CLINICAL MICROSCOPY Deals primary with the analysis of body fluids Urine, stool, semen, vaginal secretion, peritoneal

al and pleural fluids are some of the specimens presented in the clinical microscopy section Although the analysis may extend to special examinations with CSF (Cerebro Spinal Fluid) KIDNEYS Each kidney contains approximately 1 1.5 million functional units called nephrons. The main function of the kidney is to clear waste products selectively from the blood and simultaneously to maintain the body essential water and electrolyte balances is controlled in the nephron by the following renal blood flow, glomerular filtration (first step in urine filtration), tubular re absorption, and tubular secretion. GLOMERULAR FORMATION Consist of approximately eight capillary lobes referred to collectively as capillary tuft. Bowmans capsule forms the beginning of the renal tubule. Glomerolus serves as a non selective filter of plasma substances with molecular weights less than 70,000. URINALYSIS Urine analysis the beginning of laboratory medicine. Diagnostic information is obtained through observations on urine color, turbidity, odor, volume, viscosity, and even sweetness. In early years physicians never saw the patient, only the patients urine. These same urine characteristics are still reported by laboratory personnel 24 hrs urine test used in hospital

URINE FORMATION, COMPOSITION, and VOLUME Urine is the filtration of the plasma; this converts approximately 170,000 ml of filtered plasma to the average daily urine output of 1200ml. Urine consists of urea and other organic and inorganic chemicals dissolved in water. Urine is 95% water and 5% solutes. BETA HCG (Human Chorionic Gonadotropin) The Pregnancy Hormone Dietary intake greatly influences the concentration of these inorganic compounds, making it difficult to establish normal levels. Urine volume depends on the amount of water that the kidney excretes. OLIGURIA is a term for decrease in urine output. ANURIA is a cessation of urine flow and may result to a serious damage to the kidney. NOCTURIA is an increase in nocturnal excretion of urine. POLYURIA is an increase in daily urine volume and is seen in diabetic patients.

TYPES OF URINE SPECIMEN Random Specimens Fasting Specimens 2 hour postprandial specimen Glucose tolerance specimens toxic test 24 hour specimens Catheterized specimen unable to walk patients Midstream clean catch Suprapubic specimen special technique Drug specimen collection URINE COLOR Dark yellow/ Amber/ Orange presence of bilirubin Red/ Pink/Brown presence of RBCs, hemoglobin, methemoglobin and fresh blood Brown/ black- presence of melanin infesting malignant melanoma.

MICROSCOPIC EXAMINATION OF URINE NORMAL Epithelial cells (reported as rare for males) Urates Crystals Bacteria (reported as rare) Cast (reported as few numbers) ABNORMAL RBCs WBCs Rural Tubular Cells Oval fat bodies Yeast (Candida Albicans) Parasites Casts (reported as many)

CRYSTALS NORMAL Uric acid Amorphous urates Calcium oxalate Amorphous phosphate Calcium phosphate Triple phosphate Ammonium biurate Calcium carbonate ABNORMAL Cystein Cholesterol Leucine Tyrosine Bilirubin Sulfonamides Ampicillin

CSF CEREBRO SPINAL FLUID It is produced on the choroid plexus of the two lumbar ventricles The CSF provides a physiologic system to supply nutrients to the nervous tissue, remove metabolic waste and produce a mechanical barrier to cushion the brain and the spinal cord against trauma. SPECIMEN COLLECTION AND HANDLING CSF is a routine collected by lumbar puncture between the third, fourth or fifth lumbar vertebrate. The volume of CSF that can be removed is based on the volume available in the patient. Specimens are collected in three different tubes 1, 2 and 3. Chemistry tubes are frozen, Microbiology tubes remain in room temp and Hematology tubes are refrigerated. CELL SEEN IN CSF Lymphocytes unless the presence is too numerous, its presence in the CSF is normal. Otherwise it indicates Viral Meningitis. Neutrophils bacterial meningitis Monocytes multiple sclerosis Blast forms acute leukemia Malignant cells metastatic carcinoma

NORMAL VALUES FOR SPERM ANALYSIS Volume 2-5 ml Viscosity pours in droplets Ph 7.2 8.0 Sperm concentration 20million/ml Sperm count 40 million/ ejaculate Motility 50% within 1 hour Quality 2.0 class a,b,c Morphology -> 14% normal forms (strict criteria); 30% normal forms (routine criteria)