NAME: LENARD S.

ABO

COURSE: III BMLS

SUBJECT: AUBF

CASE STUDIES CHAPTER 5

1. A patient taken to the emergency department after an episode of syncope has a fasting blood
glucose level of 450 mg/dL. Results of the routine urinalysis are as follows:
COLOR: Yellow KETONES: 2+
CLARITY: Clear. BLOOD: Negative
SP. GRAVITY: 1.015 BILIRUBIN: Negative
pH: 5.0 PROTEIN-LOW: 15 mg/dL
PROTEIN-HIGH: NITRITE: Negative
30 mg/dL
GLUCOSE: 250 mg/Dl LEUKOCYTES: Negative
CREATININE: 200 mg/dL

a. Explain the correlation between the patient’s blood and urine glucose results?
Elevated blood glucose volume. Hence, glucose appears in urine because blood glucose level has
exceeded the Tm (renal tubular maximum) for glucose.
b. What is the most probable metabolic disorder associated with this patient?
Since the patient has a condition of high glucose level in blood the probable disorder related is
Diabetes mellitus
c. Considering the patient’s condition, what is the significance of the patient’s protein to
creatinine ratio result?
The given ratio is abnormal which indicates renal disease associated with diabetes mellitus
d. If the patient in this study had a normal blood glucose level and normal protein and
creatinine results, to what would the urinary glucose be attributed?
If the patient had normal protein to creatinine ratio, and normal blood glucose level, the presence
of urinary glucose can be due to tubular reabsorption disorders in the kidney in which the
glucose is not reabsorbed in the tubules of nephron, and appears in urine.

2. Results of a urinalysis performed on a patient scheduled for gallbladder surgery are as follows:

COLOR: Amber. KETONES: Negative

CLARITY: Hazy BLOOD: Negative

SP. GRAVITY: 1.022 BILIRUBIN: Moderate

pH: 6.0 UROBILINOGEN: Normal

PROTEIN: Negative. NITRITE: Negative

GLUCOSE: Negative LEUKOCYTES: Negative

What would be observed if this specimen were shaken?

If the specimen is shaken, yellow form is observed due to the existence of bilirubin pigment

Explain the correlation between the patient’s scheduled surgery and the normal urobilinogen?

There Is the occurrence of biliary obstruction that prevents the bilirubin from being transported into
the intestine and be converted to urobilinogen. That is why there is normal urobilinogen even with
the appearance of moderate quantity of bilirubin in urine

If blood were drawn from this patient, how might the appearance of the serum be described?

The specimen or serum may appear icteric or may appear jaundice as there is accumulation of
yellow pigment.

Facts: Icteric serum is caused by the presence of excess bilirubin in the blood stream as a result of
increased production (pre-hepatic) or inappropriate excretion (hepatic and post-hepatic).

What special handling is needed for serum and urine specimens from this patient?

Serum and urine specimens should be kept away from direct sunlight or light exposure to prevent
photo oxidation of bilirubin to biliverdin which may cause a false negative result.

3. Results of a urinalysis on a very anemic and jaundiced patient are as follows:

COLOR: Red. KETONES: Negative

CLARITY: Clear BLOOD: Large
SP. GRAVITY: 1.020 BILIRUBIN: Negative
pH: 6.0. UROBILINOGEN: 8 EU
PROTEIN: Negative. NITRITE: Negative
GLUCOSE: Negative LEUKOCYTES: Negative
a. Would these results be indicative of hematuria or hemoglobinuria?
It would be indicative of hemoglobinuria since the color of urine is red and clear

b. Correlate the patient’s condition with the urobilinogen result?

The increase of hemoglobin causes also the increase of production of bilirubin In the liver and be
transported to the intestine which will further increases the production of urobilinogen

b. Why is the urine bilirubin result negative in this jaundiced patient?

The jaundice of increase RBC destruction does not produce bilorubinuria since the bilirubin that
are circulating are in unconjugated form.
c. Would this method also measure urine porphyrins? Why or why not?
Yes it would measure the porphyrins if multistix reagent strips is used since multistix uses the
Ehrlich’s reagent reaction which is used also as the principle or as a screening test for detection
of porphyrins particularly porphobilinogen. But using Chemstrip does not give aid for detection.
Further test such as the Watson-schwartz differentiation test can detect and differentiate
urobilinogen and porphobilinogen present in urine.

4. A female patient arrives at the outpatient clinic with symptoms of lower back pain and
urinary frequency with a burning sensation. She is a firm believer in the curative powers
of vitamins. She has tripled her usual dosage of vitamins in an effort to alleviate her
symptoms; however, the symptoms have persisted. She is given a sterile container and
asked to collect a midstream clean-catch urine specimen. Results of this routine
urinalysis are as follows:

COLOR: Dark yellow KETONES: Negative

CLARITY: Hazy. BLOOD: Negative
SP. GRAVITY: 1.012. BILIRUBIN: Negative
pH: 7.0. UROBILINOGEN: Normal
PROTEIN: Trace. NITRITE: Negative
GLUCOSE: Negative LEUKOCYTES: 1+
Microscopic
8 TO 12 RBC/HPF Heavy bacteria
40 TO 50 WBC/HPF Moderate squamous epithelial cells

a. What discrepancies between the chemical and microscopic test results are present? State
and explain a possible reason for each discrepancy.
In reagent strip the blood and nitrite test is negative even with the increase number of RBC
and WBC reported in microscopic test. This Is probably the cause of the vitamins that patient
is taking which is maybe she is taking ascorbic acid which will cause false negative result on
reagent strip. The patient ingested ascorbic acid (vitamin C), which interfered in the diazo
reaction of nitrite that prevented exact nitrite measurement, and large quantities of ascorbic
acid interferes in the reagent strip test for blood. Or probably she did not follow the
instruction, instead of collecting midstream she collected random specimen.

b. What additional chemical tests could be affected by the patient’s vitamin dosage? Explain
the principle of the interference.
Since the patient takes vitamins particularly ascorbic acid this cause false negative results on
test such as Glucose test, Bilirubin and Leukocyte esterase. In glucose the ascorbic acid will
 Interfere with enzymatic reaction and will serve as strong reducing agent that prevent
oxidation of chromogen. In bilirubin and Leukocyte esterase in reagent strip the ascorbic
acid may lower the sensitivity of the test since it will combine to diazonium salt which will
prevent its reaction to bilirubin and ester.

c. Discuss the urine color and specific gravity results with regard to correlation and give a
possible cause for any discrepancy.
The dark yellow color may be produce by beta-carotene and vitamin A and B.
Increase specific gravity may be due to the presence of cremated red cells that do not lyse
when they come in contact with reagent pads. As well the creation of leukocytes preventing
the release of esterase.

d. State three additional reasons not previously given for a negative nitrite test in the presence of
increased bacteria.
False negative nitrite test may cause by the presence of non-reductase containing bacteria which do
not have the ability to reduce nitrate to nitrite, lack of urinary nitrate such as having Green vegetable
diet and when the patient is taking antibiotics that kills the nitrate reducing bacteria, the presence
also of increase bacteria causes the nitrite to be converted to nitrogen causing false negative result.

5. Results of a urinalysis collected following practice from a 20-year-old college athlete are
as follows:

COLOR: Dark yellow KETONES: Negative

CLARITY: Hazy BLOOD: 1+
SP. GRAVITY: 1.029. BILIRUBIN: Negative
pH: 6.5. UROBILINOGEN: 1 EU
PROTEIN: 2+. NITRITE: Negative
GLUCOSE: Negative LEUKOCYTES: Negative

The physician requests that the athlete collect another specimen in the morning prior to classes and
practice.

a. What is the purpose of the second sample?

To detect the abnormal result caused by exercise. In glomerular proteinuria, glomerular
membrane damage allows serum protein, white blood cells, and red blood cells to pass
through in urine. Elevated pressure of blood in the glomerulus will dominate the selective
filtration, which causes albumin to enter the filtrate. This condition occurs after strenuous
exercise

b. What changes would you expect in the second sample?

The second sample will be negative for protein and blood and changes also in specific
gravity and color will occur.

c. Is the proteinuria present in the first sample of prerenal,renal, or postrenal origin?

It is associated with renal proteinuria.

6. A construction worker is pinned under collapsed scaffolding for several hours prior to
being taken to the emergency room. His abdomen and upper legs are severely bruised,
 but no fractures are detected. A specimen for urinalysis obtained by catheterization has
the following results:

COLOR: Red-brown. KETONES: Negative

CLARITY: Clear BLOOD: 4+
SP. GRAVITY: 1.017. BILIRUBIN: Negative
pH: 6.5. UROBILINOGEN: 0.4 EU
PROTEIN: Trace. NITRITE: Negative
GLUCOSE: Negative LEUKOCYTES: Negative

a. Would hematuria be suspected in this specimen? Why or why not?

No. Hematuria is the existence of Red Blood Cells in urine. In hematuria condition, red and
cloudy appearance is seen in urine
b. What is the most probable cause of the positive blood reaction?
It is caused by the muscle damage from the accident known as rhabdomyolysis causing
presence of myoglobin in urine

c. What is the source of the substance causing the positive blood reaction and the name of the
condition?
The presence of myoglobin in urine caused by the accident as muscle has been damage
causes the positive blood reaction relating to myoglobinuria.

d. Would this patient be monitored for changes in renal function? Why or why not?
Yes since myoglobin is toxic to the renal tubules.

7. Considering the correct procedures for care, technique, and quality control for reagent
strips, state a possible cause for each of the following scenarios.

a. The urinalysis supervisor notices that an unusually large number of reagent strips are
becoming discolored before the expiration date has been reached.
Laboratory personnel did not cap the containers containing reagent strips properly in time.

b. A physician’s office is consistently reporting positive nitrite test results with negative LE test
results.
The staff in that office did not wait the accurate reading time of the Leukocyte esterase in the
reagent strip which is it should be 2 minutes. Less than of that can cause negative result

c. A student’s results for reagent strip blood and LE are consistently lower than those of the
laboratory staff.
The student particularly did not mix the specimen causing the blood and Leukocyte to
submerge at the bottom of the tube

d. One morning the urinalysis laboratory was reporting results that were frequently questioned by
physicians.
Particularly the main idea is that errors keep on happening on how the lab perform their test and it may
be due to not performing quality control on strips prior to reporting the result or they are using reagent
strips that are damage or have been deteriorated.