LESSON 9:

THE DIFFERENT NON-

BLOOD SPECIMENS FOR
LABORATORY TESTING

PRESENTED BY:
CHARMAINE GELLIEANN R. MAGSINO, RMT
FACULTY, MEDICAL TECHNOLOGY DEPARTMENT
LEARNING OUTCOMES:
1. IDENTIFY THE DIFFERENT NON-BLOOD SPECIMENS
FOR LABORATORY TESTING.
2. DESCRIBE THE VARIOUS TESTS PERFORMED ON THE
DIFFERENT NON-BLOOD SPECIMENS.
3. DISCUSS THE COLLECTION AND HANDLING
PROCEDURES FOR THE NON-BLOOD SPECIMENS.
NON-BLOOD SPECIMENS
• There are cases when the phlebotomist is asked to transport these
specimens to the laboratory.
• To avoid delays in testing,
• He should check and verify information on the label of the specimen
before receiving them.
• The specimen should be labeled with the same ID information as the
blood specimen and the type or source of the specimen should
also be included.
• The label should be placed in the container and not the lid,
because the lids are removed during testing.
• He should also follow standard precautions in handling specimen
because all body substances are potentially infectious.
NON-BLOOD SPECIMENS
• The non-blood specimens are substances produced by the body which
can be in liquid or semi-liquid form. These are found within body
organs such as the bladder and spaces such as the joints.
I. URINE
• Most analyzed in the laboratory
• Inexpensive to test because collecting the specimen is not tedious and
urine is available most of the time.
• The procedure for collection should be explained properly to the
patient since the type of urine collection and the method of
collection depends on the type of test ordered by the physician.
• Accuracy of urine analysis results will largely depend on several
factors such as the collection method, container use, transportation
and handling of specimen, and the timeliness of the testing.
Why do we analyze urine?
• Monitoring wellness
• Diagnosis and treatment of urinary tract infections
• Detection and monitoring the progress of treatment in metabolic
diseases,
• Determines the effectiveness of an administered therapy as well
as checking if the patients exhibited any therapy-related
complications.
Common Urine Tests
1. Routine Urinalysis (UA)
- Frequently ordered urine test; screens the patient for any urinary or systematic
disorders.
- physical analysis (color, clarity, and odor)
- chemical (pH, specific gravity, detection of bacteria, etc.)
- microscopic analysis (urine components such as cells, crystals, and
microorganisms) of the specimen.
- midstream collection is recommended (no contamination caused by genital
secretions, pubic hair, or bacteria surrounding the urinary opening )
- specimen container used for collection should be clear and dry with tight-fitting lids
- After collection, the specimen should be transported to the laboratory immediately, but
it could be held at room temperature for 2 hours or it could be refrigerated if transport
will take longer than prescribed.
- Make sure that the specimen is protected from light.
2. Culture & Sensitivity (C&S)
- symptoms of a urinary tract infection (UTI)
- midstream clean-catch collection which is placed in a sterile container
- A measured portion of urine is cultured on a special nutrient medium for
18 to 24 hours.
- If a microorganism is present and identified, a sensitivity or antibiotic
susceptibility test is performed to determine the most effective antibiotic
that should be prescribed for treatment.
3. Urine Cytology Studies
- detect cancer, cytomegalovirus, & other viral and inflammatory diseases in
the urinary system.
- fresh clean-catch specimen is required
- A smear from the cells of the lining of the urinary tract is stained using the
Papanicolaou (PAP) method and examined under the microscope for
abnormal cells.
- The collected specimen should be examined immediately but if delays
could not be avoided, the specimen is preserved by adding an equal
volume of 50% alcohol.
4. Urine Drug Testing
- Drug screening is performed using urine since many drugs are detected in
the urine but not in the blood.
- This test is performed to detect:
- (1) illicit use of recreational drugs,
- (2) use of anabolic steroids to enhance performance in sports,
- (3) unwarranted use of prescription drugs.
- Can also monitor therapeutic drug use to minimize the symptoms
associated with the withdrawal and also confirm drug overdose.
- Random sample is placed in a chemically clean container with lid and
submitted for testing
5. Urine Glucose and Ketone Testing
- screen diabetes and determine the glucose level
for patients who are already diabetic.
- urine ketone level test is used to determine if the
patient is suffering from diabetic ketoacidosis.
- The color changes in the test strip are compared
to a color chart to interpret the result of the test.

6. Urine Pregnancy Testing

- confirm pregnancy which can be detected 8 to
10 days from conception.
- first morning urine specimen - highest
concentration of human gonadotropin (HCG).
Types of Urine Specimen
• Random: collected at any time
• First morning/8-hour urine specimen: collected immediately upon
waking up from 8 hours of sleep.
• Fasting: second specimen voided after fasting (glucose monitoring)
• Timed: collected at specific times or pooled throughout a specific time.
• Tolerance test (glucose) - fasting, 1/2-hour, 1 hour, etc.
• 2-hour postprandial - 2 hours after a meal
• 24-hour - collection & pooling of all urine which is voided in 24 hours
• Double-voided - wait for specific time (30 minutes) after emptying the
bladder.
24-Hour Urine Collection Procedure
• Empty the bladder upon waking up.
• Affix the label in the container and write down the time and
date of the specimen collection. Start timing.
• Collect all the urine that has been passed for the next 24
hours.
• If instructed, refrigerate the specimen collected all
throughout the collection period.
• The urine is collected prior to bowel movement.
• Drink fluid as needed to avoid dehydration.
• Take one last void at the end of the 24-hour collection period.
• Make sure to seal the container before placing in the cooler.
Arrange to transport the specimen to the laboratory at the
soonest possible time.
Urine Collection Methods:
• Regular voided: patient voids or urinates into clean container.
• Midstream: patient voids or urinates into toilet first, interrupted and
then restarted into the container with the last urine flow voided in the
toilet.
• Midstream clean catch: requires special cleaning of genital area
before collection
• Catheterized: collected from sterile catheter inserted through urethra
into the bladder
• Suprapubic aspiration: collected by inserting needle directly into
bladder & aspirating the urine using a sterile syringe.
• Pediatric: collected in a plastic bag for children not potty trained and
checked every 15 minutes until the required volume is collected.
II. AMNIOTIC FLUID
- clear and slightly yellowish liquid contained in the
amniotic sac that is surrounding and cushioning the
fetus during pregnancy
- collected by the physician using transabdominal
amniocentesis preferably 15 weeks after gestation.
- is guided by the ultrasound machine and about 10
mL of fluid is aspirated from the amniotic sac thru the
needle inserted in the mother's abdominal wall into the
uterus
- detect any genetic disorder, check any problem in
fetal development, and verify the gestational age.
- collected in a sterile container should be protected
from light and transported immediately to the clinical
laboratory.
III. CEROBROSPINAL FLUID
- refers the liquid that surrounds brain & spinal
cord
-clear and colorless and is obtained by the
physician using lumbar puncture or spinal
tap.
- diagnose meningitis and other disorders such
as brain abscess, CNS cancer, and multiple
sclerosis
- The routine tests performed are cell counts,
chloride, glucose, and total protein.
- collected in 3 special sterile tubes: first tube -
chemistry and immunology test, second tube -
microbiology studies, and the third tube for cell
counts.
- should be kept at room temperature and
sent to the laboratory for immediate analysis.
IV. Gastric Fluid/Gastric Analysis
- performed to check for abnormal substances in the
stomach and evaluate the production of acid by
evaluating the gastric acid concentration.
- In basal gastric analysis, a tube is passed through the
mouth and throat (oropharynx), or nose and throat
(nasopharynx) into the stomach after the patient has
done fasting for a specified period.
- The sample is aspirated to determine acidity before
the stimulation.
- A gastric stimulant is administered intravenously
after the specimen collection. A series of collections
will follow with timed intervals.
- The collected specimens are placed in sterile
containers. The phlebotomist labels the specimens
properly and assists by drawing blood for serum
gastrin determination.
V. NASOPHARYNGEAL SECRETIONS
- The Nasopharyngeal (NP) secretions specimen are collected and
cultured to determine the presence of bacteria that causes:
- (1) diphtheria, (2) meningitis, (3) pertussis (whooping cough), and (4)
pneumonia.
- Collection is performed by gently inserting a dacron or sterile
cotton-tipped flexible wire swab into the nose into the nasopharynx
(nasal cavity & pharynx).
- The swab is rotated and gently removed then placed in a
properly labeled sterile container containing transport medium for
immediate transport to the laboratory.
VI. SALIVA
- The saliva which is the fluid secreted by the glands inside the mouth is
used to check the hormone levels and determine alcohol and drug
or substance abuse.
- The collection of saliva is easy and non-invasive because testing kits are
available, and many are point-of-care test (POCT).
- The specimen needs to be frozen to ensure stability prior to the delivery
to the clinical laboratory.
VII. SEMEN
- The seminal fluid is a thick yellowish-white fluid that contains sperm
release during the male ejaculation.
- Analysis is done to evaluate the fertility and assess the effectiveness
of sterilization after a vasectomy procedure, but it is also ordered for
forensic or legal reasons such as criminal investigations involving sexual
assault.
- The collected specimen is placed in sterile container, kept warm, and
protected from light.
VIII. SEROUS FLUIDS
- The serous fluid is found between the membrane that encloses that pleural,
pericardial, & peritoneal cavity.
- This serum-like fluid is pale-yellow in color and watery and its main
function is to allow the membranes to pass each other with minimal friction.
- An effusion or increase in volume indicates inflammation, infection, or
decrease in the serum protein level.
- The fluid is collected by the physician by aspiration and placed in tubes
depending on the type of test.
- EDTA tubes are used for cell counts and smears, heparin or sodium
fluoride tubes for chemistry tests, non-anticoagulant tubes for biochemical
tests, and for cultures the heparinized should be used.
VIII. SEROUS FLUIDS
- The type of fluid which is based on the body cavity origin should be indicated
in the label as follows: pleural fluid (lungs), peritoneal fluid (abdominal cavity),
and pericardial fluid (heart).
IX. SPUTUM
- Sputum (mucous or phlegm) specimen are used to diagnose and/or
monitor lower respiratory tract infections like tuberculosis.
- It is recommended that the collection be done first thing in the
morning since larger volume have accumulated overnight and at
least 1 hour after meal to avoid gagging.
- The patient should gargle with water and remove dentures (if any).
- The patient should:
- (1) take takes 3 or 4 deep breaths, (2) inhale and exhale, (3)
cough forcefully on the last breath, and (4) expectorate and expel
sputum into the sterile container.
The procedure is repeated until adequate amount is collected which
is about 3 to 5 mL. The collected specimen is transported and should
be processed immediately upon arrival at the laboratory.
X. SWEAT
- The sweat is used to analyze the chloride
content of patients under the age of 20 with
symptoms of cystic fibrosis (exocrine gland
disorder).
- During the sweat chlorides test, electrical
stimulation in the forearm or thigh
(iontophoresis) is used to transport the
pilocarpine (sweat-stimulating drug) into the
skin. The sweat is then collected, the weight
is recorded, and the chloride content is
analyzed.
- The sweat specimen can also be used to
determine illegal use of drug by placing
patches on the skin for an extended period
and which is further confirmed by subsequent
drug testing.
XI. SYNOVIAL FLUID
- The synovial fluid (viscous fluid that
lubricates movable joints) are tested to
determine conditions such as arthritis, gout
and other inflammatory conditions since
increase in volume is attributed to
inflammation. These are collected in 3 tubes:
• EDTA/heparin: for cell counts, ID of
crystals, smear preparation
• Sterile: culture & sensitivity
• Non-additive: macroscopic appearance,
chemistry, immunology tests and
observing the clot formation.
BUCCAL (CHEEK) SWABS
- Buccal swabs are used to obtain loose cells inside the cheek for purposes
of DNA analysis.
- This is less invasive and painless alternative to blood collection. The
phlebotomist collects sample by placing the swab inside the cheek and
gently massages the area.
- After the collection the swab is sent to the laboratory where the DNA is
extracted from the cells in the swab.
BREATH SAMPLES
- two types: C-urea breath test (C-UBT) and Hydrogen breath test.
C-urea Test
- checks for the presence of Helicobacter pylori (H. pylori) which is a type of bacteria
that damages the stomach lining.
- After the collection of the baseline breath sample, the patient is asked to drink a
special substance that has synthetic urea. He is then asked to breath into a Mylar
balloon at specified intervals. The breath specimens are analyzed for carbon-13
which confirms the presence of the H. pylori.
BREATH SAMPLES
Hydrogen Breath Test
- helps in the detection of carbohydrate digestion problems such as lactose (milk
sugar) and fructose (fruit sugar).
- This test can also detect bacterial overgrowth in the small intestine and is thought
as the most accurate tolerance test. In preparation for the test, the patient must
not take antibiotics 2 weeks prior to the scheduled test.
- He should not eat certain food for 24 hours before the test. Smoking and exercise
is also restricted 30 minutes before the test. The baseline breath sample is taken by
breathing into a special bag before the introduction of a special drink.
- Additional breath samples are taken every 30 minutes for 3 hours and all are sent
to the laboratory for analysis.
BONE MARROW
- The bone marrow is examined to identify blood diseases.
- The physician inserts a large-gauge needle into the sternum (breastbone) or
iliac crest (hip bone) and aspirates 1.0 to 1.5 mL of specimen.
- A hematology technologist makes special slides from the first marrow aspiration.
FECES (STOOL)
The fecal specimen (feces or stool) is collected to:
(1) determine gastrointestinal disorder,
(2) analyze for presence of intestinal ova & parasites (O&P),
(3) cultured for the presence of pathogenic bacteria and viruses,
(4) check fat and urobilinogen content,
(5) test for presence of occult blood.
- They are collected in a clean and wide-mouth container that are sealed and
sent to the laboratory after collection.
HAIR
- Analyzed for trace & heavy metal analysis
- also used to detect chronic drug abuse where hair is the preferred
specimen because not only is it easy to obtain, but it is also not easy to
alter or tamper.
TISSUE SPECIMEN
- The tissue specimen is usually collected using biopsy where the tissue
sample is removed for examination.
- The phlebotomist should check the proper handling procedure if the
specimen arrived is not immersed in a solution.
- In the case of genetic analysis, the tissue samples are not to be placed in
formalin.
- Improper handling is costly, inconvenient, and cannot be easily
repeated.
THROAT SWAB
- Throat swabs are mostly collected to aid in streptococcal (strep) infection detection. A
special kit contains a sterile polyester-tipped swab and a covered transport tube.
THROAT SWAB PROCEDURE:
• Follow hand hygiene and PPE procedures.
• Open the container to remove the swab in an aseptic manner.
• Stand to the side of the patient or stand back to avoid droplet contact when the patient
coughs.
• Ask the patient to tilt his head back and open his mouth wide.
• Examine the throat by directing a flashlight to the back of the throat.
• Use a tongue depressor to depress the tongue and ask the patient to say "Ah" to raise
the uvula and get it out of the way.
• Swab the tonsils, tonsillar crypts, back of the throat, and any area that has ulceration
and inflammation but avoid touching the lips, tongue, and uvula.
• Discard the tongue depressor only after the swab has been taken out of the mouth.
• The swab is placed in the transport tube (dipped in the medium) and the covered
carefully.
• Follow proper labeling procedure for the specimen.
• Remove the gloves properly & apply proper hand decontamination technique.
• The collection tube is sent to the laboratory for immediate processing.