MLSC 3054 Clinical Fluid Analysis

Charity Accurso, PhD

MLS Program
Chapter 7

 Simple and rapid

 Detect medically significant analytes
 pH, protein, glucose, ketones, blood, bilirubin, urobilinogen,
nitrite, leukocytes, and specific gravity, ascorbic acid
 Major strips
 Multistix
 Chemstrips
 vChem Strips
 Aution Strips

 Reagent pads are chemically impregnated

 Color producing reaction occurs upon addition of urine
 Compare color change
 Result reporting:
 Concentration – mg/dL
 Small, moderate or large
 Plus system - 1+, 2+, 3+, or 4+
 Positive or negative

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MLSC 3054 Clinical Fluid Analysis

Technique Errors
 Unmixed specimens- formed
1. Dip strip into well-mixed, elements may stick to bottom of
room temperature tube
specimen  RBCs and WBCs

2. Remove excess urine from  Strip in urine too long- leaching

of reagents from strip
strip when withdrawing
 Excess urine on strip- runover
3. Wait specified amount of reactions
time  Blot strip on absorbent paper
 Incorrect timing
4. Compare color change to
chart  Rxns temp dependent –
specimen should be room temp

 Follow manufacturers guidelines

 Protect from moisture, volatile chemicals, heat and
light
 Store below 30˚C
 Expiration date
 Don’t touch chemical pads

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MLSC 3054 Clinical Fluid Analysis

 Performed  “at a frequency defined by the

laboratory, related to workload, suggested by the
manufacturer, and in conformity with any applicable
regulations.”
 Regular QC performance
 Test new bottles- even within same lot number
 Positive control- should agree ± one color block
 Negative control- all should be negative
 Designed to mimic urine

 Good QC does not rule out possibility inaccurate

results
 Interfering substances in urine
 Technical carelessness
 Color blindness
 Urine pigments – use alternative tests

Specific gravity Glucose

pH Ketones
Blood Bilirubin
Leukocyte esterase Urobilinogen
Nitrite Prophobilinogen
Protein Ascorbic acid

Tables 7.1 & 7.2 – VERY HELPFUL

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MLSC 3054 Clinical Fluid Analysis

 Normal range: 1.002-1.035

 1.010 – isothenuric SG
 >1.010 – hypersthenuric
 <1.010 – hyposthenuric

 Other significant values

 1.000 – physiologically not possible; consistent with water – possible
adulteration
 1.001-1.009 – Dilute urine; increased water intake; diuretic use; ADH issues
 1.010-1.025 – average intake and excretion
 1.025-1.035 – concentrated – dehydration, fluid restriction, excessive sweating
 >1.040 – physiologically not possible, presence of iatrogenic substance

 Kidneys – major regulators of acid-base content

 Secretion of H+ in the form of ammonium ions, hydrogen phosphate
and weak organic acids
 Reabsorption of bicarbonate from filtrate in convoluted tubules
 Healthy first morning specimen – pH 5.0-6.0
 More alkaline following meals
 Normal random – pH 4.5-8.0
 No normal values – consider results in conjunction with other patient info
– renal fx, presence of inf, dietary intake, age of specimen
 Table 7.2

 Aid in determination of existence of systemic acid-base

disorders
 Acidosis – acidic urine
 Alkalosis – alkaline urine
 Aid in management of urinary conditions requiring that urine
be maintained at a specific pH
 Renal calculi and crystals – precipitation of inorganic
chemicals

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MLSC 3054 Clinical Fluid Analysis

 Alkaline  Acid urine

 Dietary  Dietary
 Dairy products  High protein (meat)
 Vegetables  Cranberries
 Alkalosis  Acidosis
 UTI  Diabetes mellitus
 Ammonia producing  Respiratory and metabolic
bacteria acidosis (excluding RTA)
 Renal tubular acidosis  Fever
 Respiratory and metabolic
alkalosis

 Test principle
 0.5- or 1-unit increments  Limitations
 Acid-base double  Sensitivity
indicator system  Specificity
 Methyl red (pH 4.4-6.2)
 Bromthymol blue (pH 6.0-
9.0)

 Interferences
 Most state none
 False increase: Bacterial proliferation
 False decrease: Runover
 Dyes and pigments
 Critical Steps
 Procedure must be followed exactly to achieve
reliable results

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MLSC 3054 Clinical Fluid Analysis

 In urine in two forms:

 Intact red blood cells – hematuria
 Cloudy red
 Hemoglobin – hemoglobuinuria
 Clear red

 Myoglobin – myoglobinuria
 Clear red

 Hematuria  Hemoglobinuria
 Disorders of renal or  Lysis of RBCs or intravascular
genitourinary origin – hemolysis
bleeding due to trauma or  Transfusion rxns, hemolytic anemia,
damage in system organs severe burns, inf, malaria, strenuous
 Renal calculi, glomerular ds, exercise
tumors, trauma,
pyelonephritis, toxic chem,  Myoglobinuria
anticoagulant therapy  Clear red-brown urine
 Conditions with muscle destruction –
rhabomyolysis
 Trauma, crush syndrome, prolonged
coma, convulsions, muscle-wasting ds,
alcoholism, heroin abuse

 Hemoglobinuria  Myoglobinuria
 Pink to red plasma  Normal plasma color
 Decreased/absent  Normal haptoglobin
haptoglobin  Increased myoglobin
 Normal myoglobin  Normal free hemoglobin
 Increased free hemoglobin  Increased CK, >10x ULN
 Increased CK, but less than
10x ULN
 Will precipitate with
 Not precipitated with
ammonium sulfate
ammonium sulfate

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MLSC 3054 Clinical Fluid Analysis

 Basic test Principle

 Pseudoperoxidase action of hemoglobin catalyzes
the oxidation of chromogens
 Positive test
 Hemoglobin, RBCs, myoglobin
 Terms
 Neg, trace, small, mod
 Trace, 1+, 2+, 3+

 False Positives:  False Negatives:

 Oxidizing contaminants  Reduce sensitivity
(bleach)  Oxidizing nitrites
 Microbial peroxidase (in  High ascorbic acid levels
UTI)  Elevated specific gravity
 Menstrual contaminants  Captopril – BP med
 High salt and protein levels
 Formalin
 Failure to mix adequately

 Limitations
 Sensitivity
 Manufacturer guidelines
 Specificity
 Equally sensitive to hemoglobin and myoglobin

 Confirmatory tests
 Microscopic examination for intact RBCs
 Clinical significance
 Reference range: Negative

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