OUR LADY OF FATIMA UNIVERSITY

City of Sta. Rosa, Laguna Campus

College of Medical Laboratory Science

Other Non-Blood Sample

Instructor: Milwida Josefa B. Villanueva, RMT
Feces (Stool)
- Routine fecal examination includes macroscopic, microscopic, and
chemical analyses for the early detection of gastrointestinal (GI)
bleeding, liver and biliary duct disorders, maldigestion/malabsorption
syndromes, pancreatic diseases, inflammation, and causes of diarrhea
and steatorrhea
- normal fecal specimen contains: bacteria, cellulose, undigested
foodstuffs, GI secretions, bile pigments, cells from the intestinal walls,
electrolytes, and water
Feces (Stool)
- Approximately 100 to 200 g of feces is
excreted in a 24-hour period
- approximately 9000 mL of ingested fluid,
saliva, gastric, liver, pancreatic, and intestinal
secretions enter the digestive tract each day.
Under normal conditions, only between 500 to
1500 mL of this fluid reaches the large
intestine, and only about 150 mL is excreted in
the feces.
Feces (Stool)
Specimen Collection
- normally collected in clean, dry, wide-mouthed containers
that should be sealed and sent to the laboratory
immediately after collection.
- Special containers with preservative are available for ova
and parasite collection
- Preserved specimens can usually be kept at room
temperature.
- Large gallon containers, similar to paint cans, are used for
24-, 48-, and 72-hour stool collections for fecal fat and
urobilinogen; these specimens must normally be
refrigerated throughout the collection period
Feces (Stool)
Macroscopic Screening
Color and Appearance
- The first indication of GI disturbances can often
be changes in the brown color and formed
consistency of the normal stool.
- Appearance: watery consistency present in
diarrhea; small, hard stools seen with
constipation; and slender, ribbon-like stools,
which suggest obstruction of the normal passage
of material through the intestine.
Feces (Stool)
Chemical Testing of Feces
Occult Blood
- Annual testing for occult blood has a high positive predictive value for detecting
colorectal cancer in the early stages
Guaiac-Based Fecal Occult Blood Tests
- most frequently used screening test for fecal blood
- based on detecting the pseudoperoxidase activity of hemoglobin
Feces (Stool)
Quantitative Fecal Fat Testing
- quantitative fecal analysis requires the collection of at least a 3-day
specimen. The patient must maintain a regulated intake of fat (100 g/d) before and
during the collection period. The specimen is collected in a large, pre-weighed
container. Before analysis, the specimen is weighed and homogenized. Refrigerating
the specimen prevents any bacterial degradation.
- confirmatory test for steatorrhea

Steatorrhea (fecal fat) - Absence of bile salts that assist pancreatic lipase in the
breakdown and subsequent reabsorption of dietary fat (triglycerides) produces an
increase in stool fat
Cerebrospinal Fluid
- major fluid in the body
- provides a physiologic system to
supply nutrients to the nervous tissue, remove
metabolic wastes, and produce a mechanical
barrier to cushion the brain and spinal cord
against trauma
Cerebrospinal Fluid
- CSF is produced in the choroid
plexuses of the two lumbar ventricles and the
third and fourth ventricles. In adults,
approximately 20 mL of fluid is produced every
hour. The fluid flows through the subarachnoid
space located between the arachnoid and pia
mater

- Body maintains a volume of 90 to 150 mL in

adults and 10 to 60 mL in neonates
Cerebrospinal Fluid
Specimen Collection
- CSF is routinely collected by lumbar puncture between the
third, fourth, or fifth lumbar vertebra
- Specimens are obtained by a physician; most often through
lumbar puncture (spinal tap)

Collection:
Tube No. 1: Chemistry and Immunology
Tube No. 2: Microbiology
Tube No. 3: Hematology (Cell counts)
*A Fourth tube may be drawn for the microbiology lab
Cerebrospinal Fluid
Cerebrospinal Fluid
Appearance
Normal CSF: Clear, Crystal-clear and Colorless
The major terminology used to describe CSF
appearance includes crystal-clear, cloudy or turbid,
milky, xanthocromic, and hemolyzed/bloody.
Xanthochromia - used to describe CSF supernatant
that is pink, orange, or yellow.

Collection:
Tube No. 1: Chemistry and Immunology/Serology
Tube No. 2: Microbiology
Tube No. 3: Hematology (Cell counts)
*A Fourth tube may be drawn for the microbiology
lab
Cerebrospinal Fluid
Appearance
Cerebrospinal Fluid
Appearance
Cerebrospinal Fluid
Reason for collection:
- to diagnose meningitis, subdural hemorrhage, and other neurological
disorders.
Routine tests performed on CSF:
- cell counts, chloride, glucose, and total protein.
Semen
Semen is composed of four fractions that are contributed by the testes,
epididymis, seminal vesicles, prostate gland, and bulbourethral glands

Semen Composition:
• Spermatozoa 5%
• Seminal fluid 60% to 70%
• Prostate fluid 20% to 30%
• Bulbourethral glands 5%
Semen
Semen
Sperm Morphology
- normal sperm has an oval-shaped head
approximately 5 µm long and 3 µm wide and a long, flagellar
tail approximately 45 µm long
- it contains a head, neckpiece, midpiece, and tail.
Semen
Specimen Collection
- collected and tested to evaluate fertility and postvasectomy.
- When a part of the first portion of the ejaculate is missing, the sperm count will be
decreased, the pH falsely increased, and the specimen will not liquefy
- When part of the last portion of ejaculate is missing, the semen volume is decreased, the
sperm count is falsely increased, the pH is falsely decreased, and the specimen will not clot.
- Specimens are collected following a period of sexual abstinence of at least 2 days to not
more than 7 days
- warm sterile glass or plastic containers should be given
- If the sample is collected at home, it must be kept warm and delivered to the laboratory
within 1 hour.
- Specimens should be collected by masturbation; only nonlubricant-containing rubber or
polyurethane condoms should also be used to collect the specimen
Semen
Specimen Collection
- When accepting a semen sample, it is essential that the phlebotomist record the time of
sample collection, and the sample receipt, on the requisition form because certain parameters
of the semen analysis are based on specimen life span.
- Sample should be kept at 37°C.
- A fresh semen specimen is clotted and should liquefy within 30 to 60 minutes after collection
- Normal semen volume ranges between 2 and 5 mL
- pH: 7.2 to 8.0
Semen
Appearance
- Normal semen has a gray-white color, appears
translucent, and has a characteristic musty odor
- Semen analysis for fertility evaluation consists of
both macroscopic and microscopic examination. Parameters
reported include appearance, volume, viscosity, pH, sperm
concentration and count, motility, and morphology
Synovial fluid
- joint fluid
- is a viscous liquid found in the cavities of the
movable joints (diarthroses) or synovial joints
- hyaluronic acid: contribute the noticeable
viscosity to the synovial fluid
- clear, pale-yellow, viscous fluid that
lubricates and decreases friction in movable joints
- normally occurs in small amounts but
increases when inflammation is present
Reason for collection:
- to identify or differentiate arthritis, gout, and other
inflammatory conditions.
Synovial fluid
Specimen Collection
- Synovial fluid is collected by needle aspiration called
arthrocentesis
- Normal synovial fluid does not clot (usually it is
collected in a syringe moisten with heparin)
- Turbidity is frequently associated with the presence
of WBC
- Normal viscous synovial fluid resembles egg white

Collected in tubes:
• EDTA or heparin tube for cell counts, identification of
crystals, and Smear preparation;
• Sterile tube for culture and sensitivity;
• Nonadditive tube for macroscopic appearance, and
immunology tests and to observe clot formation.
Synovial fluid
Specimen Collection
Serous Fluid
- it provides lubrication between
the parietal and visceral membranes
Serous fluids are identified according to the body
cavity of origin as follows:
• Pleural fluid: aspirated from the pleural space, or cavity,
surrounding the lungs
• Peritoneal fluid: aspirated from the abdominal cavity
• Pericardial fluid: aspirated from the pericardial cavity
surrounding the heart
Serous Fluid
- pale-yellow, watery, serum-like fluid found between the double-
layered membranes enclosing the pleural, pericardial, and peritoneal
cavities
- lubricates the membranes and allows them to slide past one
another with minimal friction.
- normally present in small amounts, but volumes increase when
inflammation or infection is present or when serum protein levels
decrease.

EFFUSION: increased in fluid volume

Serous Fluid
- aspiration procedures are referred to as thoracentesis
(pleural), pericardiocentesis (pericardial), and paracentesis
(peritoneal).
- >100 mL is usually collected
Collected in:
• EDTA tube is used for cell counts and the differential.
• Sterile heparinized or sodium polyanethol sulfonate (SPS) evacuated
tubes are used for microbiology and cytology.
• Chemistry tests can be run on clotted specimens in plain tubes or in
heparin tubes
Amniotic Fluid
- Amniotic fluid is present in the
amnion, a membranous sac that surrounds
the fetus
- provides a protective cushion for
the fetus, allow fetal movement, stabilize
the temperature to protect the fetus from
extreme temperature changes, and permit
proper lung development.
- amount of amniotic fluid increases
in quantity throughout pregnancy, reaching
a peak of approximately 800 to 1200 mL
during the third trimester, and then
gradually decreases prior to delivery.
Amniotic Fluid
- can be analyzed to detect genetic disorders such as Down’s
syndrome, identify hemolytic disease resulting from blood incompatibility
between the mother and fetus, and determine gestational age
*most common reasons: to detect problems in fetal development and assess fetal
lung maturity.
- preferably collected after 15 weeks of gestation (pregnancy) and is obtained
by a physician using a procedure called transabdominal amniocentesis
Amniotic Fluid
Collection:
- Amniotic fluid is obtained by needle
aspiration into the amniotic sac, a procedure called
amniocentesis
- maximum of 30 mL of amniotic fluid is
collected in sterile syringes.
- the first 2 or 3 mL collected can be
contaminated by maternal blood, tissue fluid, and
cells and are discarded
- Normal amniotic fluid is colorless and may
exhibit slight to moderate turbidity from cellular
debris, particularly in later stages of fetal
development
Amniotic Fluid
Clinical
1. Alpha-fetoprotein (AFP)
• an antigen normally present in the human fetus that is also found in amniotic
fluid and maternal serum.
• AFP testing is initially performed on maternal serum, and abnormal results are
confirmed by amniotic fluid AFP testing.
• Abnormal AFP levels: problems in fetal development (such as neural tube
defects or the potential for Down’s syndrome
Amniotic Fluid
Clinical
2. Fetal lung maturity
• can be assessed by measuring the amniotic fluid levels of substances called phospholipids,
which act as surfactants to keep the alveoli of the lungs inflated.

• Results are reported as a lecithin-to-sphingomyelin (L/S) ratio.

• Lungs are most likely to be immature if the L/S ratio is less than 2.

• Amniotic fluid testing to assess fetal lung maturity may be ordered on or near the patient’s due
date and is often ordered stat when the fetus is in distress
Amniotic Fluid
Specimen Handling
• The specimen should be protected from light to prevent breakdown of bilirubin and
delivered to the laboratory ASAP.

• Specimens for chromosome analysis (cytology) must be kept at room temperature.

• Specimens for some chemistry tests (gases) must be kept on ice.

Sputum
• mucus or phlegm that is ejected from the trachea, bronchi, and lungs through deep
coughing
• For the diagnosis or monitoring of lower respiratory tract infections such as
tuberculosis (TB), caused by Mycobacterium tuberculosis.
• FYI: The microbe that causes TB is called an acid-fast bacillus (AFB), and the sputum test for TB is often
called an AFB culture.
• Preferred specimen: First morning
• Atleast 1 hour after meal