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Cuyahoga Community College *

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1000

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Chemistry

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May 4, 2024

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docx

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11

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Performing a Urinalysis: Physical Examination There are several steps to performing a urinalysis in the clinical laboratory. This lecture will go over the first step and covers what we will be doing on our first day in urinalysis lab. The first step in performing a urinalysis is the physical examination. This includes recording the color and clarity of the sample. This may also include a specific gravity measurement on a refractometer. Color and Clarity Before observing the color and clarity, it is important to mix the sample well, as particles sometimes collect in the bottom of the urine cup. If the urine cup is not clear, and color and clarity cannot accurately be determined, it is also good practice to pour it off into a clear tube to best determine the color and clarity of the sample. Urine can come in various colors, but there is a standard when determining urine colors, that we must follow in the lab. Unfortunately, we are not allowed to come up with our own descriptions and determine that a urine sample looks to be canary yellow. Below are the color descriptions that are expected to be used in the laboratory when determining urine color.
Normal Urine Color Typically, normal urine is represented by some shade of yellow, and this is due to the urochrome pigmentation. Appropriate descriptions are as follows: Colorless Pale Yellow (also commonly referred to as Light Yellow, Straw) Yellow Dark Yellow Amber Abnormal Urine Color The abnormal urine colors include: Orange-yellow Yellow-green Green Blue-green Pink-red Portwine Red-brown Brown-black Refer to the table in your textbook that describes the different causes for varying colors of urine. When working in a hospital laboratory, most computer systems will have the tech select a color choice, rather than having them type in a color. This helps to streamline variation in terminology. The terminology above is what is used in our textbook, so when determining color and clarity, we are going to stick with these descriptions. Shades of pink and red are some of the most common deviations from the normal shades of yellow urine colors. Pink and red urine can have various causes. The flow chart below helps to determine if the source of the red urine is due to
hemoglobinuria, myoglobinuria, or hematuria. Note that if the sample is red and cloudy, this can be indicative of red blood cells being present in the urine. However, we must rule out the possibility that the cause of the cloudy sample could be due to white blood cells, mucus, bacteria, etc. Clarity Normal freshly voided urine is typically clear. The presence of particles in the urine can create a hazy or cloudy appearance. Fresh urine that exhibits cloudiness is a good indicator that the sample will require a microscopic exam, although not all cloudiness indicates a pathological issue The following terms are used to describe urine clarity: Specific Gravity
The specific gravity is also included in the physical examination of urine. Most current test methods will include a specific gravity in their chemistry measurement. However, previous methods included the urinometer and refractometer for determining the specific gravity of urine. In our college lab, we will learn how to use the refractometer but will utilize reagent strip testing to determine the specific gravity for most of our samples. Refractometer A refractometer is a meter that measures the total solids of a solution, usually by measuring the refractive index of the solution. Refractive Index- the ratio of the velocity of light in air to the velocity of light in solution. One downside to using the refractometer is that the presence of dense molecules requires a correction. Due to the influence of highly dense molecules such as protein and glucose on specific gravity, certain laboratory procedures necessitate adjustments for elevated concentrations of glucose and protein. This correction involves subtracting 0.003 from the specific gravity reading for every 1g/dL of protein and 0.004 for every 1g/dL of glucose. Specific Gravity on Reagent Strip Some reagent dipsticks feature a specific gravity measurement pad based on the dissociation constant of pretreated polyelectrolytes in relation to ionic concentration. This procedure assesses the ionic concentration of urine, correlating with specific gravity. Polyelectrolytes in the pad have acid groups that dissociate based on the ionic concentration. More ions lead to more dissociation, changing pH. The reagent pad contains a pH indicator to measure this change. Higher urine specific gravity makes the pad more acidic, reflected in color changes from deep
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