Clinical

Microscopy

What is Clinical Microscopy?

- It is an analysis and examination
that involves non-blood procedures.
- Involves Urinalysis, fecalysis (stool
examination) and Body Fluids.

History
Laboratory medicine began 6000
years ago with the analysis of human
urine, which was called uroscopy
until the 17th century and today is
termed urinalysis. Today physicians
use urine to diagnose selective
conditions but from ancient times
until the Victorian era, urine was
used as the primary diagnostic tool.

History
Uroscopy,
from
the
word
'uroscopia,'
means
'scientific
examination of urine.' The word is
derived from the Greek 'ouron'
meaning
'urine'
and
'skopeo',
meaning to 'behold, contemplate,
examine, inspect'.

History
Sanskrit medical works from 100 BC
describe 20 different types of urine.
Hindu cultures were aware that some
people's urine tasted sweet, and that
black ants were attracted to this
sweet urine, a characteristic of the
disease now known as diabetes
mellitus.

History
In the fourth century BC,
Hippocrates
(460355
BC)
hypothesized that urine was a
filtrate of the humors, which
came from the blood and was
filtered through the kidneys, a
fairly accurate description.

History
Galen (AD 129200) began his
scientific findings in Rome. Galen
refined Hippocrates' ideas, theorizing
that urine represented, not a filtrate
of the four humors and overall
condition, but rather, a filtrate of the
blood.

History
During the renaissance, uroscopy
entered the household through the
bestselling bookFasiculus Medicinae,
published in 1491 by Johannes de
Ketham from Germany. De Ketham
explained current
theories
and
included a self-diagnostic color
wheel, with which individuals could
self-diagnose their condition.

History
In 1800, Bichat (17711802), a
young pathologist, published a book
in which, for the first time, morbid
anatomic
and
histopathologic
changes of various organs of the
body were discussed and illustrated.
Soon thereafter the microscope
became an indispensable laboratory
tool at medical schools all around the

Urinalysis

What is Urinalysis?
- It is a physical, chemical, and
microscopic examination of urine.
- - It involves a number of tests to
detect and measure various
compounds that pass through the
urine (Vorvick, 2011)

Purpose of Urine tests

To screen for metabolic and kidney

disorders and for urinary tract
infections.

A urine test can determine whether

or not a woman is ovulating or
pregnant.

Types of Urine Specimens

Timed Specimen:
24-hour
Quantitative chemical tests,
hormone studies
12-hour

Addis count

2-hr Postprandial

Diabetic monitoring

Afternoon Specimen Urobilinogen determination

Glucose Tolerance Test Accompaniment to blood
samples in GTT

Random
First Morning

Routine screening
Routine screening
Pregnancy Tests
Orthostatic Proteinuria
Fasting/Second Morning Diabetic screening /
monitoring
Catheterized
Bacterial culture
Midstream clean-catch Routine screening
Bacterial culture
Suprapubic aspiration Bladder urine for bacterial
culture
Cytology
Three-glass collection Prostatic infection
Drug Specimen
Drug testing

3 Stages of Urinalysis
A complete urinalysis consists of three
distinct testing phases:
1. physical examination, which evaluates the
urine's color, clarity, and concentration;
2. chemical
examination,
which
tests
chemically for 9 substances that provide
valuable information about health and
disease; and
3. microscopic examination, which identifies
and counts the type of cells, casts,
crystals, and other components, such as
bacteria and mucus, that can be present
in urine.

Physical Examination
Color. Many things affect urine color, including
fluid balance, diet, medicines, and diseases. How
dark or light the color is* tells you how much
water is in it. Vitamin B supplements can turn
urine
bright
yellow.
Some
medicines,
blackberries, beets, rhubarb, or blood in the urine
can turn urine red-brown.
Clarity. Urine is normally clear. Bacteria, blood,
sperm, crystals, or mucus can make urine look
cloudy.
Odor. Urine does not smell very strong, but has a
slightly "nutty" odor. Some diseases cause a
change in the odor of urine. For example, an

Chemical Examination
Specific gravity. This checks the amount
of substances in the urine. It also shows
*
how well the kidneys balance the amount
of water in urine. The higher the specific
gravity, the more solid material is in the
urine.
pH. The pH is a measure of how acidic or
alkaline (basic) the urine is. A urine pH of 4
is strongly acidic, 7 is neutral (neither
acidic nor alkaline), and 9 is strongly

Chemical Examination
Protein. The protein test pad
measures the amount
ofalbuminin
*
the urine. Normally, there will not be
detectable quantities. When urine
protein is elevated, a person has a
condition calledproteinuria; this can
be an early sign ofkidney disease.
Albumin is smaller than most other
proteins and is typically the first
protein that is seen in the urine when

Chemical Examination
Glucose. Glucose is normally not
present in urine. When
glucose is
*
present, the condition is called
glucosuria. It results from either:
An
excessively
high
glucose
concentration in the blood, such as may
be seen with people who have
uncontrolleddiabetes mellitus
A reduction in the "renal threshold."
Whenblood glucose levelsreach a
certain concentration, the kidneys begin

Chemical Examination
Ketones. Ketones are not normally
*
found in the urine.
They are
intermediate
products
of
fat
metabolism. They can form when a
person
does
not
eat
enough
carbohydrates (for example, in cases
of starvation or high-protein diets) or
when a person's body cannot use
carbohydrates properly.

Chemical Examination
Blood (Hemoglobin). This test is used to
detect
hemoglobin
in
the
urine
(hemoglobinuria). Hemoglobin
is an oxygen*
transporting protein found inside red blood cells
(RBCs). Its presence in the urine indicates blood
in the urine (known ashematuria).
Bilirubin. Bilirubin is not present in the urine of
normal, healthy individuals. Bilirubin is a waste
product that is produced by the liver from the
hemoglobin of RBCs that are removed from
circulation. It becomes a component of bile, a
fluid that is secreted into the intestines to aid in

Microscopic Examination
Red Blood Cells (RBCs). Normally, a
few RBCs are present in urine
sediment.Inflammation,
injury,
or
disease in the kidneys or elsewhere in
the urinary tract, for example, in the
bladder orurethra, can cause RBCs to
leak out of the blood vessels into the
urine. RBCs can also be a contaminant
due to an improper sample collection
and blood from hemorrhoids or

Microscopic Examination
White Blood Cells (WBCs). The
number of WBCs in urine sediment is
normally low. When the number is
high, it indicates an infection or
inflammation somewhere in the
urinary tract. WBCs can also be a
contaminant, such as those from
vaginal secretions.

Microscopic Examination
Epithelial Cells. Normally in men
and women, a few epithelial cells
from the bladder (transitional
epithelial cells) or from the external
urethra (squamous epithelial cells)
can be found in the urine sediment.
Cells from the kidney (kidney cells)
are less common.

Microscopic Examination
Microorganisms
(bacteria,
trichomonads, yeast). In health,
the urinary tract is sterile; there will
be nomicroorganismsseen in the
urine sediment. Microorganisms are
usually reported as "none," "few,"
"moderate," or "many" present per
high power field (HPF).

Microscopic Examination
Trichomonads areparasitesthat
may be found in the urine of
women or men (rarely). As with
yeast,
the trichomonads
are
actually infecting the vaginal canal
and their presence in urine is due
to contamination.

Microscopic Examination
Casts.
Casts
are
cylindrical
particles sometimes found in urine
that are formed from coagulated
protein secreted by kidney cells.
Under the microscope, they often
look like the shape of a "hot dog"
and in healthy people they appear
nearly clear. This type of cast is
called a "hyaline" cast.

Microscopic Examination
Crystals. Urine contains many
dissolved substances (solutes)
waste chemicals that the body
needs to eliminate. These solutes
can form crystals, solid forms of a
particular substance, in the urine if:
The urinepHis increasingly acidic or
basic;
The concentration of dissolved substances
is increased; and
The urine temperature promotes their
formation.

Fecalysis

What is Fecalysis?
Routine
fecal
examination
includes
macroscopic,
microscopic,
and
chemical
analyses for the detection of
gastrointestinal bleeding, liver
and
biliary
duct
disorders,
malabsorption syndromes, and
the detection and identification of
pathogenic
bacteria
and

Specimen Collection
Adult
Passed out in a well rinsed bed pan
Get a pea size stool from the middle
part
Place in a transport vial
Avoid mixing the specimen with urine or
water from the toilet
URINE has harmful effect to protozoans;
alter the pH, ammonia, and chloride content
WATER FROM TOILET may contain
chemical disinfectants

Preservation of Stool
Specimen

PHYSICAL

Freezing
Refrigeration

CHEMICAL
1 part stool: 3 parts preservative

Formalin
40% Ethanol
20% glycerin in NSS
Merthiolate Iodine Formaldehyde
Polyvinyl Alcohol

Physical Examination
Appearance
Soft to Well Formed
Small, hard, dark ball
Voluminous, odorous,
floating
Loose with mucus
Loose with blood and
mucus
Sticky, black, tarry

Cause
Normal
Constipation
Malabsorption of fats
or proteins
Villous adenoma
Inflammatory bowel
syndrome
Upper GIT
hemorrhage

Physical Examination
Color normally light brown to
dark brown
Substances responsible for the
color of the stool
Stercobilin
Urobilin
Hydrobilin

Physical Examination
pH/Reaction
Normal neutral

Mucus
Transluscent gelatinous mucus
clinging to the surface of formed
stool

Blood
Indicates bleeding
HEMOFECIA presence of blood in
stool

Chemical Examination
Occult Blood hidden blood
Screening test for carcinoma
Patient will undergo 3-4 days
fish and meat free diet
GUIAC TEST routine test

Guiac test
Blue color indicates
gastrointestinal bleeding
NEGATIVE

POSITIVE

Chemical Examination
Bilirubin Gmelins
concentrated HNO3
POSITIVE: GREEN

Urobilinogen Ehrlichs
reagent
POSITIVE: CHERRY RED

Urobilin Schlesingers test

POSITIVE: GREENISH
FLUORESCENCE

Microscopic Examination
Cells

Crystals

Epithelial
Calcium
cells
oxalate
Pus cells
Triple
phosphate
RBC
Charcot Macrophag

Food Remnants
leyden
e
Bacteria
Mucus threads

Microscopic Examination
White blood cells
Neutrophils are seen in the feces in
conditions that affect the intestinal
wall, such as ulcerative colitis and
infection with invasive bacterial
pathogens

Parasites
Presence of a parasite or worm-like
infection of the intestine, or ova.

Semen Analysis

What is Semen Analysis?

Asemenanalysis measures the
amount of semen a man produces
and determines the number and
quality
ofspermin
the
semen
sample. A semen analysis is usually
one of the first tests done to help
determine whether a man has a
problem fathering a child (infertility).

Tests that may be done during

asemen analysisinclude:
Volume.This is a measure of how much
semen is present in one ejaculation.
Liquefaction time.Semen is a thick gel at
the time of ejaculation and normally
becomes liquid within 20 minutes after
ejaculation. Liquefaction time is a measure
of the time it takes for the semen to
liquefy.
Sperm count.This is a count of the

Tests that may be done during

asemen analysisinclude:
Sperm morphology.This is a measure
of the percentage of sperm that have
a normal shape.
Sperm motility.This is a measure of
the percentage of sperm that can
move forward normally. The number
of sperm that show normal forward
movement in a certain amount of
semen can also be measured (motile
density).

Tests that may be done during

asemen analysisinclude:
pH.This is a measure of the acidity
(lowpH) or alkalinity (high pH) of the
semen.
Whitebloodcell count.White blood cells
are not normally present in semen.
Fructose level.This is a measure of the
amount of a sugar called fructose in the
semen. The fructose provides energy for
the sperm.

Equipment

Urine Strips

Equipment

Automatic Urine Analyzer

Equipment

Microscope

Equipment

Microscope slide(s)

Equipment

Urine Sample Container

Equipment

Stool specimen container

References

http://www.annclinlabsci.org/content/32/3/309.full
http://pioneerlab.ph/Clinical_Microscopy_(P).html
http://www.nature.com/ki/journal/v71/n5/full/5002057a.html
http://www.bd.com/vacutainer/labnotes/Volume14Number2/
http://labtestsonline.org/understanding/analytes/urinalysis/ui-exams/s
tart/2
http://labtestsonline.org/understanding/analytes/urinalysis/ui-exams/s
tart/1
http://www.webmd.com/infertility-and-reproduction/guide/semen-anal
ysis

Thank you!
Presented by Group 3:
David, Florielle
Gamboa, Lois Danielle
Lacson, Maria Michaela
Lusung, Ashley Jane
Quiambao, Mark Rayson
Sotto, Kristel Joy
Velayo, Erika