Hey guys! This is the 4th week, and it's my turn to post!
My topic will be on Biochemistry, Urinalysis.
The main aim of this test is to determine the perimeters that are present in the urine, for example, erythrocytes, proteins, bilirubin and leukocytes.
The material used is basically the dipstick.
Control:
2x Controls (1x Normal and 1x Abnormal)
The important perimeters that must be highlighted in the urine perimeter are the following;
1. Leukocytes
2. Nitrate
3. Protein
4. Erythrocyte
These 4 perimeters, under a normal condition, is tested negative of these component presence.
A deviation from JUST 1 of these perimeters from a normal condition, for e.g. a 4+ grade on Protein component, the urine sample is considered abnormal, and should be sent for microscopy examination.
Microscopy examination
Criteria: Urine is tested abnormal from dipstick test
Aim: To identify the different components present in the urine and count the number of cells present in the cells (e.g. White Blood Cells, Erythrocytes, Epithelial cells, Fungi)
* Counting of cells under microscopy examination
For control tests, all 81 grids of the counting chamber has to be counted, and records of the control test is to be taken down.
*The main perimeters to count are the RBC and WBC*
- If the WBC count exceeds >50 for a "Children Emergency" case, it's immediately sent for further testings.
Certain KEY perimeters to look out for in urine samples under the microscope:
1. Red Blood Cells
Variety of renal and systolic diseases, including trauma
2. White Blood Cells
Presence indicates an infection
3. Epithelial Cells
Active tubular degeneration
Squamous epithelil found in normal urine
4. Crystals
Urine is considered abnormal is the following are identified; cystine, leucine nd tyrosince
Varible to the pH of urine
E.g. Squarish crystals are calcium oxidate
Hexagonal crystals are uric acid
5. Bacteria
Evidence of infection (e.g. UTI)
6. Yeast
Urinary moniliasis
7. Casts
Further tests
Under certain circumstances, results reflected in the dipstick results will lead to further tests to confirm the reliability of the dipstick results (e.g. Bilirubin level)
If there is bilirubin detected in the urine, Fouchet is done
1. Mix well, 2 parts of urine with 1 part of Barium Chloride
2. Shake and observe for precipitation
3. If there is no precipitation, add 1 drop of saturated ammonium sulphate
4. Once the precipitate is obtained, filter the mixture and obtain the residue on the filter paper
5. Add 1 drop of Fouchet's reagent onto the residual area
5. Observe for a blue colour change
*A blue colour change is evident of bilirubin presence
Ok so that's all from me! =)
Any questions, feel free to comment and I'll answer it as soon as I can.
Till then, ciaos ~
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Hi there ^^ Jess here
ReplyDeleteWanna ask u about casts, lolz, wat does it tell us about the patient's condition yah?
I heard that there are different types of casts, so is it true that different type of casts will indicate different diseases? =D
Vo Thu Hong Anh [Jess]
0705364H
hi sherman,
ReplyDeleteu mentioned that if there is 4+ grade on protein component, urine is abnormal. what if it was not so significant like 2+ ? thanks!
zi shuang
Reply to Jess
ReplyDeleteHEY JESS! Sorry for the late reply =x
The presence of casts usually give the physician an indication of kidney diseases.
Yes different casts indicate different diseases. There are the common ones that we've read about when we did our CChem report like Hyaline, Waxy, Fatty and Granular casts etc...and those of cellular casts like RBC and WBC casts, bacterial casts.
The term "cast" basically indicates the shape only (cylindrical), but the content of it is described in the word before like Red Blood Cell Cast.
So erm different casts indicate different diseases...but some are common even in normal individuals.
For e.g.
Hyaline casts can be seen in normal individuals who are dehydrated or who've just done vigorous exercise.
Fatty casts can be seen in individuals with diabetes or epithelial cell death
Red Blood Cell casts are usually serious cases because it's a strong indication of Glomerular damage.
White Blood Cell casts can be seen when there's inflammation or infection.
These are basically the common ones, the rest can be found in Google or literatures =)
THANKS FOR ASKING! =DD
Enjoy your attachment! =)
Reply to Zi Shuang
ReplyDeleteHey Zi Shuang! Under the circumstances of a not so significant level of protein in the urine like 2+, it's still abnormal.
Cos there isn't suppose to be protein in the urine at all yea~
So even if it's graded 1+ in the result slip, it's considered abnormal, just not to the extent of considering it severe.
THANKS FOR ASKING!
Enjoy your attachment! =))
Hi Sherman.
ReplyDeleteWould like to clarify something.
You said that Microscopy Examination will only be done when the urine dip stick's result is abnormal. Then. how about the normal dip stick's results? Do you verify them straight away as normal results?
How do you process the Urine Dip Stick? Is it done manually by comparing the colour charts? Or you used a certain type of urinalysis machine to process the dip stick?
How sure that the normal results from dip stick are really normal?
If the result of the urobilinogen from the dip stick is graded more then 1+, do you guys do any confirmation to verify that the dip stick result is correct?
One last question,
If protein is graded more than 1+, you will count it as abnormal and had to undergo microscopic examination? Will you guys look out for cast? And what happens if there are no casts viewed in the microscope when protein level is graded more than 1+? Cos, if im not wrong, protein and cast are related right?
Enjoy yr attachment!
With regards
Jordan Wong Wei Jie
TG02 Group 9
0703992H
@ Sherman: Thankz for the detailed answer yo! ^^
ReplyDeleteVo Thu Hong Anh [Jess]
0705364H
To Jordan
ReplyDeleteYes if the results are normal, they're verified as normal straightaway =) as long as the results fall within the range of results that the lab has set in the Positive Control
The DipStik is done by a machine, so the results will all be generated by the machine and graded.
The results from the dipstick are ensured to be normal from the controls that we run.
There are 2 controls that were run, 1 in the morning, and the other in the afternoon after lunch hours.
The 2 controls consist of a normal urine (POSITIVE) and an abnormal urine (with erythrocytes, proteins and casts presence etc)(NEGATIVE). So we have to verify that the control results are accepted first. From then on, we can assure that all normal results on the dipstick are normal
For Urobilinogen, the machine only tests for bilirubin...so that's one of the perimeters the urinalysis machine points out for only.
Like in my post, and comment replies, even if an abnormal deviation is present, further test is done. The test is the Fouchet test, where a positive blue colour change confirms the presence of bilirubin (any mismatch of results will be further investigated for contamination or the medical technologist responsible for processing the particular sample)
Yes you're correct, casts are protein tubules present in the urine. Like I've replied to Zi Shuang's question, even a small significant change in protein levels, it is considered abnormal (because under normal circumstances, protein is not supposed to be present in the urine at all...so even if 1+ is there, confirm already got problem ma true? =P).
IF there are no casts, there's only 2 reasons;
#1 The machine read it wrongly. So the medical technologist will check the Controls used at the particular morning/afternoon period, or jus rerun the specimen in the machine again to verify.
#2 The medical technologist didn't mix (shake) the sample properly before charging a portion into the counting chamber for microscopy examination.
*It's just a simple matter of human error*
That should answer all yea? Any questions feel free to ask again =)))
Enjoy your attachment Jordan! =D
Hi Sherman :),
ReplyDeleteI would like to understand what is the importance of testing bilirubin since you mention it quite frequently? Is it a bad sign?
Second Question
Under microscopic examination, you mention the aim is to identify the different components present in the urine and count the number of cells present in the cells. What do u mean by count the number of cells present in the cells?
Rachel :)
Hey Rachel!
ReplyDeleteHmm bilirubin is a product of heme catabolism. So from what you've learnt, bilirubin will be processed in the liver then in the end will be excreted faeces, giving the brownish colour.
Well in a urine test, bilirubin presence is clinically significant, cos in the first place, there isn't suppose to have any hahaha! 1 of the highlights could be liver dysfunction or increased RBC lysis (since bilirubin originate from heme)...so yea doesn't sound healthy doesn't it =P
Ok for M.E (microscopy examination), when the machine states that there's RBC, WBC present, you must count the number of cells to prove the severity. For e.g. a small no. of WBC count vs a high no. of RBC count can determine the severity of the infection involved. Another e.g. would be a small no. of RBC count vs a high RBC count can determine maybe the severity of a glomerular damage (excluding women having their period)
yep that's all~ anything ask me k =D
Hi Sherman.
ReplyDeleteFrom what you have posted, you said you have to count all the 81 grips, are the grips used for cell counting same as the ones we used for MCT cell counting? and for the bilirubin test, if there is precipitation, does it straight away show that bilirubin is present?
Jennifer