Urine microscopic



URINE MICROSCOPIC

Principle The formed elements suspended in urine are precipitated by centrifugation and analyzed under a microscopic. Crystalline structures are of little importance, but shed cellular elements and casts often give valuable information as to the pathology of urinary tract disease.

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Sample First morning specimen is specimen of choice; should be examined within two hours of collection.

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Materials

|Equipment |Reagents |Supplies |

|Centrifuge with cover |( Abnormal urine control |KOVA 12 ml disposable tube |

|Bright field microscope | ( Sedi-stain Becton Dickinson |KOVA microscope slide |

| | |KOVA plastic transfer pipette |

| | |PPE |

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Quality

Control

|Abnormal Quality Control material is tested weekly. |

|Step |Action |

|1 |Remove the control materials from the refrigerator and allow to reach room |

| |temperature (at least 15 minutes). |

|2 |Reconstitute control by adding 15ml of distilled water. Mix control by gently |

| |inverting several times. |

|3 |Follow procedure used for microscopic analysis and treat the control as a patient |

| |sample. |

Check to ensure that the lot number on the control specimen matches the insert. Compare the quality control test results with expected values. If the results are outside acceptable range, repeat quality control analysis. If results are still out of range, consider system variables. Call manufacturer if necessary. Record quality control results on the QC log sheet.

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Test

Procedure

|Step |Action |

|1 |Mix urine specimen thoroughly. |

|2 |Transfer 12ml of urine specimen into a KOVA tube. |

|3 |Centrifuge specimen at approximately 1500RPM for five minutes. |

|4 |Insert a KOVA Petter into the KOVA Tube. Push the KOVA Petter to the bottom of the|

| |KOVA Tube until it seats firmly (at the 1ml graduation). |

|5 |Decant and discard 11ml from the KOVA Tube while the KOVA Petter is locked in |

| |position in the KOVA Tube. This will retain 1ml of urine sediment at the bottom of|

| |the KOVA Tube. |

|6 |Withdraw the KOVA Petter from the KOVA Tube and add one drop of KOVA Stain to the |

| |1ml of urine sediment. |

|7 |Using the KOVA Petter, gently resuspend the sediment and stain until a homogeneous|

| |mixture is obtained. Withdraw a small sample of the urine sediment stain mixture |

| |by squeezing the bulb of the KOVA Petter. Transfer the sediment mixture to the |

| |KOVA Slide by placing one drop in the corner of the well. The chamber will be |

| |filled by capillary action. |

|8 |Find the field using the low power magnification |

| |(10X eyepiece/10X objective). Examine the |

| |sediment for casts, crystals, and other elements. |

|9 |Switch to the high power (40X) objective and examine 10 high power fields |

| |examining the sediment for red blood cells (RBC), white blood cells (WBC), |

| |epithelial cells, crystals and bacteria. |

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Interpretation

Low Power Field (10X); HPF = High Power Field (40X)

|Analyte |Normal |Abnormal |

|WBC |0-5/HPF |>5/HPF |

|RBC |0-3/HPF |>3/HPF |

|Epithelial cells |0-10/HPF |Any (other than squamous) |

|Crystals |0-3/HPF (non-pathogenic) |>3/HPF (any pathogenic) |

|Yeast |0/HPF |Any/HPF |

|Trichomonas |0/HPF |Any/HPF |

|Casts |0/LPF |Any/LPF identify type |

|Bacteria |0-1+/HPF |2-4+/HPF |

Bacteria is reported as trace = few organisms present in some fields, 1+ = present in some fields, 2+ = Present in all fields, 3+ = many in all fields, 4+ = packed fields

Panic Values: Presence of Pathologic Crystals (cystine, leucine and tyrosine)

Recording and Results are written on the lab form and entered into EMR.

Reporting

Results

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Procedure

Notes

• Microscopic examination of clean catch or random urine specimens is to be performed within two hours of collection.

• If testing must be delayed, specimens can be refrigerated up to 24 hours. Refrigeration of the urine specimen at 2-8°C usually preserves the elements.

• If refrigerated, always allow the specimen to warm to room temperature before testing.

• A new abnormal urine control must be reconstituted weekly.

• Some erythrocytes, leukocytes and casts are excreted by normal individuals, but they are seen only occasionally in urinary sediments examined microscopically. Two to three red blood cells, 4-5 leukocytes per high power field and occasional hyaline casts are expected in normal patient samples.

• The presence of more than 10 squamous epithelial cells per low power field is suggestive of contamination.

• Use Koehler illumination for optimal contrast. Control the amount and intensity of light with the rheostat/transformer, filters, or very slight adjustments of the aperture diaphragm. Do not lower the condenser or close down the field diaphragm.

• Differentiation of formed elements from a variety of contaminants and artifacts is critical. The most common contaminants and artifacts are: cotton and/or wool thread, hair, paper fibers, glass and/or plastic fragments, oil droplets, starch, talc, air bubbles, meat and/or vegetable fibers, plant cells, and pollen.

• Each day of testing, the testing personnel monitors the completeness, accuracy, and adherence to the written procedure.

• On urine specimens ................
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