See the Emergency Closures page before visiting a CDFW office, facility or property. Hemolyzed Specimens: A Reason for Rejection or a Clinical Challenge Many gram-negative and some gram-positive organisms are capable of this conversion, and a positive dipstick nitrite test indicates that these organisms are present in significant numbers (i.e., more than 10,000 per mL). Microscopic examination also may detect RBC casts or dysmorphic RBCs. Specimens in which there has been a si gnificant time delay between specimen coll ection and specimen receipt (more than 24 Each case study walks you through a clinical problem using appropriate techniques in microscopy at each step. (2018). How does negative staining help us visualize capsules? Is endospore staining an example of positive, negative, or differential staining? Specimen rejection criteria | The Doctors Laboratory What is Hemolysis and How to Prevent it - Phlebotomy Leukocyte esterase is produced by neutrophils and may signal pyuria associated with UTI. Project-level impacts to listed (rare, threatened, or endangered species) species are generally considered significant thus requiring lead agencies to prepare an Environmental Impact Report to fully analyze and evaluate the impacts. However, you may need to stop taking some types of medication that can alter your test results. Causes and impact of specimen rejection in a clinical chemistry Except where otherwise noted, textbooks on this site A secondary counterstain, methylene blue, is then applied, which renders nonacid-fast cells blue. Squamous epithelial cells are large and irregularly shaped, with a small nucleus and fine granular cytoplasm; their presence suggests contamination. A complete urinalysis includes physical, chemical, and microscopic examinations. 1999-2023, Rice University. The waxy, acid-fast cells retain the carbolfuchsin even after a decolorizing agent (an acid-alcohol solution) is applied. [ corrected] To detect significant pyuria accurately, 30 seconds to two minutes should be allowed for the dipstick reagent strip to change color, depending in the brand used. View press releases. In assigning "impact significance" to populations of non-listed species, analysts usually consider factors such as population-level effects, proportion of the taxon's range affected by a project, regional effects, and impacts to habitat features. Some staining techniques involve the application of only one dye to the sample; others require more than one dye. An alternative approach for determining the presence of M. tuberculosis is immunofluorescence. When using this technique, it is important to handle the specimen with great care; flagella are delicate structures that can easily be damaged or pulled off, compromising attempts to accurately locate and count the number of flagella. In healthy persons, the glomerular capillary wall is permeable only to substances with a molecular weight of less than 20,000 Daltons. In fact, a recent study1 found that contamination rates were similar in specimens obtained with and without prior cleansing (32 versus 29 percent). Urologic causes of hematuria include tumors, calculi, and infections. Prepare a smear using 2 to 3 drops of the specimen depending on density. (2005). If the culture results are reported as mixed normal upper respiratory flora, clinicians may be more likely to de-escalate empiric treatment and search for other causes of the patients symptoms. Clearly define specimen rejection criteria that will identify those circumstances when a new specimen is required. After testing several antibiotics, the lab is able to identify one that is effective against this particular strain of S. aureus. Access your health information from any device with MyHealth. If no endospores are present, then only the pink vegetative cells will be visible (Figure 2.38). Unconjugated bilirubin is water insoluble and cannot pass through the glomerulus; conjugated bilirubin is water soluble and indicates further evaluation for liver dysfunction and biliary obstruction when it is detected in the urine. Glucose normally is filtered by the glomerulus, but it is almost completely reabsorbed in the proximal tubule. Hunter Ed is committed to Hunting education safety. Epithelial cells often are present in the urinary sediment. Note that population estimates are unavailable for the vast majority of California taxa; depend on a habitat that has shown substantial historical or recent declines in size and/or quality or integrity. The CPD additive in a donor unit of blood serves to do all of the following except: Control bacterial contamination. Organisms such as Chlamydia and Ureaplasma urealyticum should be considered in patients with pyuria and negative cultures. Rejection criteria for sputum samples is still broad and not universal, but they have provided algorithms for laboratories to follow in order to prevent the culture of samples that are grossly contaminated with oropharyngeal flora. A Species of Special Concern (SSC) is a species, subspecies, or distinct population of an animal* native to California that currently satisfies one or more of the following (not necessarily mutually exclusive) criteria**: *for the purposes of this discussion, "animal" means fish, amphibian, reptile, bird and mammal, **criteria for fishes are similar except that Federally listed taxa are not defined as SSCs. Glycosuria occurs when the filtered load of glucose exceeds the ability of the tubule to reabsorb it (i.e., 180 to 200 mg per dL). 2023 Healthline Media LLC. phlebotomy chapter 11 venipuncture complications - Quizlet Cloudy urine often is a result of precipitated phosphate crystals in alkaline urine, but pyuria also can be the cause. Privacy Policy sets forth the information we collect about you, how we use A midstream clean-catch technique usually is adequate in men and women. From the results of the Gram stain, the technician now knows that Cindys infection is caused by spherical, gram-positive bacteria that form grape-like clusters, which is typical of staphylococcal bacteria. Certain bacteria and yeasts have a protective outer structure called a capsule. what is the major cause of specimen rejection? too much vacuum on vaine. Fluorescence microscopy can be useful in testing the effectiveness of new antibiotics against resistant strains like MRSA. Criteria used to develop this document were vetted by the Departments scientific staff across the state, by Department leadership, and by the scientific community. Incorrect patient identification. In general, specimens will be rejected for the following reasons: Specimens which are improperly labeled. Scores in the NSD will be updated regularly by the Department with the assistance of the appropriate Technical Advisory Committee. Stains, or dyes, contain salts made up of a positive ion and a negative ion. They play an important role in supporting optimal body functioning and health. We have already alluded to certain techniques involving stains and fluorescent dyes, and in this section we will discuss specific techniques for sample preparation in greater detail. Although a few of the 5 colony types have morphologies consistent with. Urine must be refrigerated if it cannot be examined promptly; delays of more than two hours between collection and examination often cause unreliable results.2. All rights reserved. PDF Specimen Collection, Handling, Transport and Processing - APHL There are gram-negative rods growing in this culture. This book uses the A total protein test is often done as part of your regular checkup. Microscopic examination is an indispensable part of urinalysis; the identification of casts, cells, crystals, and bacteria aids in the diagnosis of a variety of conditions. Specimen rejection criteria Laboratories should provide specific feedback to individual healthcare providers regarding problems with the quality of specimens received and provide recommendations for improvement Specimen Types I. Depending on the type of dye, the positive or the negative ion may be the chromophore (the colored ion); the other, uncolored ion is called the counterion. To complete a UPEP test, you need to collect a small amount of urine in the container provided. This study outlined various types of factors that influence pre-analytical phase of QC and QM and the errors, which may influence the results and reports. Thus, a positive result is helpful, but a negative result does not rule out UTI.6 The nitrite dipstick reagent is sensitive to air exposure, so containers should be closed immediately after removing a strip. Clinical Consequences of Specimen Rejection: A College of American Nitrites normally are not found in urine but result when bacteria reduce urinary nitrates to nitrites. Their cylindrical shape reflects the tubule in which they were formed and is retained when the casts are washed away. Like hunger or thirst, our need for acceptance emerged as a mechanism for survival. We avoid using tertiary references. Exercise-induced hematuria is a relatively common, self-limited, and benign condition. Type II (proximal) RTA is characterized by an inability to reabsorb bicarbonate. 4.4 Gram-Positive Bacteria - Microbiology | OpenStax Causes and impact of specimen rejection in a clinical chemistry It is especially important to manage mechanically ventilated patients as appropriately as possible in the time of SARS-CoV-2/COVID-19. Nonglomerular hematuria is secondary to tubulointerstitial, renovascular, or metabolic disorders. Proteinuria can be classified as transient or persistent (Table 5).21 In transient proteinuria, a temporary change in glomerular hemodynamics causes the protein excess; these conditions follow a benign, self-limited course.34,35 Orthostatic (postural) proteinuria is a benign condition that can result from prolonged standing; it is confirmed by obtaining a negative urinalysis result after eight hours of recumbency. If AFB are present in a tissue sample, their red or pink color can be seen clearly against the blue background of the surrounding tissue cells (Figure 2.36). The effect of saline on specimen quality will vary depending on transport time, processing and culture methods. We provide support Monday through Friday from 8AM to 8PM CST and Saturday and Sunday from 8AM to 5PM CST. Ketonuria most commonly is associated with uncontrolled diabetes, but it also can occur during pregnancy, carbohydrate-free diets, and starvation. This helps flush out impurities from the urethra so that they wont be included in the sample. Visualization of intact erythrocytes on microscopic examination of the urinary sediment can distinguish hematuria from other conditions. Acid-fast staining is another commonly used, differential staining technique that can be an important diagnostic tool. Some laboratories have specimen transport requirements for tracheal aspirate culture specimens and others do not. Patients with dipstick results of 3+ or greater may have significant proteinuria; further work-up is indicated. Oxalate nephropathy is a rare cause of kidney disease and failure. If the organism is fully identified and reported, should susceptibility testing be performed? In clinical settings, light microscopes are the most commonly used microscopes. Midstream clean collection is acceptable in most situations, but the specimen should be examined within two hours of collection. Both use carbolfuchsin as the primary stain. The ratio of rejected specimens was higher in the EDs (40%) compared to ICUs (30%) and inpatient services (28%). PDF Criteria For Specimen Rejection The technician decides to make a Gram stain of the specimen. The Schaeffer-Fulton method (the most commonly used endospore-staining technique) uses heat to push the primary stain (malachite green) into the endospore. Dipstick reagents detect acetic acid through a reaction with sodium nitroprusside or nitro-ferricyanide and glycine. Whereas antibiotics were once routinely prescribed for common illnesses without a definite diagnosis, doctors and hospitals are much more likely to conduct additional testing to determine whether an antibiotic is necessary and appropriate before prescribing. This suggests damage to the individual cells or that decolorizer was left on for too long; the cells should still be classified as gram-positive if they are all the same species rather than a mixed culture. Mycobacterium tuberculosis, the bacterium that causes tuberculosis, can be detected in specimens based on the presence of acid-fast bacilli. are not subject to the Creative Commons license and may not be reproduced without the prior and express written In some reports, hemolyzed specimens, the most common reason for rejection, account for 60% of rejected specimens, fivefold more than the second most common cause . Some specimens, such as a drop of urine, are already in a liquid form and can be deposited on the slide using a dropper. A Species of Special Concern (SSC) is a species, subspecies, or distinct population of an animal* native to California that currently satisfies one or more of the following (not necessarily mutually exclusive) criteria**: is extirpated from the State or, in the case of birds, is extirpated in its primary season or breeding role; When samples are prepared for viewing using an SEM, they must also be dehydrated using an ethanol series. Often, a smear is prepared from a sample of the patients sputum and then stained using the Ziehl-Neelsen technique (Figure 2.36). if a specimen which should have been chilled is received unchilled, the specimen will be rejected. Name the device that is used to create thin sections of specimens for electron microscopy. venipuncture Flashcards | Quizlet Textbook content produced by OpenStax is licensed under a Creative Commons Attribution License . Through root cause analysis, we identified hemolysis of laboratory specimens as the most common cause of rejected specimens (Table 3). Responsibility, Safety Skills, Knowledge, and Involvement, Animation: Parts of a Pump-Action Shotgun, Animation: Parts of a Double-Action Revolver, Animation: Parts of a Semi-Automatic Pistol, Choosing the Correct Type and Size of Shot, Video: How a Semi-Automatic Handgun Fires, Video: How a Double-Action Revolver Fires, Differences Between Rifles, Shotguns, and Handguns. Diabetic ketoacidosis can cause urine to have a fruity or sweet odor, and alkaline fermentation can cause an ammoniacal odor after prolonged bladder retention. None of the organisms were seen in the original Gram stain, but there is a predominant organism and it is growing in significant amounts. It is important that measures are taken to prevent the development of VAP, but also that these measures do not lead to inappropriate treatment or extended time in the hospital. Alkaline urine in a patient with a UTI suggests the presence of a urea-splitting organism, which may be associated with magnesium-ammonium phosphate crystals and can form staghorn calculi. To the patient who simply wants to feel better as quickly as possible, the potential benefits of taking an antibiotic may seem to outweigh any immediate health risks that might occur if the antibiotic is ineffective. Unit 9 of 9. Specimen Rejection - Specimen Rejection - CCR Wiki Strains of bacteria such as methicillin-resistant S. aureus (MRSA), which has developed a high level of resistance to many antibiotics, are an increasingly worrying problem, so much so that research is underway to develop new and more diversified antibiotics. Flagella (singular: flagellum) are tail-like cellular structures used for locomotion by some bacteria, archaea, and eukaryotes. Keeping the NSD up-to-date is an important part of the SSC process. In symptomatic patients, a colony count as low as 100 CFU per mL suggests UTI, and antibiotics should be considered. This must be documented in a laboratory procedure. a condition in which the concentration of blood cells is increased in proportion to the plasma. A lab technician analyzes the bands to determine if the two proteins are present in the sample and, if so, how much of them there are. It ( Evolution ) does not work like t. Glomerular hematuria typically is associated with significant proteinuria, erythrocyte casts, and dysmorphic RBCs. Next, thin sections are cut using a specialized device called an ultramicrotome (Figure 2.42). How are SSCs addressed under the California Environmental Quality Act? There is insufficient specimen (serum, plasma, whole blood) to perform the ordered test (s). In type I (distal) RTA, the serum is acidic but the urine is alkaline, secondary to an inability to secrete protons into the urine. Your browser either doesnt support JavaScript or you have it turned off. Specimen Acceptance and Rejection Criteria - Saskatoon Health Region How does the Department use the SSC designation? Species of Special Concern - California Department of Fish and Wildlife Or, should they be included in normal upper respiratory microbiota? This criterion infers the population viability of a species based on trends in the habitats in which it specializes. This is a corrected version of the article that appeared in print. Session 6-- Quality of Laboratory Specimens and Reasons for - Quizlet Casts in the urinary sediment may be used to localize disease to a specific location in the genitourinary tract (Table 6).38 Casts, which are a coagulum of Tamm-Horsfall mucoprotein and the trapped contents of tubule lumen, originate from the distal convoluted tubule or collecting duct during periods of urinary concentration or stasis, or when urinary pH is very low. this information and the choices you have about how we use such information. Children aged 6 months to 6 years are considered anemic at Hb levels less. Sections 15063 and 15065 of the CEQA Guidelines, which address how an impact is identified as significant, are particularly relevant to SSCs. (credit a: modification of work by Frost Museum/Flickr; credit b: modification of work by U.S. Most globulins are produced in the liver. Last medically reviewed on April 30, 2018. Some bacteria that cause meningitis can also cause septicemia, particularly the meningococcal form. More Online Recreational Safety Courses from Kalkomey. which complication can you develop with long-term phlebotomy. Final publication of an SSC document requires approval of the Director. The specimen was plated on blood, chocolate and MacConkey agars. Who is responsible for developing and maintaining SSC documents and lists? Reasons for Specimen Rejection Flashcards | Quizlet Further evaluation of patients with glomerular and nonglomerular hematuria should include determination of renal function and 24-hour urinary protein or spot urinary protein-creatinine ratio. rejected will need to be redrawn. In this condition, lowmolecular-weight proteins predominate over albumin and rarely exceed 2 g per day. Analgesic Nephropathy: How Pain Relievers Can Affect Your Kidneys. Clean-catch specimens from female patients frequently are contaminated by vaginal flora. Triple phosphate crystals may be normal but often are associated with alkaline urine and UTI (typically associated with Proteus species). To cut cells without damage, the cells must be embedded in plastic resin and then dehydrated through a series of soaks in ethanol solutions (50%, 60%, 70%, and so on). Scores for a taxon may change as a result of new information gained from scientific, peer-reviewed literature, expert opinion, or other reliable sources. This looks like normal respiratory microbiota without the presence of a predominant pathogen. There are two basic types of preparation used to view specimens with a light microscope: wet mounts and fixed specimens. Although prior cleansing of the external genitalia often is recommended in women, it has no proven benefit. Patients with microscopic hematuria (i.e., at least three red blood cells per high-power field in two of three specimens) should be evaluated to exclude renal and urinary tract disease. Learn how analgesics (pain medications) can affect your kidneys and what symptoms may result. The use of saline during collection and/or specimen processing. Urinalysis is invaluable in the diagnosis of urologic conditions such as calculi, urinary tract infection (UTI), and malignancy. The ethanol replaces the water in the cells, and the resin dissolves in ethanol and enters the cell, where it solidifies. To continue the clean-catch process, urinate a small amount before you begin collecting the sample. Persons with UTIs often have urine with a pungent odor. 8 Clinical labs should establish specific rejection criteria for specimens and should follow them closely. What is the main difference between preparing a sample for fluorescence microscopy versus light microscopy? Increased USG is associated with glycosuria and the syndrome of inappropriate antidiuretic hormone; decreased USG is associated with diuretic use, diabetes insipidus, adrenal insufficiency,.