1

CLINICAL MICROSCOPY
Types of Safety Hazards

Type Source Possible injury

Biological Infectious agents Bacterial, fungal, viral or parasitic
infections
Sharp Needles, lancets, and broken glass Cuts, punctures, or bloodborne
pathogen exposure
Chemical Preservatives and reagents Exposure to toxic, carcinogenic or
caustic agents
Radioactive Equipment and radioisotopes Radiation exposure
Electrical Ungrounded or wet equipment and Burns or shock
frayed cords
Fire/Explosive Bunsen burners and organic Burns or dismemberment
chemicals
Physical Wet floors, heavy boxes and patients Falls, sprains, or strains

Types of Fire and Fire Extinguishers

Fire Type Composition of Fire Type of Fire Extinguishing Material

Extinguisher
Class A Wood, paper, or clothing Class A Water
Class B Flammable organic Class B Dry chemicals, carbon
chemicals dioxide, foam, or halon
Class C Electrical Class C Dry chemicals, carbon
dioxide, or halon
Class D Combustible metals None Sand or dry powder
Class ABC Dry chemicals

Tubular Reabsorption

Substance Location
Active Transport Glucose, amino acids, and salts Proximal convoluted tubule
Chloride Ascending loop of Henle
Sodium Distal convoluted tubule
Passive transport Water Proximal convoluted tubule,
descending loop of Henle, and
collecting tubules
Urea Proximal convoluted tubule and
ascending loop of Henle
Sodium Ascending loop of Henle

Urine Clarity

Clarity Term
Clear No visible particulates, transparent
Hazy Few particulates, print easily seen through urine
Cloudy Many particulates, print blurred through urine
Turbid Print cannot be seen through urine
Milky May precipitate or be clotted

Causes of Urine Turbidity

Nonpathologic Pathologic
Squamous epithelial cells Red blood cells
Mucus White blood cells
Amorphous phosphates, carbonates, urates Bacteria
Semen, spermatozoa Yeast
Fecal contamination Nonsquamous epithelial cells
 2
Nonpathologic Pathologic
Radiographic contrast media Abnormal crystals
Talcum powder Lymph fluid
Vaginal creams Lipids

Summary of Urine Specific Gravity Measurements

Method Principle
Urinometry Density
Refractometry Refractive index
Harmonic oscillation densitometry Density
Reagent strip pKa change of a polyelectrolyte

Common Causes of Urine Odor

Odor Cause
Aromatic Normal
Foul, ammonia-like Bacterial decomposition, urinary tract infection
Fruity, sweet Ketones (diabetes mellitus, starvation, vomiting)
Maple syrup Maple syrup urine disease
Mousy Phenylketonuria
Rancid Tyrosinemia
Sweaty feet Isovaleric acidemia
Cabbage Methionine malabsorption
Bleach Contamination

Causes of Acid and Alkaline Urine

Acid Urine Alkaline urine

Emphysema Hyperventilation
Diabetes mellitus Vomiting
Starvation Renal tubular acidosis
Dehydration Presence of urease-producing bacteria
Diarrhea Vegetarian diet
Presence of acid-producing bacteria (E.coli) Old specimens
High protein diet
Cranberry juice
Medications (methenamine mandelate [Mandelamine],
fosfomycin tromethamine)

Summary of Clinical Significance of Urine pH

Respiratory or metabolic acidosis/ketosis

Respiratory or metabolic alkalosis
Defects in renal tubular secretion and reabsorption of acids and bases – renal tubular acidosis
Renal calculi formation
Treatment of urinary tract infections
Precipitation/identification of crystals
Determination of unsatisfactory specimens

pH Reagent Strip Summary

Reagents Methyl red, bromthymol blue

Sensitivity pH 5 - 9
Sources of error/interference No known interfering substances
Runover from adjacent pads
Old specimens
Correlations with other tests Nitrite
Luekocytes
Microscopic
 3

Summary of Clinical Significance of Urine Protein

Prerenal Renal Renal Postrenal

Glomerular Disorders Tubular Disorders
Intravascular hemolysis Immune complex Fanconi’s syndrome Lower UTI/inflammations
Muscle injury disorders Toxic agents/heavy metals Injury/trauma
Severe infection and Amyloidosis Severe viral infections Menstrual contamination
inflammation Toxic agents Prostatic
Multiple myeloma Diabetic neuropathy fluid/spermatozoa
Strenuous exercise Vaginal secretions
Dehydration
Hypertension
Pre-eclampsia
Orthostatic or postural
proteinuria

Protein Reagent Strip Summary

Reagents Multistix: Tetrabromphenol blue

Chemstrip: 3’, 3” 5’, 5” tetrachlorophenol, 3, 4, 5, 6-
tetrabromosulfonphthalein
Sensitivity Multistix: 15-30 mg/dL albumin
Chemstrip: 6 mg/dL albumin
Sources of error/interference False-positive:
Highly buffered alkaline urine
Pigmented specimens, phenozopyridine
Quaternary ammonium compounds (detergents)
Antiseptics, chlorhexidine
Loss of buffer from prolonged exposure of the reagent
strip to the specimen
High specific gravity
False-negative: proteins other than albumin
Correlations with other tests Blood
Nitrite
Leukocytes
Microscopic

Summary of Clinical Significance of Urine Glucose

Hyperglycemia Associated Renal Associated

Diabetes mellitus Fanconi’s syndrome
Pancreatitis Advanced renal disease
Pancreatic cancer Osteomalacia
Acromegaly Pregnancy
Cushing’s syndrome
Hyperthyroidism
Pheochromocytoma
Central nervous system damage
Stress
Gestational diabetes
 4
Glucose Reagent Strip Summary

Reagents Multistix: Glucose oxidase, peroxidase, potassium

iodide
Chemstrip: Glucose oxidase, peroxidase,
tetramethylbenzidine
Sensitivity Multistix: 75 – 125 mg/dL
Chemstrip: 40 mg/dL
Interference False-positive: Conatmination by oxidizing agents and
detergents
False-negative:
High levels of ascorbic acid
High levels of ketones
High specific gravity
Low temperatures
Improperly preserved specimens
Correlations with other tests Ketones

Summary of Clinical Significance of Urine Ketones

Diabetes acidosis
Insulin dosage monitoring
Starvation
Malabsorption/pancreatic disorders
Strenuous exercise
Vomiting
Inborn error of amino acid metabolism

Ketone Reagent Strip Summary

Reagents Sodium nitroprusside

Glycine (Chemstrip)
Sensitivity Multistix: 5 – 10 mg/dL acetoacetic acid
Chemstrip: 9 mg/dL acetoacetic acid, 70 mg/dL acetone
Interference False-positive:
Phthalein dyes
Highly pigmented red urine
Levodopa
Medications containing free sulfhydryl groups
False-negative:
Improperly preserved specimens
Correlations with other tests Glucose

Summary of Clinical significance of a Positive Reaction for Blood

Hematuria Hemoglobinuria Myoglubinuria

Renal calculi Transfusion reactions Muscular trauma/crush syndromes
Glomerulonephritis Hemolytic anemias Prolonged coma
Pyelonephritis Severe burns Convulsions
Tumors Infections/malaria Muscle-wasting diseases
Trauma Strenuous exercise/red blood cell Alcoholism/overdose
Exposure to toxic chemicals trauma Drug abuse
Anticoagulants Metabolic diseases Extensive exertion
Strenuous exercise Renal/Kidney damage Stroke
Renal damage MI
Renal carcinoma
Menstruation
 5

Blood Reagent Strip Summary

Reagents Multistix: Diisopropylbenzene dehydroperoxide

tetramethylbenzidine
Chemstrip: 2,5-dimethyl-2,5-dihydroperoxide
tetramethylbenzidine
Sensitivity Multistix: 5-20 RBCs/L, 0.015-0.062 mg/dL
hemoglobin
Chemstrip: 5 RBCs/L, hemoglobin corresponding to
10 RBCs/L
Interference False-positive:
Strong oxidizing agents
Bacterial peroxidases
Menstrual contamination
False-negative:
High specific gravity/creanated cells
Formalin
Captopril
High conc. of nitrite
Ascorbic acid >25 mg/dL
Unmixed specimens
Correlations with other tests Protein
Microscopic

Urine Bilirubin and Urobilinogen in Jaundice

Urine Bilirubin Urine Urobilinogen

Bile duct obstruction +++ Normal
Liver damage + or - ++
Hemolytic disease Negative +++

Summary of Clinical Significance of Urine Bilirubin

Hepatitis
Cirrhosis
Other liver disorders
Biliary obstruction (gallstones, carcinoma)

Bilirubin Reagent Strip Summary

Reagents Multistix: 2,4-dichloroaniline diazonium salt

Chemstrip: 2,6-dichlorobenzene-diazonium-
tetrafluoroborate
Sensitivity Multistix: 0.4-0.8 mg/dL bilirubin
Chemstrip: 0.5 mg/dL bilirubin
Interference False-positive:
Highly pigmented urines, phenazopyridine
Indican (intestinal disorders)
Metabolites of Lodine
False-negative:
Specimen exposure to light
Ascorbic acid >25 mg/dL
High concentrations of nitrite
Correlations with other tests Urobilinogen

Summary of Clinical Significance of Urine Urobilinogen

 6
Early detection of liver disease
Liver disorders, hepatitis, cirrhosis, carcinoma
Hemolytic disorders

Urobilinogen Reagent Strip Summary

Reagents Multistix: p-diethyaminobenzaldehyde

Chemstrip: 4-methoxybenzene-diazonium
tetrafluoroborate
Sensitivity Multistix: 0.2 mg/dL urobilinogen
Chemstrip: 0.4 mg/dL urobilinogen
Interference Multistix
False-positive:
Porphobilinogen
Indican
p-aminoslicylic acid
Sulfonamides
Methyldopa
Procaine
Chlorpromazine
Highly pigmented urine
False-negative
Old specimens
Preservation in formalin

Chemstrip
False-positive:
Highly pigmented urine
False-negative:
Old specimens
Preservation in formalin
High concentrations of nitrate
Correlations with other tests Bilirubin

Watson-Schwartz Test Interpretation

Urobilinogen Other Ehrlich-Reactive Porphobilinogen

Substances
Chloroform Extraction
Urine (top layer) Colorless Red Red
Chloroform (bottom layer) Red Colorless Colorless
Butanol Extraction
Butanol (top layer) Red Red Colorless
Urine (bottom layer) Colorless Colorless Red

Summary of Clinical Significance of Urine Nitrite

Cystitis
Pyelonephritis
Evaluation of antibiotic therapy
Monitoring of patients at high risk for urinary tract infection
Screening of urine culture
 7

Nitrite Reagent Strip Summary

Reagents Multistix: p-arsanilic acid

tetrahydronezo(h)quinolin-3-ol
Chemstrip: Sulfanilamide 3-hydroxy-1,2,3,4-tetrahydro-
7,8 benzoquinoline
Sensitivity Multistix: 0.06-0.1 mg/dL nitrite ion
Chemstrip: 0.05 mg/dL nitrite ion
Interference False-positive:
Improperly preserved specimens
Highly pigmented urine
False-negative:
Nonreductase-containing bacteria
Insufficient contact time between bacteria and
urinary nitrate
Lack of urinary nitrate
Large quantities of bacteria converting nitrite to
nitrogen
High concentrations of ascorbic acid
High specific gravity

Correlations with other tests Protein

Leukocytes
Microscopic

Summary of Clinical Significance of Urine Leukocytes

Bacterial and nonbacterial urinary tract infection

Inflammation of the urinary tract
Screening of urine culture specimens

Lekocyte Esterase Reagent Strip Summary

Reagents Multistix: Derivatized pyerole amino acid ester,

diazonium salt
Chemstrip: Indoxylcarbonic acid ester, diazonium salt
Sensitivity Multistix: 5-15 WBC/hpf
Chemstrip: 10-25 WBC/hpf
Interference False-positive:
Strong oxidizing agents
Highly pigmented urine, nitrofurantoin
False-negative:
High concentrations of protein, glucose, oxalic aci,
ascorbic acid. gentamicin, cephalosporins,
tetracyclines
Correlations with other tests Protein
Nitrite
Microscopic

Summary of Clinical Significance of Urine Specific Gravity

Monitoring of patient hydration and dehydration

Loss of renal tubular concentrating ability
Diabetes insipidus
Determination of unsatisfactory specimens due to low concentration
 8

Urine Specific Gravity Reagent Strip Summary

Reagents Mutistix: Poly (methyl vinyl ether/maleic anhydride)

bromthymol blue
Chemstrip: Ethyleneglycol-Bis (aminoethylether)
bromthymol blue
Sensitivity 1.000-1.030
Interference False-positive:
High concentration of protein
False-negative:
Highly alkaline urines (>6.5)

Microscopic Examination of Urine

Sediment Stain Characteristics

Stain Action
Sternheimer-Malbin Crystal violet and safranin
Delineates structure and contrasting
colors of the nucleus and cytoplasm
Toluidine blue Enhances nuclear detail
2% acetic acid Lyses RBCs and enhances nuclei of
WBCs
Lipid stains: Oil Red O and Sudan Stains triglycerides and neutral fats
III orange-red
Gram stain Differentiates gram-positive and
gram-negative bacteria
Hansel stain Methylene blue and eosin Y stain
eosinophilic granules
Prussian blue stain Stains structures containing iron
Function
Identifies WBCs, epithelial cells,
and casts
Differentiates WBCs and renal
tubular epithelial cells
Distinguishes RBCs from WBCs,
yeast, oil droplets, and crystals
Identifies bacterial casts
Identifies urinary eosinophils
Identifies yellow-brown granules of
hemosiderin in cells and casts

Cells

Cell Appearance Sources of Error Reporting Complete

Urinalysis
Correlations
RBCs Non-nucleated Yeast cells Average number per Color
biconcave disks Oil droplets 10 high power fields Reagent strip
Crenated in Air bubbles reaction
hypertonic urine
Ghost cells in
hypotonic urine
Dysmorphic with
glomerular
membrane damage
WBCs Larger than red Renal tubular Average number per Leukocyte esterase
blood cells epithelial cells 10 high power fields Nitrite
Granulated, Specific gravity
multilobed pH
neutrophils
Glitter cells in
hypotonic urine
Monuclear cells with
abundant cytoplasm
Squamous Largest cell in the Rarely encountered, Rare, few, moderate, Clarity
epithelial cells sediment with folded cells may or many per low
abundant, irregular resemble casts power field
cytoplasm and
prominent nuclei
Transitional Spherical, Spherical forms may Rare, few, moderate, Clarity
 9
Cell Appearance Sources of Error Reporting Complete
Urinalysis
Correlations
epithelial polyhedral, or resemble RTE cells or many per high Blood, if malignancy
(urothelial) cells caudate with power field associated
centrally located
nucleus
Renal tubular Rectangular, Spherical Average number per Leukocyte esterase
epithelial (RTE) polyhedral, cuboidal, transitional cells 10 high power field and nitrite
cells or columnar with an Granular casts (pyelonephritis)
eccentric nucleus, Color
possibly bilirubin Clarity
stained or Protein
hemosiderin laden Bilirubin (hepatitis)
Blood
Oval fat bodies Highly refractile Confirm with fat Average number per Clarity
RTE cells stains and polarized high power field Blood
microscopy Protein
Free fat
droplets/fatty casts

Summary of Miscellaneous Structures

Appearance Sources of Error Reporting Complete

Urinalysis
Correlations
Bacteria Small spherical and Amorphous Few, moderate, or pH
rod-shaped phosphates and many per high Nitrite
structures urates power field, the LE
presence of WBCs WBCs
may be required
Yeast Small, oval, RBCs Rare, few, moderate, Glucose
refractile structures or many per high LE
with bud and/or power field, the WBCs
mycelia presence of WBCs
may be required
Trichomonas Pear-shaped, motile, WBCs, renal tubular Rare, few, moderate, LE
flagellated epithelial cells or many per high WBCs
power field
Spermatozoa Tapered oval head None Present, based om Protein
with long, thin tail laboratory protocol
Mucus Single or clumped Hyaline casts Rare, few, moderate, None
threads with a low or many per low
refractive index power field

Casts

Cast Appearance Sources of Reporting Complete Clinical

Error Urinalysis Significance
Correlations
Hyaline cast Colorless, Mucus, fibers, Average number Protein Glomerulonephritis
homogenous hair per low power Pyelonephritis
matrix field Chronic renal
disease
Congestive heart
failure
Stress and exercise
RBC cast Orange-red RBC clumps Average number RBCs Glomerulonephritis
color, cast per low power Blood Strenuous exercise
matrix field Protein
containing
 10
Cast Appearance Sources of Reporting Complete Clinical
Error Urinalysis Significance
Correlations
RBCs
WBC cast Cast matrix WBC clumps Average number WBCs Pyelonephritis
containing per low power Protein Acute interstitial
WBCs field LE nephritis
Bacterial cast Bacilli bond to Granular casts Average number WBC cast Pyelonephritis
protein matrix per low power WBCs
field LE
Nitrite
Protein
Bacteria
Epithelial cell RTE cells WBC cast Average number Protein Renal tubular
Cast attached to per low power RTE cells damage
protein matrix field
Granular Coarse and fine Clumps of small Average number Protein Glomerulonephritis
Cast granules, and crystals per low power Cellular casts Pyelonephritis
protein Columnar RTE field RBCs Stress and exercise
aggregates in a cells WBCs
protein matrix
Waxy cast Highly refractile Fibers and fecal Average number Protein Stasis of urine flow
witj jagged ends material per low power Cellular casts Chronic renal
and notches field Granular casts failure
RBCs
WBCs
Fatty cast Fat droplets and Fecal debris Average number Protein Nephrotic
oval fat bodies per low power Free fat droplets syndrome
attached to field Oval fat bodies Toxic tubular
protein matrix necrosis
Diabetes mellitus
Crush injuries
Broad cast Wider than Fecal material Average number Protein Extreme urine
normal cast per low power RBCs stasis
matrix field WBCS Renal failure
Granular casts
Waxy casts

Normal Values for Semen Analysis

Volume 2-5 mL
Viscosity Pours in droplets
pH 7.2-8.0
Sperm concentration 20-160 million/mL
Sperm count >40 million/ejaculate
Motility > 50% within 1 h
Quality > 2.0
Morphology > 30% normal forms (strict criteria)
> 50% normal forms (routine criteria)
White blood cells < 1.0 million/mL

Normal Semen Chemical Values

Neutral -glucosidase  20 m /ejaculate

Zinc  2.4 mol/ejaculate
Citric acid  52 mol/ejaculate
Acid phosphatase  200 /ejaculate
 11

Sperm Motility Grading

Grade Criteria
4.0 Rapid, straight-line motility
3.0 Slower speed, some lateral movement
2.0 Slow forward progression, noticeable lateral movement
1.0 No forward progression
0 No movement

Additional Testing for Abnormal Semen Analysis

Abnormal Result Possible Abnormality Test

Decreased motility with normal
count
Decreased count
Decreased motility with clumping
Normal analysis with continued
infertility
Viability Eosin-nigrosin stain
Lack of seminal vesicle support Fructose level
medium
Male antisperm antibodies Mixed agglutination reaction and
immunobead tests
Sperm agglutination with male
serum
Female antisperm antibodies Immunobead test
Sperm agglutination with female
serum

Sperm Function Tests

Test Description
Hamster egg penetration Sperm are incubated with species-nonspecific hamster
eggs and penetration is observed microscopically
Cervical mucus penetration Observation of sperm penetration ability of partner’s
midcycle cervical mucus
Hypo-osmotic swelling Sperm exposed to low-sodium concentrations are
evaluated for membrane integrity and sperm viability
In vitro acrosome reaction Evaluation of the acrosome to produce enzymes
essential for ovum penetration

Normal Synovial Fluid Values

Volume < 3.5 mL

Color Pale yellow
Clarity Clear
Viscosity Able to form a string 4 – 6 cm long
Erythrocyte count < 2000 cells/ L
Leukocyte count < 200 cells/L
Neutrophils < 20% of the differential
Lymphocytes < 15% of the differential
Monocytes and macrophages 65% of the differential
Crystals None present
Glucose < 10 mg/dL lower than blood glucose
Lactate < 250 mg/ dL
Total protein < 3 g/ dL
Uric acid Equal to blood volume

Joint Disorders
Group Classification
I. Noninflammatory
II. Inflammatory
III. Septic
IV. Hemorrhagic
Laboratory Differentiation of Transudates and Exudates
Appearance
Fluid:serum protein ratio
Fluid:serum LD ratio
White blood cell count
Spontaneous clotting
Pleural fluid cholesterol
Pleural fluid:serum cholesterol ratio
Pleural fluid:bilirubin ratio
Serum-ascites albumin gradient
12
Pathologic Significance Laboratory Findings
Degenerative joint disorders Clear, yellow fluid
Good viscosity
WBCs < 2000 L
Neutrophils < 30%
Normal glucose (similar to
blood glucose)
Immunologic problems, including rheumatoid Immunologic origin:
arthritis and lupus erythematosus Cloudy, yellow fluid
Poor viscosity
WBCs 2000-5000 L
Neutrophils > 50%
Decreased glucose level
Possible autoantibodies present
Crystal-induced gout and pseudogout Crystal-induced origin:
Cloudy or milky fluid
Poor viscosity
WBCs up to 50, 000 L
Neutrophils < 90%
Decreased glucose level
Elevated uric acid level
Crystals present
Microbial infection Cloudy, yellow-green fluid
Poor viscosity
WBCs 10,000-200,000 L
Neutrophils > 90%
Decreased glucose level
Positive culture and Gram stain
Traumatic injury Cloudy, red fluid
Coagulation deficiencies Poor viscosity
WBCs < 5000 L
Neutrophils > 50%
Normal glucose level
RBCs present
Transudate Exudate
Clear Cloudy
<0.5 >0.5
<0.6 >0.6
<1000/L >1000/L
No Possible
<60 mg/dL >60 mg/dL
<0.3 >0.3
<0.6 >0.6
>1.1 <1.1
 13
Correlation of Pleural Fluid Appearance and Disease

Appearance Disease
Clear, pale yellow Normal
Turbid, white Microbial infection (tuberculosis)
Bloody Hemothorax
Hemorrhagic effusion
Milky Chylous material from thoracic duct leakage
Pseudochylous material from chronic inflammation

Differentiation Between Chylous and Pseudochylous Pleural Effusions

Chylous Effusion Pseudochylous Effusion

Cause Thoracic duct leakage Chronic inflammation
Appearance Milky/white Milky/green tinge
Leukocytes Predominantly lymphocytes Mixed cells
Cholesterol crystals Absent Present
Triglycerides >110 mg/dL <50 mg/dL
Sudan III staining Strongly positive Negative/weakly positive

Significance of Cells Seen in Pleural Fluid

Cell Significance
Neutrophils Pneumonia
Pancreatitis
Pulmonary infarction
Lympocytes Tuberculosis
Viral infection
Autoimmune disorders
Malignancy
Mesothelial cells Normal and reactive forms have no clinical significance
Decreased mesothelial cells are associated with
tuberculosis
Plasma cells Tuberculosis
Malignant cells Primary adenocarcinoma and small-cell carcinoma
Metastatic carcinoma

Significance of Chemical Testing of Pleural Fluid

Test Significance
Glucose Decreased in rheumatoid inflammation
Decreased in purulent infection
Lactate Elevated in bacterial infection
Triglyceride Elevated in chylous effusions
pH Decreased in pneumonia not responding to antibiotics
Markedly decreased with esophageal rupture
Amylase Elevated in pancreatitis, esophageal rupture, and
malignancy
 14
Significance of Pericardial Fluid Testing

Test Significance
Appearance
Clear, pale yellow Normal
Blood-streaked Infection, malignancy
Grossly bloody Cardiac puncture, anticoagulant medications
Milky Chylous and pseudochylous material
Differential
Increased neutrophils Bacterial endocarditis
Malignant cells Metastatic carcinoma
Carcinoembryonic antigen Metastatic carcinoma
Gram stain and culture Bacterial endocarditis
Acid-fast stain Tubercular effusion
Adenosine deaminase Tubercular effusion

Significance of Peritoneal Fluid Testing

Test Significance
Appearance
Clear, pale yellow Normal
Turbid Microbial infection
Green Gallbladder, pancreatic disorders
Blood-streaked Trauma, infection, or malignancy
Milky Lymphatic trauma and blockage
Peritoneal lavage >100,000 RBCs/L indicates blunt trauma injury
WBC count
<500 cells/L Normal
>500 cells/L Bacterial peritonitis, cirrhosis
Differential Bacterial peritonitis
Malignancy
Carcinoembryonic antigen Malignancy of gastrointestinal origin
CA 125 Malignancy of ovarian origin
Glucose Decreased in tubercular peritonitis, malignancy
Amylase Increased in pancreatitis, gastrointestinal perforation
Alkaline phosphatase Increased in gastrointestinal perforation
Blood urea nitrogen/creatinine Ruptured or punctured bladder
Gram stain and culture Bacterial peritonitis
Acid-fast stain Tubercular peritonitis
Adenosine deaminase Tubercular peritonitis

Tests for Fetal Well-Being and Maturity

Test Normal Values at Term Significance

Bilirubin scan A450 > 0.025 Hemolytic disease of the newborn
Alpha-fetoprotein <2.0 MoM Neural tube disorders
Lecithin-sphingomyelin ratio 2.0 Fetal lung maturity
Amniostat-fetal lung maturity Positive Fetal lung maturity/ phosphotidyl
glycerol
Foam stability index 47 Fetal lung maturity
Microviscosity 70 mg/g Fetal lung maturity
Optical density 650 nm 0.150 Fetal lung maturity
Lamellar body count 32,000/ Fetal lung maturity
 15

Summary of Amniotic Fluid Color

Color Significance
Colorless Normal
Blood-streaked Traumatic tap, abdominal trauma, intra-amniotic
hemorrhage
Yellow Hemolytic disease of the newborn (bilirubin)
Dark green Meconium
Dark red-brown Death

Common Fecal Tests for Diarrhea

Secretory Diarrhea Osmotic Diarrhea

An increased secretion of water and electrolytes into An increased retention of water and solutes in the
the large intestine caused by bacterial large intestine associated with malabsorption and
enterotoxins maldigestion
Stool cultures Microscopic fecal fats
Ova and parasite examination Muscle fiber detection
Rotavirus immunoassay Qualitative fecal fats
Fecal leukocytes Trypsin screening
Microscopic fecal fats
Muscle fiber detection
Quantitative fecal fats
Clinitest
D-xylose tolerance test
Lactose tolerance test