology (Brunzel)
preservative agent
Interfere
with chemical
tests for
glucose,
blood,

4 Clinical Microscopy – Coaching Notes| JBCRMT

 leukocyte
esterase,and
copper
reduction
False-
negative
reagent strip
testsfor
blood and
urobilinogen
Does not Floats on
interfere with surface of
routine test specimens and
clings to
pippete and
testing
materials
Sodium Prevents Inhibits May use sodium
Fluoride glycolysis good reagent strip benzoate instead of
for drug tests for fluoride for reagent
analysis glucose, strip testing
blood, and
leukocytes
Does no Causes an Use 1 drop per ounce
interfere with odor change of specimen
routine test
Gray C Preserves Decreases pH; Preservative is
and S bacteria do not use if boric acid
tube Sample stable at urine is
RT for 48hr below minimum
fill line
Cherry Stable for 72 Bilirubin and Preservative is
red/ hours urobilinogen sodiumpropionate
yellow may be
top tube decreased if
specimen is
exposedto
light and
left at RT
Yellow For automated Must Round or conical
Plain UA instruments refrigerate bottom
within2 hours
Preserves Used for Cytological

5 Clinical Microscopy – Coaching Notes| JBCRMT

 cellular Examination
elements
Sodium Inexpensive Unacceptable For quantitative
carbonate Stabilizes for analysis of
porphyrins, urinalysis porphyrins,
porphobilinogen, testing porphobilinogen, etc
etc.
10g boric acid
Catecholamines, cysteine,
homovanilic acid, hydroxyproline,
metanephrines, oxalate, VMA
Random Routine monitoring
First morning Routine screening
Pregnancy tests
Evaluation of orthostatic
proteinuria
Fasting Diabetic screening/monitoring
2-hour Postprandial Diabetic monitoring
Glucose tolerance test Optional with blood samples in
glucose tolerance
Quantitative chemical tests
Catheterized Bacterial culture
Midstream Clean Catch Bacterial screening
Bacterial culture
Suprapubic aspiration Bladder urine for bacterial culture
Cytology
Three-glass Collection Prostatic infection
Drug Specimen Collection
Step-by-step documentation of the
handling and testing of legal
specimens
Collector adds bluing agent to the
toilet water reservoir to prevent
and adulterated specimen
Specimen
Urine temperature

Routine Urinalysis
Routine urinalysis Specimens must be collected in
clean, dry, leak-proof containers.
Needed for microscopic analysis,
additional specimen for repeat

6 Clinical Microscopy – Coaching Notes| JBCRMT

 analysis, and enough room for the
specimen to be mixed by swirling
the container
Recommended capacity of the
container
Normal daily urine output
Polyuria
Oliguria
Anuria
Nocturia
Urine Color and Clarity 1. Evaluate an adequate volume of
Procedure specimen
2. Use a well-mixed specimen
3. View the urine through a clear
container
4. View the urine against a white
background using adequate room
lighting
5. Maintain adequate room lighting
6. Evaluate a consistent volume of
urine
7. Determine the urine color
8. Describe the urine clarity
Color Examine the specimen under a good
light source, looking down through
the container against a
_______________.
Clarity Visually examining the mixed
specimen while holding it in
__________________.
Yellow pigment that is present the
highest concentration and is
secreted by tubule cells; actual
amount produced is dependent on the
body’s metabolic state, with
increased amounts produced in
thyroid conditions and fasting
states
Red pigment
Orange-red pigment from the
oxidation of urobilinogen
Increased hematoporphyrin

7 Clinical Microscopy – Coaching Notes| JBCRMT

Produces red urine Medications, including rifampin,
phenolphthalein, phenindione, and
phenothiazines
A large amount of White Increased concentration of
foam ____________.
No visible particulates,
transparent
Few particulates, print easily seen
through urine
Many particulates, print blurred
through urine
Print cannot be seen through urine
May precipitate or be clotted
Acidic urine Amorphous urates, radiographic
contrast media
Alkaline urine Amorphous phosphates, carbonates
Soluble with heat
Soluble in dilute acetic
acid
Insoluble in dilute acetic WBCs, Bacteria, yeast, spermatozoa
acid
Soluble in ether Lipids, lymphatic fluid chyle
Odor Causes
Aromatic Normal
Foul, ammonia-like, fetid Bacterial decomposition, urinary
tract infection, old urine
Fruity, sweet Ketones, DM, Starvation, vomiting,
strenuous exercise, diarrhea
Maple syrup Maple syrup urine disease, caramel
sugar
Mousy odor, Barny or musty Phenylketonuria
Rancid Tyrosinemia
Sweaty feet Isovaleric academia
Cabbage, Hops Methionine malabsorption
Bleach Contamination
Ingestion of certain foods,
including onions, garlic, asparagus
Ingestion of asparagus, garlic and
egg
Major disadvantage of Large volume (10-15mL) of specimen
using a urinometer to

8 Clinical Microscopy – Coaching Notes| JBCRMT

measure specific gravity
Advantages of Small volume of specimen is
Refractometer required
No temperature corrections are
required
Simple to operate; it gives rapid,
reliable results
Disadvantages Corrections for large amounts of
glucose and protein, as with the
urinometer
Scale reading maximum of 1.035
Very concentrated specimens need to
be diluted and remeasured
Calibrations for Refractometer
Distilled water
3% NaCl
5% NaCl
9% Sucrose
Temperatures of
refrigerators and water
baths
Calibration of centrifuge
Disinfection of
centrifuges
Microscopes Kept clean at all times and have an
annual professional cleaning
Acid Urine Alkaline Urine
Emphysema Hyperventilation
DM Vomiting
Dehydration RTA
Diarrhea Presence of urease-producing
Presence of acid-producing bacteria
bacteria Vegetarian diet
High protein diet, Old specimens
cranberry juice
Medications
False Positive False Negative
None Runover the adjacent
pH
pad
Protein Highly buffered Alkaline Proteins other than
High Specific Gravity albumin
Pigmented Specimen Microalbumin

9 Clinical Microscopy – Coaching Notes| JBCRMT

 Phenazopyridine
QUATS
Antiseptics
Chlorhexidine
Loss of Buffer
(Prolonged contact of
strip to urine)
Ketones
Ascorbic Acid
High SG
Glucose
Low Temp
Improperly Preserved
Specimen
Pthalein Dyes Improperly Preserved
Highly Pigmented Red specimen
Urine Volatilization of
Ketones Improperly Timed acetone
Readings Breakdown of AAA
Levodopa
MESNA
Menstrual contamination High SG
Oxidizing Agents Ascorbic Acid
Vegetable peroxidase High Nitrite
Blood
E. coli peroxidase Formalin
Unmixed Specimen
Captopril
Phenazopyridine Photo-oxidation
Highly Pigmented Urine Ascorbic Acid
Bilirubin
Indican High Ntirite
Lodine Metabolites
Erhlich Reactive ____________
Components Photo-oxidation
Porphobilinogen Improperly Preserved
Procaine Specimen
Urobilinogen P-Aminosalicylic Acid High Nitrite
Indican
Methyldopa
Chlorpromazine
Highly Pigmented Urine
Nitrite Improperly preserved Reductase (-) bac
spx Insufficient contact
Highly pigmented urine bet. Bac & urine
Lack of urinary

10 Clinical Microscopy – Coaching Notes| JBCRMT

 nitrate
Nitrate reduced to
Nitrogen Bac
Antibiotics
Ascorbic Acid, SG
High Con Protein
Glucose
Strong Oxidizing Agents
Oxalic acid
Leukocyte Formalin
Ascorbic Acid
Esterase Highly pigmented Urine
Gentamicin
Nitrofurantoin
Cephalosporins
Tetracyclines
High concentration of
Specific
proteins because of
Gravity
protein anions
Vitamin C inhibits several
reagent strip reactions
Care of reagent strips Store with desiccant in an
opaque, tightly closed
container
Store below 30C; do not freeze
Do not expose to volatile fumes
Do not use past the expiration
date
Do not use if chemical pads
become discolored
Remove strips immediately prior
to use
Reflectance photometry Light reflection from the test
pads decreases in proportion to
the intensity of color produced
by the concentration of the
test substance
SSA Test Add 3mL of 3% SSA reagent to 3
mL of centrifuged urine
Mix by inversion and observe
for cloudiness
Grade the degree of turbidity
Grade Turbidity Protein Range (mg/dl)
Negative No increase in turbidity <6
Trace Noticeable turbidity 6-30
1+ Distinct Turbidity w/ no 30-100
granulation

11 Clinical Microscopy – Coaching Notes| JBCRMT

2+ Turbidity w/ granulation 100-200
w/ no flocculation
3+ Turbidity w/ granulation 200-400
& w/ flocculation
4+ Clumps of protein >400
Reagent strips contain a gold-
labeled antihuman albumin
antibody-enzyme conjugate
Microalbumin considered 30-300 mg of albumin is
significant excreted in 24 hours AER is 20
to 200 ug/min
Albumin: Creatinine Ratio Simultaneous measurement of
albumin/protein and creatinine
that permits an estimation of
the 24 hour microalbumin
excretion
Salt Precipitation Method of 2.8 gram of Ammonium Sulfate
Blondheim are added to 5 mL of
centrifuged urine; after mixing
and allowing the specimen to
sit for 5 minutes, the urine is
filtered or centrifuged, and
the supernatant is tested for a
reaction for blood with a
reagent strip
Hemoglobin
Myoglobin
Bright-Field Microscopy Used for routine urinalysis
Object appears dark against a
light background
Low-refractive index sediments are
overlooked decreased light
Phase-Contrast Microscopy Enhances visualization of elements
w/ Low refractive Index
Hyaline Cast, Mixed Cellular cast,
Mucuos threads, Trichomonas
Polarizing Microscopy Aids in the identification of
cholesterol in Oval Fat Bodies,
Fatty Casts, Crystals, fat
droplets that produce Maltese-
Cross Patterns
Dark-Field Microscopy Aids in the identification of

12 Clinical Microscopy – Coaching Notes| JBCRMT

 Treponema pallidum
Fluorescence Microscopy Allows visualization of naturally
fluorescent microorganisms or
those stained by fluorescent dyes
Interference-Contrast Microscopy Produces a 3-dimensional
microscopy and layer by layer
imaging of spx
Object will appear bright against
dark background but w/o the
diffraction halo (phase contrast
_______________ - Differential-
Interference Contrast
_______________ - Modulation-
Contrast
Oculars, Objectives; Coarse & Fine
Adjustment Knobs
Light Source; Condenser; Field &
Iris Diaphragm
Base, Body Tube, Nosepiece
First procedure to standardize the
quantitation of formed elements in
the urine microscopic analysis
Specimen
Normal values

Sternheimer-Malbin stain Most frequently sused stain in

urinalysis
Consists of ___________________
Touluidine blue Metachromatic enhancement of
nuclear detail
Useful in the differentiation
between WBCs and renal tubular
epithelial cells and is also used
in the examination of cells from
other body fluids.
Oil Red O and Sudan III
Red Blood Cells Most difficult for students to
recognize
The cells shrink due to loss of
Concentrated urine water and may appear crenated or
irregularly shaped
Dilute urine The cells absorb water, swell, and
lyse rapidly, releasing their

13 Clinical Microscopy – Coaching Notes| JBCRMT

 hemoglobin and leaving only the
cell membrane
Dysmorphic RBCs Associated with glomerular
bleeding
Macroscopic hematuria Frequently associated with
advanced glomerular damage but is
also seen with damage to the
vascular integrity of the urinary
tract caused by trauma, acute
infection or inflammation,
coagulation disorders
Microscopic hematuria Can be critical to the early
diagnosis of glomerular disorders
and malignancy of the urinary
tract and to confirm the presence
of renal calculi
Largest cells found in urine
sediment
Often the first structures
observed when the sediment is
examined under low-power objective
Indicative of vaginal infection by
bacterium Gardnerella vaginalis
Most clinically significant of the
epithelial cells
Increased amounts of RTE cells
May indicate _____________, and
Presence of >2 RTE cells such specimens should be refereed
for cytologic urine testing
Lipid-containing
RTE cells
RTE cells
containing,
nonlipid filled
vacuoles
Primary associated with drug
induced interstitial nephritis
Preferred eosinophil stain
Not normally seen in the urine More than 1% eosinophil is
considered significant
Spermatozoa Rarely of clinical significance
except in cases of
_____________________________in
which sperm is expelled into
the bladder instead of the

14 Clinical Microscopy – Coaching Notes| JBCRMT

 urethra
Increased amounts of semen are Positive reagent test for
present protein
Reporting Laboratory protocols vary with
regard to reporting or not
reporting the presence of
spermatozoa in urine specimen
Laboratories not reporting its Cite the lack of clinical
presence significance and possible legal
consequences
Laboratories supporting the Cite the possible clinical
reporting of spermatozoa significance and the minimal
possibility of legal
consequences
Yeasts Appear in the urine as small,
refractile obal structures that
may or may not contain a bud
Seen in the urine of diabetic
patients, immunocompromised
patients and women with vagina
moniliasis
Ideal medium for the growth of
yeast
Most frequent parasite
encountered in urine
Resembles T. vaginalis
Fecal contaminant
Formation of casts at the
junction of the ascending loop
of Henle and the distal
convoluted tubule may produce
structures with a tapered end
Only elements found in the
urinary sediment that are
unique to the kidney
Formed within the lumens of
_______________________________
.
Increased number of casts due
to increased albuminuria
RBC casts Associated with damage to the
glomerulus

15 Clinical Microscopy – Coaching Notes| JBCRMT

 Easily detected under low power
by their
_______________________.
Granular, dirty brown casts
Differentiation of epithelial
casts from WBC casts

Broad casts All types of casts may occur in

the broad form
Most commonly seen broad casts
are ______________
_______________________________
Crystal formation Formed by the precipitation of
urine solutes, including
inorganic salts, organic
compounds, and medications
Amorphous urate crystals Frequently encountered in
specimens that have been
refrigerated and produce a very
characteristic pinks sediment
Uric acid crystals Seen in variety of shapes
including rhombic or four-sided
flat plates, prisms, oval forms
with pointed ends, wedges,
rosettes, and irregular plates
Increased amounts of uric acid Patients with leukemia who are
crystals receiving chemotherapy

Dihydrate CaOX Envelopes, pyramid

Monohydrate CaOX Oval, dumbbell
Ethylene glycol poisoning
Triple phosphate Coffin lid, may develop a
feathery appearance
Calcium phosphate Appear as colorless, flat
rectangular plates or thin
prims often in rosette
formations
Fine colorless to yellow Soluble in alkali or
needles that frequently hear
form clumps or rosette
May also be encountered in

16 Clinical Microscopy – Coaching Notes| JBCRMT

 inherited disorders of
amino-acid metabolism
Yellow-brown spheres that Soluble in hot
demonstrate concentric alkali or alcohol
circles and radial
striations
Clumped needles or granules Soluble in acetic
with the characteristic acid, HCL, NaOH,
yellow color ether and chloroform
Sulfonamide crystals Inadequate patient hydration
was and still is the primary
cause of sulfonamide
crystallization
Ampicillin crystals Following massive doses of this
penicillin compound without
adequate hydration
Renal Lithiasis Formation Calyces and pelvis of the
Kidney, Ureters, And Bladder
Renal Lithiasis COmposition Most stones contain calcium,
mostly calcium oxalate or
calcium oxalate mixed with
calcium phosphate.
Uric acid calculi Increased intake of foods with
high purine content and with
Uromodulin-Associated Kidney
Disease
Yellow to brownish red and are
moderately hard
Pale and friable, resembling
chalk
Very hard, often of a dark
color, and typically have a
rough surface
Yellow brown and feel somewhat
greasy, resembling and old soap
Screening tests for urinary Acid alumin yesy
mucopolysaccharides CTAB test
Metchromatic staining spot test
Resulting galactosemia with
toxic intermediate metabolic
products results in infant
failure to thrive, combined

17 Clinical Microscopy – Coaching Notes| JBCRMT

 with liver disorders,
cataracts, and severe mental
retadation
Ingestion of large amounts of
fruit
Seen during pregnancy and
lactation
Associated with parenteral
feeding
Fructose Screening Test Place 5mL of urine in tube
Ad 5 mL of 25% HCl
Boil 5 minutes
Add 5 mg resorcinol
Boil 10 seconds
Observe for a red precipitate
ANCA
Increased 5HAA
Dietary instruction prior to Serotonin is a major
the collection of any sample constituent of foods such as
to be tested for 5-HIAA ___________________.
Most well known aminoacidurias
Darkening appears after the
urine is exposed to air
Phenylketonuria
Tyrosyluria
Alkaptonuria
Melanuria
MSUD
Indicanuria
5-HIAA
Patients with this condition
darkened after becoming
alkaline from standing at room
temperature
Primary urinalysis results for Glucosuria, possible Cystine
Fanconi’s syndrome Crystals
CSF Collected in three sterile
tubes
Tube 1
Tube 2
Tube 3
Identification of CSF Based on the appearance of an

18 Clinical Microscopy – Coaching Notes| JBCRMT

 extra isoform of tau
transferrin that is found only
in CSF
Turbidimetric Measurement of TCA : reagent of choice
CSF Total Protein SSA : unless combined with
sodium sulfate, albumin will
contribute more to the
turbidity than globulin
Dye-binding Cooassie brilliant blue dye
Presence of two or more Other neurologic disorders
oligoclonal bands in the CSF produce oligoclonal banding
that are not present in the that may not be present in the
serum can be valuable tool in serum.
diagnosing ________________
particularly when accompanied
by an increased IgG index

Traumatic Tap Intracranial hemorrhage

Uneven blood distribution Even blood distribution
May form clots Does not clot
Clear supernatants Xanthochromic supernatant
Absence of erythrophages Presence of erythrophages
Negative D-dimer Positive D-dimer
Clot formation but do not Conditions include meningitis,
usually produce a bloody fluid froin syndrome, and blocked CSF
circulation through the
subarachnoid space
Weblike-like clot/Pellicle Associated with tubercular
formation meningitis and can be see after
overnight refrigeration of CSF
CSF cell counts should be WBCs and RBCs begin to lyse
performed immediately within 1 hour and 40% of the
leukocytes disintegrate after 2
hours
Clarity Dilution
Clear specimens May be counted undiluted
Slightly hazy
Hazy
Slightly Cloudy
Cloudy
Slightly Bloody

19 Clinical Microscopy – Coaching Notes| JBCRMT

Bloody
Turbid
Total Cell Count : Normal WBC Count: 3% Glacial acetic
Saline acid
CSF Differential Count Performed on a stained smear
and not for the cells in the
counting chamber
100 cells should be counted,
classified, and reported in
terms of percentage
As little 0.1 mL of CSF
combined with one drop of 30%
albumin produces an adequate
cell yield when processed with
the cytocentrifuge
Amniotic fluid After first trimester, fetal
urine is the major contributor
to the amniotic fluid
Amount of amniotic fluid
Polyhydramnios
Oligohydramnios
Color Significance
Colorless
Blood-steaked
Yellow
Dark Green
Dark Red-Brown
Bilirubin Protected from light, amber-
colored tubes, wrapping the
collection tube in foil, or by
use of a black plastic cover
for the specimen container
Fetal Lung Maturity Placed in ice for delivery to
the laboratory and kept
refrigerated
Cytogenetic and microbial Processed aseptically and
studies maintained at room temperature
or body temperature prior to
analysis to prolong the life of
the cells needed for analysis.
Test Normal Values Significance
at Term

20 Clinical Microscopy – Coaching Notes| JBCRMT

Bilirubin Scan HDN
Alpha-fetobilirubin NTD
Lecithin-Sphingomyeline Ratio FLM
Amniostat-Fetal Lung Maturity FLM
Foam Stability Index FLM
Microviscosity FLM
Optical Density 650 NM FLM
Lamellar Body Count FLM
NTD Elevated amniotic fluid AFP
levels are followed by
measurement of
_____________________
Foam or shake test Amniotic fluid is mixed with
95% ethanol shaken for 15
seconds, and allowed to sit
undisturbed for 15 minutes
OD 650 Presence of lamellar bodies
increases the OD of the
amniotic fluid; wavelength of
650 nm
Normal Gastric fluid Pale gray and contains mucus
Fasting residual volume
pH
Basic Acid Output
Maximum Acid Output
Introduced through the mouth
Inserted through the nose
Insulin-induced hypoglycemia Hypoglycemia stimulates the
test is often used to test for vagus to stimulat gastric acid
the completeness of vagotomy secretion within 2 hours after
insulin injection
Tubless gastric analysis is a Dianex is given orally to the
noninvasive method to individual
determnine gastric acidity
Most common cause of
infertility
Hardeing of veins that drain
the testes
Testes and epididymis Testes: secretion of sperm,
production of spermatozoa
Epididymis: maturation of
sperms

21 Clinical Microscopy – Coaching Notes| JBCRMT

Seminal vesicles Produce mist of the fluid
present in semen
Transport medium for the sperm
Fluid contains a high
concentration of fructose and
Flavin
Prostate Approximately 20% to 30% of the
semen volume is acidic fluid
produced by the prostate gland
Bulbourethral gland Contribute about 5% of the
fluid volume in the form of a
thick, alkaline mucus that
helps to neutralize acidity
form the prostate secretion and
the vagina
Round cells Immature sperms and WBCs
Seminal fluid viscosity Droplets that form threads
longer than 2 cm are considered
highly viscous and are recorded
as abnormal
Grade WHO Criteria Sperm Motility Action
4.0 a Rapid, straight-line motility
3.0 b Slower speed, some lateral
movement
2.0 b Slow forward progression,
noticeable lateral movement
1.0 c No forward progression
0 d No movement
Computer-Assisted Semen CASA provides objective
Analysis determination of both Sperm
Velocity and Trajectory
Sperm Concentration and
Morphology are also included in
the analysis.
Sperm Concentration and Sperm Most commonly used dilution is
Count 1:20 prepared using a
mechanical pipette
Traditional diluting fluid
contains sodium bicarbonate and
formalin
Sperm Concentratiom Sperm Count

22 Clinical Microscopy – Coaching Notes| JBCRMT

Answer multiplied by 1000 to Sperm Conc. X specimen volume
convert uL to mL
Abnormal result Possible abnormality Test
Decreased Count Lack of seminal
vesicle support
medium
Decreased motility Vitality
with normal count
Decreaed motility Male antisperm
with clumping antibodies
Normal analysis Female antisperm
with continued antibodies
infertility
Seminal Fluid Fructose Specimens can be screened for
the presence of fructose using
the Resorcinol Test that
produces an Orange Color when
fructose is present
Specimens for fructose levels
should be tested within 2 hours
of collection or frozen to
prevent fructolysis
Disorder of epididymis Decreased neural a-glucosidasem
glycerophosphocholine, and L-
carnitine
Lack of Seminal Fluid Decreased fructose levels
Lack of Prostatic Fluid Decreased zinc, citric acid,
glutamyl transpeptidase and ACP
Sperm Vitality
Living Sperms Not infiltrated by the dye and
remain bluish white
Dead sperms Red against the purple
background
Collection of synovial fluid arthrocentesis
Synovial Fluid test Required tube type
Gram stain and culture Sterile heparinized or sodium
polyanethol sulfonate
Cell counts Heparin or liquid EDTA
Glucose analysis Sodium fluoride
All other tests Non-anticoagulated
Synovial fluid WBC count
Normal count WBC counts less than 200

23 Clinical Microscopy – Coaching Notes| JBCRMT

 cells/uL are considered normal
Synovial fluid crystal
identification
Crystal Significance Shape Compensated
Polarized Light
Gout Needles
Pseudogout Rhombid
squares
Osteoarthritis Small
particles
Extracellular Notchedm
rhomboid
plates
Injections Flat,
variable-
shaped plates
Renal dialysis Envelops
Collection and Handling of
serous Fluid
Serous Fluid Test Required Tube Type
Cell counts
Microbiology and cytology
Chemistry
Transudates Effusions that form becase of a
systemic disorder that disrupts
the balance in the regulation
of fluid filtration and
reabsorption
Exudate Produced by conditions that
directly involve the membranes
of the particular cavity,
including infection and
malignancies
Differentiation Between If the blood is from a
Hemothorax and Hemorrhagic hemothorax, the fluid
effusion hematocrit is more than 50% of
the WB hematocrit
Recommended over the
fluid:serum total protein and
LD ratios to detect
transudates of hepatic origin
Contains concentric striations

24 Clinical Microscopy – Coaching Notes| JBCRMT

 of collagen material
Material secreted by the
tracheobronchial tree and
brought up by coughing.
Yellowish or gray caseous
matter, the size of a pinhead
or navy bean which when crushed
will give a foul odor
Myelin globules in sputum Little or no significance but
may be mistaken for
_____________________.
Fecal leukocytes Specimens can be examined as
wet preparations stained with
methylene blue or as dried
smears stained with Wright’s or
Gram stain
Differential WBC count Only those cells clearly
identified as either
mononuclear or
polymorphonuclear are included
in the differential count
Quantitative Fecal Fat testing Requires the collection of
______________________.
Gold standard for fecal fat
measurement
Most frequently performed fecal
analysis
False Positive False Negative
Aspirin Vitamin C >250 mg/dL
Red Meat Iron supplements containing
Horseradish vitamin C
Raw broccoli, cauliflower, Failure to wait specified time
radishes, turnips after sample is applied to add
Melons the developer reagent
Menstruation
APT test Differentiates between the
presence of fetal blood or
maternal blood in an infant’s
stool or vomitus
Reagent: __________
Fetal Hemoglobin Adult Hemoglobin
Alkali resistant Denatured by sodium hydroxide

25 Clinical Microscopy – Coaching Notes| JBCRMT

 Solution remains pink Yellow-brown supernatant
X-ray Film test Screening for fecal trypsin
Biologic Test Animal Used Mode of Positive
for Pregnancy Injection Result
Aschem Zondek Immature Subcutaneous Formation of
female mice hemorrhagic
follicles and
corproa lutea
Friedman Mature virgin Marginal ear Hyperemic
female rabbit vein uterus and
corpora
hemorrhagica
Hogben Female toad Lymph sac Oogenesis
South African
clawed frog
Galli-Manini Male frog and Subcutaneous Spermatogenesi
Male toad s
Frank-Berman Immature Subcutaneous Ovarian
female rats hyperemia
Kupperman Female rat Intraperitoneal Ovarian
hyperemia
Pregnancy testing Not direct test for pregnancy,
but rather is a test to detect
the presence of hCG
Alpha subunit of HCG HCG, LH, FSH,TSH
Beta subunit of HCG Unique for hCG
Minimum detectable amount 25mIU/mL
Preferred sample First morning urine
False negative Dilute urine
False positive Increased protein

26 Clinical Microscopy – Coaching Notes| JBCRMT