PRINCIPLES OF MEDICAL LABORATORY TYPE 1: Separate hard lumps like nuts (hard to pass)

SCIENCES 2: FECALYSIS TYPE 2: Sausage shaped but lumpy

TYPE 3: Like sausage but with cracks
TYPE 4: Like a sausage or snake, smooth and soft
FECES TYPE 5: Soft blobs with clear cut edges (passed easily)
• An end product of body metabolism TYPE 6: Fluffy pieces with ragged edges; a mushy stool
• Contains bacteria, cellulose and other undigested food TYPE 7: Watery; no solid pieces, entirely fluid
stuffs, gastrointestinal secretions, bile pigments, cells,
electrolytes and water. TYPES OF FECAL SPECIMENS
• Around 100-200g of feces is excreted in 24hour period RANDOM SPECIMEN
• A random specimen is used for most determinations,
Why collect a fecal specimen? including bacterial cultures, ova and parasites and fats
Two most common reasons and fibers.
1.To look for intestinal infection OCCULT BLOOD SPECIMEN
2.Screen for colorectal cancer • Collected after 3 days of a meat-free diet. Patients are
instructed to avoid certain foods and medications that can
Macroscopic Screening: COLOR interfere with the test.
• The normal brown color of 72 HOUR STOOL SPECIMEN
feces results from intestinal • Rarely called for and is ordered when a random
oxidation of stercobilinogen specimen is positive for excess fat.
to urobilin. • Used for quantitative fecal fat determination.
• Changes in stool color
may due to diet, drug SPECIMEN CONTAINER
intake or underlying • Specimen containers must be screw-cap sterile
medical conditions. containers.
• A primary concern is the • Patients should be given the appropriate collection
presence of blood in stool container and instructed to defecate into it, not the
specimen. toilet.
• Color can range from • Patients should also be instructed to avoid
bright red to dark red to contamination of the specimen with urine.
black.
• BLACK/TARRY STOOL: MICROSCOPIC EXAMINATION
Blood originates from the I. FATS
esophagus, stomach or Detection of STEATORRHEA (increased fecal fat) is
duodenum (Upper GI tract) useful in diagnosing pancreatic insufficiency and
• RED small-bowel disorders that cause malabsorption.
Blood originates from the lower GI tract.
II. MUSCLE FIBERS
Macroscopic Screening: CONSISTENCY • CREATORRHEA is the abnormal excretion of muscle
BRISTOL STOOL CHART fibers in feces • Detection of undigested fibers in stool is
an abnormality caused by biliary obstruction.

III. FECAL LEUKOCYTES

• Leukocytes, primarily neutrophils are seen in the feces
in conditions that affect the intestinal mucosa.
• Microscopic screening is performed as a preliminary test
to determine whether a diarrhea is being caused by
invasive bacterial pathogens or by bacterial toxin
production.

DIARRHEA
• Defined as an increase in daily stool weight above 200g
per day with increased liquidity and frequency of more
than 3x a day.
• Acute diarrhea can last up to less than 4 weeks while
Chronic diarrhea lasts more than 4 weeks.
 • Mechanisms of diarrhea are SECRETORY, OSMOTIC CHEMICAL TESTING: OCCULT BLOOD
and ALTERED MOTILITY. SECRETORY DIARRHEA • Bleeding in excess of 2.5mL/150g of stool is considered
to be pathologically significant, at this amount no visible
• Secretory diarrhea is caused by increased secretion of signs of bleeding may be present
water and electrolytes which override the reabsorptive • Fecal Occult Blood Test is necessary for the detection
ability of the large intestine. ◦Osmotic gap of <50 Osm/kg of this hidden blood
Causes: • Annual testing for occult blood has a high predictive
● Bacterial infection, Viral infection, Protozoan infection value for detecting COLORECTAL CANCER in early
● Laxatives stages. (Age: >50 yrs. Old, recommended by American
● Hormones Cancer Society)
● Inflammatory bowel disease
PATIENT PREPARATION
• Osmotic diarrhea is caused by increased retention of Patients should be instructed to:
water and electrolytes in the large intestine due to ➢ Avoid the following 3 days before specimen
incomplete breakdown or reabsorption of food. collection:
• Osmotic gap of >50 Osm/kg • Red meats • Horseradish • Melons • Raw broccoli
Causes: • Cauliflower • Radishes • Turnips
● Maldigestion- impaired food digestion -Will cause false positive
● Malabsorption- impaired nutrient absorption by the
intestine ➢ Avoid the following 7 days before specimen
● Lactose intolerance collection:
• Aspirin – will cause false (+)
SECRETORY VS. OSMOTIC DIARRHEA • Vitamin C- will cause false (-)
Laboratory tests are used to differentiate these
mechanisms: FOBT Methods
1. Fecal electrolytes Guaiac-based FOBT (gFOBT)- most frequently used
2. Fecal osmolality screening test for fecal blood; this method is based on
3. Stool pH detecting the pseudoperoxidase activity of hemoglobin.

OSMOTIC GAP- fecal sodium and potassium are used to Immunochemical Fecal Occult Blood Test (iFOBT) -
calculate fecal osmotic gap. this method is specific for human blood in feces.
Osmotic gap= 290 – [2 (fecal sodium + fecal potassium)]
PRINCIPLES OF MEDICAL LABORATORY
SCIENCES 2: OTHER STERILE BODY
FLUIDS 1 CEREBROSPINAL FLUID
CEREBROSPINAL FLUID
• CSF is produced in the choroid plexuses of two lumbar
ventricles and the third and fourth ventricles.

Meninges- line the brain and spinal cord

• 3 Layers:
1. Dura mater (outer layer)= lines the skull and vertebral
canal
2. Arachnoid mater (spiderweb-like)= filamentous inner
membrane
Subarachinoid space (below arachnoid)= portion
where CSF flows.
3. Pia mater(innermost layer)=lines the surface of brain
and spinal cord

• CSF is the 3rd major body fluid

• Functions:
1. Supply nutrients to the nervous tissue
2. Remove metabolic wastes
3. Produce a barrier to cushion the brain and spinal cord
against trauma.
CSF COLLECTION AND HANDLING
• Routinely collected via LUMBAR PUNCTURE between
the third, fourth, or fifth lumbar vertebrae.
• Specimen is labeled in the order they are collected
(Tube 1, Tube 2, and Tube 3)

• Tube 1= least affected by

blood or bacteria introduced
by spinal tap ADDITIONAL TESTS
• Tube 2= usually designated HEMATOLOGY
for microbiology • Cell Differential Count- Identifying the type or types of
• Tube 3= least likely contain cells present in the CSF is a valuable diagnostic aid. The
cells introduced by the spinal differential count should be performed on a stained
tap smear.
• Tube 4= better exclusion of
skin contamination or for MICROBIOLOGY
additional test • CULTURE AND SENSITIVITY
If 1 CSF tube only= • GRAM STAINING
Micro-Hema-Chem/Sero
CLINICAL CHEMISTRY
Additional notes: • Left-over • CSF ELECTROPHORESIS
supernatant fluid may also be
used for additional chemical PRINCIPLES OF MEDICAL LABORATORY
or serologic tests. • Excess
SCIENCES 2: OTHER STERILE BODY
fluid should not be discarded and should be frozen until
there is no further use for it. FLUIDS 2 - SEMEN

REASONS FOR SEMINAL FLUID ANALYSIS

• Advances in the field of andrology and assisted
reproductive technology (ART), and increased concern
over fertility, particularly by couples choosing to have
children later in life, have resulted in increased emphasis
on semen analysis.
• In addition to fertility testing, the clinical laboratory
performs postvasectomy semen analysis and forensic
analyses to determine the presence of semen.

SEMEN COMPOSITION
Semen is composed of four fractions that are contributed
by the testes, epididymis, seminal vesicles, prostate
gland, and bulbourethral glands.
SPECIMEN COLLECTION • Analysis of the specimen cannot begin until
Patient Preparation: liquefaction has occurred.
• Male patients should be instructed to observe sexual
abstinence of at least 2 days to not more than 7 days.
Prolonged abstinence= higher volume, decreased
motility
• Warm sterile glass or sterile plastic containers should be
provided by the laboratory. Whenever possible, the
specimen is collected in a room provided by the
laboratory.
• Specimens awaiting analysis should be kept at 37°C.
Specimens should be collected by masturbation.

The MLS should take note of the following;

• Patient’s name, birth date, and age
•Period of sexual abstinence
• Completeness of the sample
• Difficulties with collection
•Time of collection
•Time of specimen receipt

APPEARANCE

ANTISPERM ANTIBODIES
• Antisperm antibodies can be present in both men and
women. They may be detected in semen, cervical
mucosa, or serum, and are considered a possible cause
of infertility.
• It is not unusual for both partners to demonstrate
antibodies, although male antisperm antibodies are more
frequently encountered
• Under normal conditions, the blood–testes barrier
separates sperm from the male immune system. When
this barrier is disrupted, as can occur following surgery,
vasectomy reversal (vasovasostomy), trauma, and
infection, the antigens on the sperm produce an immune
response that damages the sperm. The damaged sperm
may cause the production of antibodies in the female
partner.
SEMEN LIQUEFACTION TIME
• A fresh semen specimen is clotted and should liquefy
Tests to detect Antibody-coated Sperm
within 30 to 60 minutes after collection; therefore,
1. MIXED AGGLUTINATION REACTION (MAR)
recording the time of collection is essential for
• Screening procedure used primarily to detect the
evaluating semen liquefaction
presence of IgG antibodies. ◦ Positive result: forming
microscopically visible clumps of sperm and particles • Functions:
or cells. 1. Lubricates joints
2. IMMUNOBEAD TEST 2. Reduce friction between
• The immunobead test is a more specific procedure in bones
that it can be used to detect the presence of IgG, IgM, 3. Provides nutrients to the
and IgA antibodies and demonstrates what area of the articular cartilage
sperm (head, neckpiece, midpiece, or tail) the 4. Lessen shock of joint
autoantibodies are affecting. compression occuring during
activities such as walking and
POSTVASECTOMY SEMEN ANALYSIS jogging
VASECTOMY -Cutting of vans deferens so that the
ejaculate will not contain any sperm cell.
• Postvasectomy semen analysis is a much less involved SPECIMEN COLLECTION & HANDLING
procedure when compared with infertility analysis • Synovial fluid is collected by needle aspiration called
because the only concern is the presence or absence arthrocentesis.
of spermatozoa.
• Specimens are routinely tested at monthly intervals,
beginning at 2 months postvasectomy and continuing
until two consecutive monthly specimens show no
spermatozoa

SEMEN TERMINOLOGIES
• Aspermia means NO EJACULATE
•Azoospermia means ABSENCE OF SPERM CELLS
•Necrospermia means IMMOTILE OR DEAD SPERM
CELLS
•Oligospermia means DECREASED SPERM
CONCENTRATION

MEDICO LEGAL TESTS

• On certain occasions, the laboratory may be called on to
determine whether semen is actually present in a
specimen. A primary example is in cases of alleged rape.
• Motile sperm can be detected for up to 24 hours after
intercourse, whereas nonmotile sperm can persist for
3 days
• As the sperm die off, only the heads remain and may
be present for 7 days after intercourse.

Other tests for SEMEN

• Seminal fluid contains a high concentration of
prostatic acid phosphatase, so detecting this enzyme
can aid in determining the presence of semen in a
specimen.

PRINCIPLES OF MEDICAL LABORATORY

SCIENCES 2: OTHER STERILE BODY
FLUIDS 3 - SYNOVIAL FLUID, GASTRIC
FLUID & AMNIOTIC FLUID

SYNOVIAL FLUID
• Synovial fluid, often referred to as “joint fluid,” is a
viscous liquid found in the cavities of the movable joints
(diarthroses) or synovial joints.
CRYSTAL IDENTIFICATION
• The synovial membrane contains specialized cells
called synoviocytes.
• Microscopic examination of synovial fluid for the ABNORMAL:
presence of crystals is an important diagnostic test in • Yellow-green- due to large amount of bile
evaluating arthritis • Red- due to small amount of fresh blood
• Crystal formation in a joint frequently results in an acute, • Coffee ground- due to large amount of blood
painful inflammation. VOLUME: NORMAL (fasting specimen): 20 to 50ml
• Causes of crystal formation include metabolic disorders
and decreased renal excretion that produce elevated • PARIETEL CELLS IN THE STOMACH PRODUCES
blood levels of crystallizing chemicals, degeneration of HYDROCHLORIC ACID (HCl)
cartilage and bone, and injection of medications,such as Hydrochloric acid functions:
corticosteroids, into a joint. 1. Breaks down food
2. Digestive enzymes split up the proteins
TYPES OF CRYSTALS 3. Kills bacteria
➢ MONOSODIUM URATE 4. Mucus covers the stomach wall with a protective
• Synovial fluid crystal found in gout coating
• Appearance: Needles shape
• Increased serum uric acid resulting from impaired AMNIOTIC FLUID
metabolism of purines; increased consumption of PRIMARY FUNCTIONS OF AMNIOTIC FLUID
high-purine-content foods, alcohol, and fructose; 1.Cushion for the fetus
chemotherapy treatment of leukemias; and decreased 2.Allows fetal movement
renal excretion of uric acid are the most frequent causes 3.Stabilizes temperature
of gout. 4.Proper lung development
➢ CALCIUM PYROPHOSPHATE
• Synovial fluid found in pseudogout
• Appearance: Rhomboid square, rods
• Pseudogout is most often associated with
degenerative arthritis, producing cartilage calcification
and endocrine disorders that produce elevated serum
calcium levels.

OTHER TESTS FOR SYNOVIAL FLUID

Microbiology
• Gram stains and cultures are two of the most important
tests performed on synovial fluid
• In addition to Staphylococcus and Streptococcus, the
common organisms that infect synovial fluid are the
fastidious Haemophilus species and Neisseria
gonorrhoeae.

Serologic
• Correlation of patients serum findings with synovial fluid
analysis is essential in detection of joint disorders.
• Ex: rheumatoid arthritis, SLE

GASTRIC FLUID
GASTRIC FLUID: SPECIMEN COLLECTION
Gastric fluid is obtained thru GASTRIC ASPIRATION
Types of gastric tube:
1. Levin Tube= passed through the nose
2. Rehfuss tube= passed through the mouth
3. Lavacuator tube= for evacuating gastric contents and
stilling an irrigant(mouth) SPECIMEN COLLECTION: AMNIOTIC FLUID
4. Ewald’s tube & Edlich tube= for aspirating large • Amniotic fluid is obtained by needle aspiration into the
amounts of gastric contents quickly (mouth) amniotic sac, a procedure called amniocentesis
• Using continuous ultrasound for guidance, the physician
MACROSCOPIC EXAMINATION locates the fetus and placenta to safely perform the
COLOR: procedure.
NORMAL: Pale gray w/ mucus
• A thin, hollow needle is inserted through the mother’s
abdomen into the mother’s uterus and into the amniotic
sac to aspirate the amniotic fluid
• Fluid for fetal lung maturity (FLM) tests should be
placed in ice for delivery to the laboratory and kept
refrigerated.
• Specimens for bilirubin testing must be immediately
protected from light.
• Specimens for cytogenetic studies or microbial
studies must be processed aseptically and maintained at
room temperature or body temperature (37°C incubation)
prior to analysis to prolong the life of the cells needed for
analysis
• All fluid for chemical testing should be separated from
cellular elements and debris as soon as possible to
prevent distortion of chemical constituents

AMNIOTIC FLUID VOLUME

The amount of amnioticfluid 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.