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Home > Archive > Medicine laboratory > September 2005 > What is the procedure for urine microscopics of bloody samples?
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What is the procedure for urine microscopics of bloody samples?
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| Avid Reader 2005-09-24, 2:07 pm |
| What is the procedure for urine microscopics on samples that contain lots of
blood in the spun down sediment?
Does one dilute the sediment with saline and placed in a urine microscopic
chamber? If this is the case, then does one multiply what is seen by the
dilution factor to get the accurate amount?
Or, does one place a very small amount on glass slide and a cover slip is
placed on top to form a single cell layer smear? If this is the case, is
there a factor to multiply what is seen? For instance, if three WBC's were
seen, then can one multiply by 3 to get the true amount?
Is there NCCLS guideline to this situation?
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| Shylirin 2005-09-24, 2:07 pm |
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"Avid Reader" <anywhere@any.com> wrote in message
news:R0NUe.172217$Hk.59284@pd7tw1no...
> What is the procedure for urine microscopics on samples that contain lots
of
> blood in the spun down sediment?
>
> Does one dilute the sediment with saline and placed in a urine microscopic
> chamber? If this is the case, then does one multiply what is seen by the
> dilution factor to get the accurate amount?
>
> Or, does one place a very small amount on glass slide and a cover slip is
> placed on top to form a single cell layer smear? If this is the case, is
> there a factor to multiply what is seen? For instance, if three WBC's
were
> seen, then can one multiply by 3 to get the true amount?
>
> Is there NCCLS guideline to this situation?
At our health system facilities, we use a Kova system in the outreach
laboratories and an automated analyzer in the main lab. For both of these
methods, as soon as >100 RBCs/hpf is reached, the results are reported as
TNTC (too numerous to count). All other elements are counted/graded and
reported as usual. For our outreach sites, they use a phase 'scope and have
a further distinction as well: If the field is so packed with RBCs that you
cannot distinguish any other elements, then the only result reported is TNTC
RBCs with the comment "Field Obscured by RBCs. Unable to determine presence
or absence of other elements." This allows the physician to make the
determination of what to do next. Usually, we get a request to add a
culture to these unless they are known kidney stones, trauma, etc.
I have heard of other facilities doing dilutions on these types of
specimens, but I haven't done this myself. I do not know of any NAACLS
guidelines, and would normally be happy to look these up for you, but I've
got a CLIA inspection coming up and just jumped on here for a sec to see
what was going on in labworld.  Judy or Manky may be able to give more
information on this.
Shylirin
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| > What is the procedure for urine microscopics on samples that contain lots
of
> blood in the spun down sediment?
>
Few facilities I know have a written procedure dealing with this situation.
Generally, if the sample is red and cloudy, I perform dipstick testing on
the mixed sample and on the supernatant, and look for significant
differences that can be attributed to red cells on the pads. Next, I
prepare a microscopic exam with and without acetic acid (lyses red cells)
and again compare the results. Finally, I decide what to report from the
information I have, giving the physician the most clinically relavent
information I can get from the sample. I always comment the results, so the
physician understands the limitations of the results.
If there is a bladder bleed from some lesion, the red cells will probably be
the only significant finding. If after lysing the red cells, I see WBCs and
bacteria, a UTI is the better reason. Just reporting that the field is
obscured doesn't give the physician any information he didn't know before
the sample was sent to the lab, and an exact quantitation above a certain
point is meaningless.
On really, really bloody urines, I have had an occasional request for a
hematocrit, presumably to see if it approaches the CBC's crit value.
Larry Smrz, MBA, MT(ASCP)SBB, CQA(ASQ)
Indianapolis, IN
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| Shylirin 2005-09-24, 2:07 pm |
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"LC" <Lcsmrz@juno.com> wrote in message
news:7w5We.248899$5N3.108204@bgtnsc05-news.ops.worldnet.att.net...
lots[vbcol=seagreen]
> of
>
> Few facilities I know have a written procedure dealing with this
situation.
>
> Generally, if the sample is red and cloudy, I perform dipstick testing on
> the mixed sample and on the supernatant, and look for significant
> differences that can be attributed to red cells on the pads. Next, I
> prepare a microscopic exam with and without acetic acid (lyses red cells)
> and again compare the results. Finally, I decide what to report from the
> information I have, giving the physician the most clinically relavent
> information I can get from the sample. I always comment the results, so
the
> physician understands the limitations of the results.
>
> If there is a bladder bleed from some lesion, the red cells will probably
be
> the only significant finding. If after lysing the red cells, I see WBCs
and
> bacteria, a UTI is the better reason. Just reporting that the field is
> obscured doesn't give the physician any information he didn't know before
> the sample was sent to the lab
Just a reminder that our procedure is for a clinic setting instead of a
hospital setting. Physicians receiving a field obscured report from the lab
usually do followup testing at a local hospital. Also, our physicians
usually don't see the sample before it comes to the lab. The nurse/patient
collects the urine sample and sends it down immediately for analysis. Any
information in this case is more that the physician knew before the test was
done. Avid Reader, I would definitely take into consideration what type of
services your lab is designed to offer when determining your procedure. If
you have a high complexity hospital/reference/speciality lab with plenty of
equipment and staff, I would suggest taking a closer look at the above
procedure. If you run a clinic lab, I would suggest looking at your data
and discussing with your physicians what your capabilities for performing
complex testing are. They can help with input regarding what results they
can reasonably expect given your lab size/budget/staffing situation.
Shylirin
>, and an exact quantitation above a certain
> point is meaningless.
> On really, really bloody urines, I have had an occasional request for a
> hematocrit, presumably to see if it approaches the CBC's crit value.
>
>
> Larry Smrz, MBA, MT(ASCP)SBB, CQA(ASQ)
> Indianapolis, IN
>
>
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