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HI-MEDICINA DIAGNOSTIC Page No.
LABORATORY (HI-MED)
BRGY. SCOTTWOOD MANILA Page | 1
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STANDARD
OPERATING
PROCEDURE:
CLINICAL
MICROSCOPY
SECTION
Prepared by: Renz Jaztine R. Alcazar, Reviewed by: Alexa Marie N. Sabiniano, MD, Approved by: Ma. Carmelita C.
MLS (ASCPi)CM FPSP Pacquing, MD, MMHoA
Date: January 2023 Date: January 2023 Date: January 2023
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HI-MEDICINA DIAGNOSTIC LABORATORY (HI-MED)

STANDARD OPERATING PROCEDURES
MISSION
To deliver the highest quality of laboratory examination that will be recognized

for its accuracy and reliable results. To be a prominent medical diagnostic laboratory
that envisions a healthy community while providing inclusive services and assistance
with utmost care.
VISION
Hi-MED is committed to providing trustworthy and top-notch service to the

community through accurate, reliable, truthful, and generous service influencing the
betterment of healthcare.
Alexa Marie N. Sabiniano,

MD, FPSP
Pathologist / Laboratory
Director
Renz Jaztine R. Alcazar, Ma. Carmelita C.

MLS (ASCPi)CM Pacquing, MD, MMHOA
Chief Medical Technologist Clinical Section Head
Edrieile Alison C. Alzate,
RMT
Medical Technologist
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Joellyn Marie S. Aguilar, Beatrice Christine M.

RMT Panotes, RMT
Medical Technologist Medical Technologist
Luke Simone S. Ibañez, RMT
TABLE OF CONTENTS
MISSION…………………………………………………………………………………2
VISION……………………………………………………………………………………2
ORGANIZATIONAL CHART…………………………………………………….……7
ROUTINE URINALYSIS………………………………………………………………..8
Macroscopic……………………………………………………………………8
Introduction …………………………………………………………...8
Materials and Equipment……………………………………………8
Procedure………………………………………………………………8
Pre Analytical…………………………………………………8
Analytical………………………………………………………9
Post Analytical………………………………………………..9
Interpretation of Lab Result………………….……9
Reference Values……………………..……………..10
Manner of Reporting…………………………….….10
Proper Disposal………………………………..……11
Chemical Urine Strip…………………………………………………………..12

Introduction …………………………………………………………...12
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Procedure………………………………………………………………12
Pre Analytical…………………………………………………12
Analytical………………………………………………………13
Post Analytical……………………………………….……….13
Interpretation of Lab Result…………….…………14
Reference Values……………………………..……..14
Manner of Reporting………………………….…….16
Proper Disposal………………………………...……16
Microscopic………………………………………………………….….………17
Introduction ………………………………………………….………...17
Materials and Equipment………………………………….…………17
Procedure………………………………………………………….……17
Pre Analytical…………………………………………….……17
Analytical…………………………………………………….…18
Post Analytical……………………………………..………….19
Interpretation of Lab Result……………….……….19
Reference Values………………………….…………23
Manner of Reporting……………………….………..25
Proper Disposal……………………………….……..25
ROUTINE FECALYSIS………………………………………………….……..26
Introduction …………………………………………………………...26
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Procedure………………………………………………………………26
Pre Analytical…………………………………………………26
Analytical……………………………………………….………27
Post Analytical………………………………………….……..28
Interpretation of Lab Result……………….……….28
Reference Values…………………………….………29
Manner of Reporting………………………….……..30
Proper Disposal………………………………….…..30
FECAL OCCULT BLOOD TEST (GUIAC TEST)………………………..….31
Introduction ……………………………………………….…………...31
Materials and Equipment………………………………….….………31
Procedure………………………………………………….……………32
Pre Analytical…………………………………….……………32
Analytical………………………………………….……………32
Post Analytical…………………………………….…………..33
Interpretation of Lab Result………………….…….34
Reference Values……………………………….……34
Manner of Reporting…………………………….…..35
Proper Disposal……………………………….……..35
ENTAMOEBA HISTOLYTICA (EIA PRINCIPLE - QUIK CHEK)………….36
Introduction ……………………………………………………….…...36
Materials and Equipment……………………………….……………36
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Procedure…………………………………………………….…………38
Pre Analytical………………………………………….………38
Analytical………………………………………….……………39
Post Analytical………………………………………………..41
Interpretation of Lab Result……………………….41
Reference Values……………………………………41
Manner of Reporting………………………………..42
Proper Disposal……………………………………..43
REFERENCES………………………………………………………………….45
APPENDIX
Appendix A…………………………………………………….………48
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ORGANIZATIONAL CHART
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● ROUTINE URINALYSIS
- MACROSCOPIC
Introduction
Aimed to detect, identify, and describe disease-indicating abnormalities in the
urine, routine urinalysis is a vital diagnostic laboratory test procedure done in 3 parts.
First among these is the macroscopic analysis. This part of the process is determined
as the simplest procedure especially as this part only required a portion of the 5 basic
senses, excluding the sense of taste, to be performed. Yet, this physical examination
provides insight into what must be expected in the upcoming in-depth analysis
procedures in the latter parts of a routine urinalysis. Through this, the parameters
tested are the color, clarity, odor, and quantity of the urine. As such, this step helps
realize the presence of leukocytes, epithelial cells, crystals, and similar contaminants
found in the urine narrowing down the possibilities of what might be detected.
Materials and Equipment

Below are the materials needed for the macroscopic analysis:
1. Urine sample
2. Sterile plastic urine collection container
3. Personal protective equipment (PPE)
Procedure
Pre-Analytical Procedures
The following procedures are to be done prior to the urine sample collection:
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1. Interact with the patient. Introduce yourself

2. Check patient identification
3. Ensure the patient’s comfort regarding the specimen collection and
test procedure. Discuss the necessary information, particularly the
“clean-catch” method, with the patient.
4. Ask for the client’s informed consent and be sure to provide proper
documentation.
5. Instruct the patient to go to the provided facility where they will have
privacy and be comfortable in providing the fresh urine sample.
6. Prepare the necessary materials and workstations necessary for the
process. Check whether the container is free from contamination and
whether the lid fits securely.
7. Wear personal protective equipment (PPE) and perform proper hand
hygiene in accordance with the handwashing guidelines.
8. Ensure that recording instruments are within the working vicinity.
The next protocols are necessary to be followed during the storage of urine
samples:
1. The urine sample must be analyzed at room temperature within an
hour after the collection.
2. If not, then urine must be stored in a tight container and kept in an
environment with 2-8°C as its temperature
3. Overall, urine collected should be processed within 24 hours.
Analytical Procedures: Step by step procedure of the Macroscopic

In performing the analytical procedure of macroscopic urinalysis the following are the
steps to be followed:
1. Place the container filled with a urine sample on the workstation.
2. Observe the urine’s color and intensity, then record it.
3. Next, check for the turbidity of the urine. Once its opacity is
determined, take note of it.
4. Lastly, smell the sample being tested. Once the odor is assessed,
keep a record of the observation.
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Post Analytical Procedure: Interpretation of lab result, reference values, and

Manner of reporting) and proper disposals
Interpretation of laboratory results and reference values:
- A macroscopic examination of urine is based on the direct visual
observation of the sample. As such, keeping a record of the color,
color intensity, odor, and turbidity and comparing it to the reference
values are essential to reach an interpretation. These determining
factors will translate as to whether the urine sample is normal or
abnormal even in hindsight.
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Characteristics of Urine Normal Findings
Color Light to medium yellow
Turbidity Clear
Odor No unpleasant smell
Proper disposal
Once all related urinalysis procedures are accomplished, empty the urine into
a toilet bowl. Any used containers should be placed in a waterproof trash bag and
disposed of in a regular trash bag. Items such as gloves on the other hand should be
placed in biohazard bins. Workstations should also be disinfected thoroughly.
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- CHEMICAL URINE STRIP

Introduction
A routine urinalysis is a test of the urine that usually helps in detecting and
diagnosing diseases such as urinary tract infection, kidney infection, and diabetes.
One way of evaluating and testing the urine is what we call the dipstick test or the
chemical urine strip test. It is a simple and inexpensive way of testing a urine sample
wherein a thin stick with chemicals attached to it are dipped in the urine sample. The
strips will change their colors if there are substances detected. A color guide is
provided to see what the results are. This chemical urine strip test is used to test
acidity, concentration, protein, sugar, ketones, bilirubin, evidence of infection, and
blood.
The materials and equipment needed for the Chemical Urine Strip Test are the
following:
1. Urine sample
2. Disposable gloves
3. In date reagent sticks / strips
4. Sterile container
5. Watch or timer
6. Means to record the results
7. Clinical waste bin (for used dipsticks)
Procedure
1. In order to improve the quality of the specimen, discuss the procedure with
the patient.
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2. Get a verbal informed consent and make a detailed, accurate record for this.
3. Make sure that the privacy and dignity are maintained in order for the patient
to provide a fresh urine sample in the sterile container that was given to them.
4. Prepare the necessary things needed for the procedure.
5. Wear personal protective equipment (PPEs) and practice proper hand
hygiene in accordance with the trust policy.
6. The clinical work area should be cleaned before testing.
7. Before using, check the reagent test strip’s expiration date and make sure the
container is tightly closed.
8. Make sure that a clock with a second hand is in your line of sight.
Analytical Procedures: Step by step procedure of the Chemical Urine Strip

1. Remove the test strip from the container, then tightly screw the cover back
on.
2. Make sure the test squares are completely submerged in the urine for the
necessary amount of time as directed by the manufacturer by dipping the test
strip into the urine.
3. Run the test strip's bottom edge around the rim of the container as it is
carefully removed, releasing any excess pee.
4. Put the test strip on a piece of gauze and wait for the amount of time
recommended by the manufacturer. Please be aware that some test strip
squares, such as leukocytes, need longer time to get an accurate reading
than others. Never shake or blot the test strip's squares.
5. To analyze and compare the test strip's results with the color reference grid,
hold it horizontally. Make sure that the test strip does not come into contact
with the container and that urine does not flow between the squares,
combining different chemicals.
6. If additional laboratory testing on the urine is necessary, accurately mark the
specimen container with the proper patient information. If the urine is not
necessary, flush it down the toilet or into a designated sluice, and put the
specimen container and urine test strip in a clinical waste receptacle.
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1. Clean up the workspace, take off and discard PPE in accordance with local
regulations.
2. Use proper hand hygiene to avoid spreading infections.
3. Document all the results and findings accurately and go over them with the
patient, including any potential further actions that may be necessary.
4. Notify the appropriate medical professional of any unusual findings.
Interpretation of Lab Results
The chemical urine test strip is done using a reagent strip with chemicals attached to
it. If substances are present and found on a tested person, the colors will change. To
read and identify the results, the color of the strips that appeared is compared with a
reference color grid.
Reference Values
Normal values are as follows:
Color – Yellow (light/pale to dark/deep amber)
Clarity/turbidity – Clear or cloudy
pH – 4.5-8
Specific gravity – 1.005-1.025
Glucose - ≤130 mg/d
Ketones – None
Nitrites – Negative
Leukocyte esterase – Negative
Bilirubin – Negative
Urobilirubin – Small amount (0.5-1 mg/dL)
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Blood - ≤3 RBCs
Protein - ≤150 mg/d
RBCs - ≤2 RBCs/hpf
WBCs - ≤2-5 WBCs/hpf
Squamous epithelial cells - ≤15-20 squamous epithelial cells/hpf
Casts – 0-5 hyaline casts/lpf
Crystals – Occasionally
Bacteria – None
Yeast - None
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Manner of Reporting
The test results are being reported based on the color of the strips that emerged. The
reference color was shown above. An example is when the ketone is tested. After
waiting for a few seconds, if the strip’s color turned into light brown, the results show
that the ketone levels are negative which means that it is a normal level for an
individual.
Proper Disposal
After doing the procedure, the materials that were used should be properly discarded
in order to prevent contamination from happening. The used urine strip should be
disposed of in a biohazardous waste in accordance with all applicable regulations.
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- MICROSCOPIC ANALYSIS
Introduction
A laboratory test called routine urinalysis is carried out to check for and
uncover a number of medical conditions. An essential feature of the urinalysis is the
microscopic analysis, which allows for the detection of cells, crystals, and other
microscopic particles that could point and indicate an underlying medical condition.
The detection and measurement of cells, crystals, and other particles found in the
urine are done via microscopic examination, which is a crucial feature of a standard
urinalysis.

The materials and equipment needed for routine urinalysis, specifically for the
microscopic analysis component are the following:
1. Fresh urine specimen: 10-50 mL
2. Sterile urine collection container
3. Centrifuge or test tube rack
4. Microscope slides
5. Cover slips
6. Pipettes or droppers
7. Staining reagents (such as wright’s stain or leishman’s stain)
8. Microscope
Procedure
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● Storage and Stability

1. Urine samples must be stored at 2-8°C if analysis is not done
or performed within 2 hours of collection.
2. The slide should be examined and inspected within 1 hour of
preparation to prevent any changes in the cells or crystals.
● Calibration
1. The microscope must be calibrated in accordance with the
manufacturer's instructions before use.
2. Check that the microscope is in focus before beginning the
analysis.
● Quality Control
1. The person doing the analysis must be trained and qualified
with necessary education and experience.
2. Results should be verified by a second person or by a
supervisor.
3. Both positive and negative control samples should be included
with each batch of tests.
Analytical Procedures: Step by step procedure of the Microscopic Analysis

1. Obtain a 10–50 mL quantity of fresh urine in a sterile, clean container.
2. To separate the cells and particles from the clear urine, centrifuge the urine
sample or let it sit for a while.
3. Using a pipette or dropper, take a small amount of the sediment from the
bottom of the container or the centrifuged urine.
4. Place a small quantity of the sediment on a microscope slide, and add a drop
of urine to it to create a wet mount.
5. To maintain the specimen in place on the slide, apply a coverslip.
6. Employ both low and high power objectives to examine the slide under a
microscope. Inspect the urine for any cells, crystals, or other particles.
7. If necessary, the specimen can be stained or dyed to make some cells and
particles extra visible. Commonly used staining agents include Wright's stain
and Leishman's stain.
8. Keep a record of any cells or particles, including their quantity, shape, and
colour.
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Manner of reporting and proper disposals
● Interpretation of lab results:
A typical urinalysis' microscopic investigation is normally
examined based on the presence or absence of different cells and
particles, such as crystals, white blood cells, and red blood cells.
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These cells and particles' sizes and shapes can also be assessed. An
infection, an inflammatory reaction, or renal disease may be indicated
by the presence of specific cells or particles.
Presence of Crystals
Normal Crystals
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Abnormal Crystals
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Reference values:
The reference values for a routine urinalysis' microscopic
analysis differ from lab to lab, but in general terms, a normal urine
sample shouldn't have any crystals and should not include more than
a few red or white blood cells per high power field.
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Manner of reporting:
The results of the microscopic analysis are typically reported
as positive or negative for the presence of specific cells or particles,
along the numbers or amount present. For instance, "Occasional white
blood cells present" or "2-3 red blood cells/HPF."
Proper Disposals:
The microscopic analysis of the urine should be carried out in
a laboratory setting, and the used slides, cover slips, and staining
chemicals should be discarded in accordance with the biohazard
waste management policies and procedures of the laboratory.
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● ROUTINE FECALYSIS
Introduction
A routine fecal analysis (fecalysis) is used in the diagnosis in the series of
tests done on feces or stool samples that contain certain conditions affecting the
digestive tract. Feces or stool is the indigestible material waste residue that is made
up of cellulose during the previous 4 days, it also contains pigments and salts that
are derived from bile. Apart from that, it consists of mucus and other intestinal
secretions. Furthermore, feces consists of bacteria and inorganic material primarily
calcium and phosphates that are collected and sent to the laboratory. The stool will
be examined for its color, consistency, amount, shape, and mucus presence. Specific
instances such as infection from parasites, viruses, or bacteria, and even poor
nutrient absorption, and cancer are cases of these conditions. Hidden occult blood,
fat, meat fibers, bile, white blood cells, and sugars known as reducing substances
can all be found in the stool. The pH of the stool can also be determined. A stool
culture is performed to determine whether bacteria are the source of infection.
The materials and equipment used for routine fecalysis are the following:
1. Fresh feces or stool sample: 3-5 grams

2. Refrigerated specimens
3. Sterile stool container: with name, date, and time collection
4. Sealable plastic bag (diarrhea)
5. Stool collection sheet or device
6. Fecal swab kit (rectal swab)
7. Transport container tube
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Procedure
The following are interventions prior to a fecal analysis:
1. Determine the level of comfort of the patient. The patient may feel embarrassed
and uncomfortable while having a stool specimen collected.
2. Instruct the patient to urinate. Allow the patient to urinate before collecting the
stool to avoid contamination.
3. Laxatives should be avoided. Inform the patient that laxatives, enemas, or

suppositories should be avoided three days before collection. Other restrictions
may apply depending on what the physician is looking for in the stool sample. For
instance, when looking for hidden (occult) blood, the physician may ask you to
refrain from taking vitamin C, pain relievers, red meat, or certain fruits and
vegetables for at least three days prior to the specimen collection.
4. Instruct a diet low in red meat and high in residue. For two (2) days before the
test, the patient must follow a special diet that includes generous amounts of
chicken, turkey, tuna, raw and uncooked vegetables, and fruits such as spinach,
celery, prunes, and bran-containing cereal.
Analytical Procedures
Below is the procedure for specimen collection:
1. Label the Container
Most laboratory clinics and hospitals provide sterile containers for stool
collection, however it can also be purchased at any pharmacy nearby.
Choose a container that includes a scoop as much as possible. Label the
container with the full name, date, and time of collection before collecting the
specimen.
2. Urinate
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It is better to empty the bladder of the patient before collecting the

sample. This way, no urine will enter the sample. After that, the patient should
thoroughly wash hands.
3. Collect the stool specimen
If proper stool specimen collection procedures were followed, the patient
will not collect feces that have come into contact with the toilet or the water in
it. To catch the stool, place a clean container in the toilet. It could be a plastic
basin, plastic wrap, or even a newspaper spread. Then, take the sample with
the scoop that came with the container. Note that feces containing blood or
mucus are especially significant. Fill about a third of the container, or about
the size of a walnut. If the patient has diarrhea, a plastic bag in the bowl is
needed to collect feces. Finally, secure the lid and place it in a sealable
plastic bag.
4. Deliver the specimen to the laboratory
It would be preferable if the stool sample can be delivered as soon as
possible. The longer it takes to deliver the specimen, the more likely the
microorganisms are to multiply. This means that the stool no longer
accurately represents the microorganism levels in the gut. Even refrigerated
specimens cannot always be analyzed.
Post-Analytical Procedures
These are the following interventions after routine fecalysis:
1. Instruct the patient to wash their hands. Allow the patient to clean his or her
hands and perianal area thoroughly.
2. Restart your activities. Unless otherwise specified, the patient may resume his or
her normal diet and medication therapy.
3. Regular screening is advised.
Interpretation of Laboratory Results
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The stool is brown, soft, and well-formed in appearance. There is no blood,

mucus, pus, undigested meat fibers, harmful bacteria, viruses, fungi, or parasites in
the stool.
Stool can be examined using one of two methods:
1. Macroscopic examination: for appearance and color.
2. Microscopic examination: for cell count and meat fiber presence; leukocyte
esterase for leukocytes; Benedict's solution (copper sulfate) for reducing
substances; guaiac for occult blood; x-ray paper for trypsin.
These are the classification of most clinically significant parasites - specially
on the diagnostic stage.
Reference Values
Characteristics of Stool Normal Findings
Appearance Solid and formed
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Color Brown
Epithelial cells Few to moderate
Fecal fat Less than 7 grams of fat per 24 hours
Leukocytes, Meat Fibers, Occult Blood, Negative

Reducing substances
Trypsin 2+ to 4+
Manner of Reporting
A reducing substance is present if the supernatant fluid turns green-brown (the
test is positive). The test result is normal if the amount of reducing substance in the
stool is 0.25 mg/dL. If it is between 0.25 and 0.5 mg/dL, the test result is
suspicious. If it is greater than 0.5 mg/dL, the test result is abnormal.
Proper Disposal
When working with specimens, wear safety glasses, gloves, and a laboratory
coat. As needed, use biological safety cabinets. In the workplace, do not eat, drink,
smoke, apply cosmetics, or manipulate contact lenses. Decontaminate the work
surface at least once per day and immediately after any spill of potentially
infectious material.
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● FECAL OCCULT BLOOD TEST (GUAIAC TEST)
Introduction
The Fecal Occult blood test or the stool guaiac test is a laboratory test
intended for checking and finding hidden or occult blood (blood that is not easily seen
by the naked eye) in the stool or feces samples. When a trace amount of blood was
found in a stool sample, this could be an indication of colon or rectal cancer. Usually,
larger polyps or cancers frequently have delicate exterior blood vessels which are
easily damaged by passing feces. Because of that, a tiny amount of blood typically
leaks from the broken blood vessels into the feces. However, it is to be noted that
there are other circumstances that can cause blood in the stool such as hemorrhoids
or colitis. Moreover, occult blood can only be detected through chemical reactions or
chemicals involved in a fecal occult blood test. Basically, the Fecal Occult blood test,
also known as, guaiac test is designed to detect whether occult blood is present in a
stool or not; it cannot identify the reason for the bleeding. That’s why additional tests
are recommended if blood was detected in a stool.
The materials and equipment used for Fecal Occult Blood test (Guaiac test) are the
following:
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1. Fresh fecal or stool samples (if given a container, fill it around 1/3 of it)
2. Clean, dry stool container (with name, date, and time collection)
3. Hemoccult Test kit
● Hemoccult slide or Hemoccult testing card (contains a guaiac paper
with a phenolic compound called alpha-guaiaconic acid)
● Hemoccult developing solution (usually a Hydrogen Peroxide reagent
is applied to the hemoccult slide containing the stool sample)
● Applicator sticks or wooden applicator sticks
4. Disposable gloves
5. Trash can
Procedure
The following procedures are done prior to the Fecal Occult Blood test:
1. Interact with the patient. Establish rapport.

2. Determine the patient’s level of cooperation with the procedure of collecting
stool samples as well as the patient’s level of comfort as he/she may feel
uncomfortable while collecting the specimen.
3. Instruct a special diet for at least 48 to 72 hours and restrict the patient with
certain foods like red meat, vitamin C supplements, peroxidase-rich
vegetables including broccoli, spinach, turnip, mushrooms, and beans, as well
as certain drugs like aspirin, anticoagulants, steroids, iron, and colchicine.
These foods may cause false-positive or false-negative results.
4. Explain the procedures of the fecal occult blood test to the patient.
5. Provide the patient with a clean, dry container for the stool specimen.
6. Remind the patient to refrain from contaminating the samples with urine or
toilet tissue.
7. Wear personal protective equipment (PPE) and perform hand hygiene.
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The next protocols are necessary to be followed once the stool specimen was
already acquired:
8. Identify the patient. Ask for his/her name, age, and birthdate. Then, label
properly the stool sample.
9. Place the stool specimen at room temperature.
10. Prepare the essential materials, especially the Hemoccult test kit.
Analytical Procedures: Step by step procedure of the Fecal Occult Blood test
Below are the procedures to be done while conducting the Fecal Occult Blood test:
1. Open the cover of the Hemoccult slide or Hemoccult testing card.

2. Obtain a small and thin stool sample using the tip of a wooden applicator
stick, and then smear it onto the guaiac paper in the first box provided by the
Hemoccult slide.
3. From a different area of the stool sample, obtain again a small and thin
specimen using the tip of a wooden applicator stick, and then smear it onto
the second box of the guaiac paper this time.
4. Wait until the smeared stool sample has dried up.
5. After closing the cover, turn the Hemoccult slide over.
6. Open the other cover or flap of the Hemoccult slide.
7. Add two (2) drops of Hydrogen Peroxide reagent (a Hemoccult developing
solution) to each paper box holding the stool sample smear. The solution then
penetrates the specimen.
8. On the verifying area of the Hemoccult testing card, apply one (1) drop of the
same Hemoccult developing solution.
9. Allow to sit for 30 to 60 seconds.
10. After the recommended time of waiting, check the result of the test. An
indication that there is occult blood in the stool (positive result) is a bluish
discoloration.
11. Note the findings.
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Post Analytical Procedures:

The following protocols are required to follow after the Fecal Occult Blood test:
1. Dispose of the used Hemoccult slide or testing card along with wooden
applicator sticks and gloves. If the test results are positive, it is recommended
to save the stool samples for future examinations.
2. Perform hand hygiene.
3. The physician may instruct the patient to resume his/her regular diet.
4. The test may be repeated.
Post Analytical Procedures:

Interpretation of lab result and reference values
The Hemoccult slide or testing card contains a guaiac paper with a phenolic
compound called alpha-guaiaconic acid which is expected to have a chemical
reaction with a reagent, Hydrogen Peroxide. If occult blood is present in the stool
sample of the tested patient, the Hemoccult slide or testing card will change its color
to blue. And, to identify the result, take note of the color change as this will help
determine whether occult blood is present in the stool sample or not.
Color Change Findings
No color change Negative for occult blood -
Light blue coloration Positive for occult blood About 5 mg per dL of occult
blood in the stool
Strong blue coloration Positive for occult blood Greater than 5 mg per dL of
occult blood in the stool
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Manner of Reporting
The Fecal Occult Blood test results are reported based on the color change
that has emerged in the Hemoccult slide or testing card. The test result is normal and
negative for occult blood if the Hemoccult slide shows no color change, this means
that there was no blood detected in the specimen. Meanwhile, if the Hemoccult slide
resulted in a blue discoloration, the stool specimen is positive for occult blood.
Hence, additional laboratory testing is advised to identify the cause of bleeding.
Proper Disposal
The used Hemoccult slide or testing card, wooden applicator sticks,

disposable gloves, and other discarded materials must be disposed of in line with the
lab's biohazard waste management rules and protocols. The workstations on the
other hand must be thoroughly sanitized and disinfected.
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● ENTAMOEBA HISTOLYTICA TEST

- EIA Principle- QUIK CHEK
Introduction
Amebiasis is caused by a protozoan parasite called Ent+amoeba histolytica,
and symptoms typically include intestinal problems. The E. histolytica (Amebiasis)
ELISA test requires three incubations, the first of which involves coating the wells
with E. Antigen that causes histolysis. The wells must then be washed in order to
remove the test sample. Enzyme Conjugate is added at this point. During this second
incubation, the Enzyme Conjugate will bind to any antibodies present. The
chromogen TMB is then added, which turns blue in the presence of the enzyme
complex and peroxide. The stop solution brings the reaction to a halt and changes
the blue color to yellow. The EIA test detects antibodies that are specific for E.
histolytica in approximately 95% of patients with extraintestinal amebiasis, 70% of
patients with active intestinal infection, and 10% of asymptomatic individuals passing
E. coli cysts. histolytica. Antigen detection can distinguish pathogenic from
nonpathogenic infections and may be useful as an adjunct to microscopic diagnosis
in detecting parasites.
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Materials Contained in the ELISA kit:
Short term Code Meaning Amount Unit
WELL 9550-01 Breakable ELISA strips sensitized with wells

Entamoeba histolytica soluble 96
trophozoite antigens
DILB 9550-02 Dilution buffer (10 x) concentrate, 50 ml

coloured purple
WASH 9550-03 Washing solution (10 x) concentrate 50 ml
ENZB 9550-04 Enzyme buffer 50 ml
STOP 9550-05 Stopping solution (0.5M K3PO4) 25 ml
CONTROL (-) 9550-06 Negative control serum (20 x), green cap
200 µl
CONTROL (-/+) 9550-07 Weak positive control serum (cut off, 20

x), yellow cap 200 µl
CONTROL (+) 9550-08 Positive control serum (20 x), red cap
200 µl
CONJ 9550-09 Protein A - alkaline phosphatase

conjugate (50 x), purple cap 300 µl
SUBS 9550-10 Phosphatase substrate (para-

nitrophenylphosphate) 20 Tablets
Multipipette reservoir, 25 ml 1 Piece
Frame for ELISA 8-well holder 1 Piece
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Materials not included in the ELISA test kit:
● Pipettes (ml and µl).

● Flasks.
● Dilution tubes.
● Adhesive tape to cover wells during incubations.
● Distilled water.
● Incubator set at 37°C.
● ELISA reader set at 405 nm.
● Manual or automatic equipment for rinsing wells.
● Vortex mixer.
● Timer.
Procedure
- Pre- Analytical Procedure:
Note: Direct detection of Entamoeba histolytica in fecal specimens is
recommended to diagnose intestinal amebiasis. This includes OAP / Ova and
Parasite, Concentrate and Permanent Smear, Microscopy, Feces or OAPNS / Ova
and Parasite, Microscopy, Varies.*
For EIA Principle-QUIK CHEK
Collection Container/Tube:
Preferred: Serum gel
Acceptable: Red top
Submission Container/Tube: Plastic vial
Specimen Volume: 0.5 mL
Collection Instructions: Centrifuge and aliquot serum into a plastic
vial.
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Storage and transportation: The preferred temperature for serum is

frozen (30 days) or refrigerated (7 days).
Preparation of reagents before use:
● ELISA wells: Remove the required number of wells from the side of
the aluminum bag 9550-01 (one for the blank, three for controls, plus
the number of samples). Fill an 8-well holder(s) with sensitized wells.
Fill the holder's empty positions with used wells if necessary. Insert
the necessary holder(s) into the frame. Use a desiccant pad to seal
the package.
● Dilution buffer: One-tenth of distilled water is used to dilute dilution
buffer (10 x) concentration 9550-02. Controls, samples, and
conjugates are all diluted with this. For two months, the diluted buffer
is stable at 2-8°C.
● Washing Solution: Dilute washing solution (10 x) concentrate 9550-
03 in distilled water by one-tenths. It is possible to create your own
washing solution. Avoid buffers containing phosphate, which may
hinder the Alkaline phosphatase enzyme activity. The diluted washing
solution is stable for 2 months at 2-8°C.
● Control Sera: 10 µl control sera 9550-06 to -08 diluted in 190 µl
dilution buffer solution (final dilution 1/20). The diluted control sera are
stable at 2-8°C for 2 months.
● Conjugate: Dilute conjugate 9550-09 in dilution buffer solution to 1/50
(final dilution). On the day of the assay, dilute the conjugate. Diluted
conjugate should not be stored.
● Substrate Solution: Dissolve phosphatase substrate 9550-10
tablet(s) in undiluted enzyme buffer 9550-04 (1 tablet in 2.5 ml buffer)
(1 tablet in 2.5 ml buffer). Vortex the mixture until the tablet is
completely dissolved (s). On the day of the assay, place the tube in a
diluted medium and keep it away from direct sunlight. Tablets and
substrate solutions should be colorless or have a slight yellow hue. If a
tablet or substrate solution turns yellow, it is possible that it has been
partially hydrolyzed and should be discarded. The substrate solution
should not be kept in storage.
Analytical Procedures:
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Step by step procedure of the ELISA test:

1. Fill wells completely with dilution buffer solution.
2. Incubate for 5 to 15 minutes at room temperature (blocking).
3. Aspirate the dilution buffer or shake the
4. Fill only the first well of the first strip with a 100 µl dilution buffer (no-serum
blank).
5. Fill the remaining three wells with 100 µl diluted negative, weak positive
(cut off), and positive control serum. For assays with more than 25 samples, it
is recommended that the three last wells be filled with control sera as a
duplicate.
6. Fill the remaining wells with the diluted samples (100 µl each).
7. Cover wells with adhesive tape and incubate for 30 minutes at 37°C.
8. Remove sera and wash four times with a 250 µl washing solution.
9. In each well, pour 100 µl of diluted conjugate (including no-serum blank).
10. Cover wells with adhesive tape and incubate at 37°C for 30 minutes.
11. Remove the conjugate and wash it four times with a 250 µl washing
solution.
12. Pour 100 µl of substrate solution into each well.
13. Cover the wells with adhesive tape and incubate at 37°C for 30 minutes.
14. Stop the reaction by adding 100 µl of stopping solution to each well.
15. Wipe the bottoms of the wells if necessary to remove bubbles. Within 1
hour of adding the stopping solution, measure absorbances at 405 nm.
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Post Analytical Procedure:

Interpretation and Reference Values:
Subtract the no-serum blank value from all measured values.
Calculate the mean absorbance values of duplicated serum controls when
applicable. If the following criteria are met, the test is valid:
- Positive control absorbance (A) > 1.200
- A of the negative control equals 14% of the A of the positive control
- A of blank versus air 0.350
The antibody concentration of the weak positive (cut off) serum 9550-07 has
been optimized to distinguish between sera from clinically documented cases of
amebiasis and healthy human sera. After subtracting the no-serum blank, the cut off
index of a sample is determined.
Manner of Reporting:
When the index of the analyzed sample is less than 1.0, the result is
negative. The IgG antibody concentration against Entamoeba histolytica soluble
antigens is clinically insignificant in this case. When the index of the analyzed sample
is greater than 1.0, the result is positive. The IgG antibody concentration against
Entamoeba histolytica soluble antigens is considered clinically significant in this case.
significant. It means the patient has had contact with the parasite. Each laboratory
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could define a grey zone based on its patient population. In the event of borderline or
doubtful results, we recommend repeating the test with a fresh sample 2-4 weeks
later.
Proper Disposal
All of the substances employed in this test are often regarded as hazardous
waste. These are the steps that we need to follow in disposing hazardous waste:
1. Classify whether waste is harmful.
Any waste that company generates must be described in full before
being sent for recycling and disposal. The description must include the waste
classification code, whether it is hazardous, the type of location or business
where the waste was produced, the name of the substance or substances,
the process that produced the waste, a chemical and physical analysis, and
any unique issues, needs, or waste-related information.
2. Safely segregate and store hazardous trash.
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Store waste in a secure location, use appropriate containers that will

stop waste from escaping, label containers clearly with the type of waste they
contain, use covers to stop waste from blowing away, use waterproof covers
if rain could cause contaminated run-off, or prevent the waste from being
reused are all examples of safe and secure waste storage.
3. To collect, recycle, or dispose of your hazardous trash, use an authorized
waste carrier.
Make sure the waste carrier chosen is registered and has the
necessary permits for their disposal facilities. Even after waste has left the
premises, your business is still liable for its disposal.
4. In the consignment note, complete the sections.

Hazardous waste must be transported using consignment notes, and
these notes must remain with the hazardous waste until it reaches its
destination.
5. Keep records at the location where the garbage was created or held for
three years.
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REFERENCES
Adventist Medical Center Manila (2022). Retrieved from https://getliner.com/picked-
by-liner/reader-mode?url=https%3A%2F%2Famcmanila.org%2FServices-and-
Treatment%2FDepartmental-Services%2FPathology-and-Laboratory%2FClinical-
Pathology%2FParasitology%2FFecalysis
Bordier Affinity Product SA (2018). Entamoeba histolytica - Bordier. Retrieved from

http://www.bordier.ch/IFU/9550/51104_05%20TN%20Eng%209550.pdf
Fecal occult blood test. (2017, July 3). RNpedia. https://www.rnpedia.com/nursing-

notes/medical-surgical-nursing-notes/fecal-occult-blood-test/
Fecalysis (2022). Retrieved from website: https://getliner.com/picked-by-liner/reader-

mode?url=https%3A%2F%2Fwww.slideshare.net%2FZawahirahSamsodin
%2Ffecalysis
Fialová, L., & Vejražka, M. (n.d.). ÚSTAV LÉKAŘSKÉ BIOCHEMIE A

LABORATORNÍ DIAGNOSTIKY 1. LF UK Urine analysis II: Physical examination
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Urinary sediment General Medicine. https://ulbld.lf1.cuni.cz/file/3376/urine-physical-

sediment1819.pdf
How to Properly Collect a Stool Sample (2021, August 2). Retrieved January 30,
2023, from Hello Doctor website:
https://hellodoctor.com.ph/health/diagnosis-tests/stool-specimen-collection-
procedure/
J. (2017, October 12). Routine Urinalysis. Cayuga Medical Center.

https://www.cayugamed.org/article/routine-urinalysis/
Kassa, A., Wolde, B., & Kibret. (2002). LECTURE NOTES Urinalysis.
https://www.cartercenter.org/resources/pdfs/health/ephti/library/lecture_notes/
med_lab_tech_students/LN_Urinalysis_final.pdf
Labpedia.net. (2022, May 5). Stool examination: stool for occult blood.
https://labpedia.net/stool-examination-part-4-stool-for-occult-blood-ob/
Lerma, E. V., MD. (2022, June 21). Urinalysis: Reference Range, Interpretation,
Collection and Panels. https://emedicine.medscape.com/article/2074001-overview
Martin, P. (2019, February 25). Fecal Analysis (Stool Analysis). Retrieved January
30, 2023, from Nurseslabs website: https://nurseslabs.com/fecal-analysis-stool-
analysis/
Mayo Clinic Laboratories (n.d.). Neurology Catalog. Retrieved from

https://neurology.testcatalog.org/
Microscopic examination of urine sediment. (2022, October). Retrieved from

https://www.uptodate.com/contents/microscopic-examination-of-urine-sediment
Mosby's nursing video skills. (n.d.). Performing Fecal Occult Blood testing.
http://mosby.lambtoncollege.ca/intermediate/skill/P002.html
N. (2016, August 16). Urine test strip. PORTAL MyHEALTH.

http://www.myhealth.gov.my/en/urine-test-strip/
Naing, K. M., Boonsang, S., Chuwongin, S., Kittichai, V., Tongloy, T., Prommongkol,
S., … Watthanakulpanich, D. (2022). Automatic recognition of parasitic products in
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stool examination using object detection approach. PeerJ Computer Science, 8,

e1065. https://doi.org/10.7717/peerj-cs.1065
Stool Analysis. (2019). Retrieved January 30, 2023, from Alberta.ca website:
https://myhealth.alberta.ca/Health/Pages/conditions.aspx?hwid=aa80714
Urinalysis - Doctors & Departments - Mayo Clinic. (2021). Retrieved January 30,
2023, from Mayoclinic.org website:
https://www.mayoclinic.org/tests-procedures/urinalysis/doctors-departments/pdc-
20384908
Urinalysis - Microscopy. (2021, January). Retrieved from

https://www.mayocliniclabs.com/test-catalog/Overview/81754
Urine Normal Values, and Their Significance - Labpedia.net. (2021, April 10).
Retrieved January 30, 2023, from Labpedia.net website: https://labpedia.net/urine-
normal-values-and-their-significance/
Urine Reagent Strip Procedure - LabCE.com, Laboratory Continuing Education.

(n.d.). https://www.labce.com/spg130902_urine_reagent_strip_procedure.aspx
Urine test strips. (n.d.). Vet Nursing Education. https://www.vetnursing.ie/urine-test-
strips
Urinalysis using a test strip. (n.d.). British Journal of Nursing.
https://www.britishjournalofnursing.com/content/clinical/urinalysis-using-a-test-strip/
Urinalysis - Mayo Clinic. (2021, October 14). https://www.mayoclinic.org/tests-
procedures/urinalysis/about/pac-20384907
Urinalysis Reagent Strips. (n.d.). imgcdn.mckesson.com.

https://imgcdn.mckesson.com/CumulusWeb/Click_and_learn/SDS_BSL_URISCAN_
2GP_URINE_TEST_STRIPS_100_BT_10BT_CS.pdf
Urine Crystals Test Purpose, Procedure, Results And More | Lab Tests Guide.(2020,
January 14). Retrieved January 30, 2023, from Lab Tests Guide website:
https://www.labtestsguide.com/urine-crystals
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Reed, A. (2023, January 10). Best Keto Urine Strips to Measure Ketones (incl. How
To). Bodyketosis. https://bodyketosis.com/best-keto-strips/
What Is Urinalysis? (2017, April 17). WebMD. https://www.webmd.com/a-to-z-
guides/what-is-urinalysis
APPENDIX A: Workflow of Receiving Specimen for Laboratory Dispatch
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Change History
New SOP no. Effective Date Significant Changes Previous SOP No.
HIMEDCM01282023 January 28, 2023 First Version N/A
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Authored by:
Joellyn Marie S. Aguilar, RMT

Edrieile Alison C. Alzate, RMT

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Luke Simone S. Ibañez, RMT

Beatrice Christine M. Panotes, RMT

Recommending Approval:
Ma. Carmelita C. Pacquing, MD, MMHoA

Clinical Section Head
Renz Jaztine R. Alcazar, MLS (ASCPi)CM

Chief Medical Technologist
Approved by:
Alexa Marie N. Sabiniano, MD, FPSP

Pathologist/ Laboratory Director

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HI-MEDICINA DIAGNOSTIC Page No.

HI-MEDICINA DIAGNOSTIC LABORATORY (HI-MED)

To deliver the highest quality of laboratory examination that will be recognized

Hi-MED is committed to providing trustworthy and top-notch service to the

Alexa Marie N. Sabiniano,

Renz Jaztine R. Alcazar, Ma. Carmelita C.

Joellyn Marie S. Aguilar, Beatrice Christine M.

Chemical Urine Strip…………………………………………………………..12

Materials and Equipment……………………………………………12

Materials and Equipment……………………………………………26

Materials and Equipment

1. Interact with the patient. Introduce yourself

Analytical Procedures: Step by step procedure of the Macroscopic

Post Analytical Procedure: Interpretation of lab result, reference values, and

Characteristics of Urine Normal Findings

Color Light to medium yellow

Odor No unpleasant smell

- CHEMICAL URINE STRIP

Analytical Procedures: Step by step procedure of the Chemical Urine Strip

Post Analytical Procedure: Interpretation of lab result, reference values, and

Materials and Equipment

● Storage and Stability

Analytical Procedures: Step by step procedure of the Microscopic Analysis

Post Analytical Procedure: Interpretation of lab result, reference values, and

1. Fresh feces or stool sample: 3-5 grams

The following are interventions prior to a fecal analysis:

3. Laxatives should be avoided. Inform the patient that laxatives, enemas, or

It is better to empty the bladder of the patient before collecting the

Interpretation of Laboratory Results

The stool is brown, soft, and well-formed in appearance. There is no blood,

Characteristics of Stool Normal Findings

Appearance Solid and formed

Epithelial cells Few to moderate

Fecal fat Less than 7 grams of fat per 24 hours

Leukocytes, Meat Fibers, Occult Blood, Negative

● FECAL OCCULT BLOOD TEST (GUAIAC TEST)

Materials and Equipment

1. Interact with the patient. Establish rapport.

1. Open the cover of the Hemoccult slide or Hemoccult testing card.

Post Analytical Procedure: Interpretation of lab result, reference values, and

Post Analytical Procedures:

Post Analytical Procedures:

Color Change Findings

No color change Negative for occult blood -

The used Hemoccult slide or testing card, wooden applicator sticks,

● ENTAMOEBA HISTOLYTICA TEST

Materials and Equipment

Materials Contained in the ELISA kit:

Short term Code Meaning Amount Unit

WELL 9550-01 Breakable ELISA strips sensitized with wells

DILB 9550-02 Dilution buffer (10 x) concentrate, 50 ml

WASH 9550-03 Washing solution (10 x) concentrate 50 ml

ENZB 9550-04 Enzyme buffer 50 ml

STOP 9550-05 Stopping solution (0.5M K3PO4) 25 ml

CONTROL (-/+) 9550-07 Weak positive control serum (cut off, 20

CONJ 9550-09 Protein A - alkaline phosphatase

SUBS 9550-10 Phosphatase substrate (para-

Multipipette reservoir, 25 ml 1 Piece

Frame for ELISA 8-well holder 1 Piece

Materials not included in the ELISA test kit:

● Pipettes (ml and µl).

Storage and transportation: The preferred temperature for serum is