A practical approach for learners

1. In-Service Training
Laboratory Section, District Hopital
Sangmelima
Date: January 23rd, 2013
Venue: Laboratory hall
Time: 2:30 pm
Coordinator/presenter: Nkengacha Marcellous Agendia

2. In-Service Training
E C B UBy
Nkengacha Marcellous Agendia
Biomedical Engineer

3. In-Service Training
1. Meaning & Aim of test
2. The Urinary System
3. Collection methods
4. Procedure
5. Results
6. Interpretation (normal/abnormal)
ECBU

4. In-Service Training
 Examen Cyto-Bacteriologie
d’Urine
 Urine Cytobacteriological Test
or Urinalysis in English
ECBU

5. In-Service Training
Cyto (-logy)  cells study
Bacteriologie  bacterial study
ECBU

6. In-Service Training
1. Diagnose UTI
 Urethral
 Bladder
 Ureter
 Nephrones
 Glomerulose
ECBU

7. In-Service Training
1. Diagnose UTI
 Urethral
 Bladder
 Ureter
 Nephrones
 Glomerulose
ECBU

8. In-Service Training
2. Treatment followup
3. Other kidney diseases
ECBU

9. In-Service Training
ECBU

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 Catheterized
 Suprapubic urine
 Clean catch midstream
 Adapted urine kits for children
ECBU

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Catheterized
 Patients with catheter
 Risk of contamination high
ECBU

12. In-Service Training
Suprapubic urine
 Contamination risk is zero.
 Involves passage of a needle via the
pubic region.
 It is the best option as far as urine
collection is concerned
 Induces pain
ECBU

13. In-Service Training
Adapted urine kits for children
 Designed for urine collection in
children.
 There is some risk of contamination
 It is more convenient
ECBU

14. In-Service Training
Clean catch midstream
 Most widely used method
 Convenient for the patient
 Risk of contamination from skin,
vagina and normal floral
 The middle portion of urine often
required
ECBU

15. In-Service Training
 Random
 First urine of the day
ECBU

16. In-Service Training
 Vagina
 Skin
 Urethral normal floral
 Environment
ECBU

17. In-Service Training
Urethral normal floral are mainly;
 Staphylococcus
 Micrococcus
 Enterobacterea
 Corynebacteria
 Non-groupable Streptococcus
ECBU

18. In-Service Training
Urethral normal floral
 These are both Gram(+) and Gram(-)
 Often found in first portion of urine
and sperm
 This can be avoided by cleaning and
collection of second portion
ECBU

19. In-Service Training
 Labelled
 Clean
 Sterile
 Dry
 Transparent
 Wide-mouth container
ECBU

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 Examine immediately or
 Note macroscopy and preserve in a
refrigerator
 T°C = 2 – 8°C
ECBU

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 Colour
 Transparency
 Others (formed physical elements)
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Colour;
 Colourless
 Yellow (dark yellow)
 Coca-cola
 Red, etc…
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Transparency;
(Ability to read a text via the sample);
 Clear
 Cloudy (lightly cloudy)
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24. In-Service Training
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25. In-Service Training
Biochemical tests with Combi 10 include;
 Nitrite
 Leukocyte esterase
 Blood
 Protein
ECBU

26. In-Service Training
Nitrite Vs Leukocyte esterase:
 Negative tests for both exclude UTI
 ECBU may not be useful
 Positive for one or both indicate UTI
 ECBU &/or culture is strongly
recommended
ECBU

27. In-Service Training
Blood:
 Suspect S. hematobium in an endemic
area
 Especially for children between 5 – 15
years
 A concomittant UTI is possible
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 Done after macroscopy
 Done to harvest cells and other elements
 Usually for about 1000r/5mins.
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To identify elements and rate their quantity;
 Cells
 Crystal
 Casts
 Parasites
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Cells;
 WBCs;
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32. In-Service Training
Cells;
 RBCs
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33. In-Service Training
Cells;
 Yeast cells
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Cells;
 Epithelial cells
1. Transitional EC
Found in;
Ureter, bladder,
part of urethral
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Cells;
 Epithelial cells
2. Squamous EC
Found on the;
Skin, and vagina.
contaminant
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Crystals;
 Calcium oxalate
 Calcium carbonate
 Amorphous
 Ammonium biurate
 Bilirubin
 Magnesium ammonium phosphate
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37. In-Service Training
Cystals;
 Calcium oxalate
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Cystals;
 Amorphous
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Cystals;
 Magnesium
ammonium
phosphate
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Parasites;
 Schistosoma hematobium
 Pinworm (very rare)
ECBU

41. In-Service Training
 Make a wet mount
 Overlay with a cover slip
 Put on a microscopic stage
 Focus with objective 10X
 Identify elements with 40X
ECBU

42. In-Service Training
Using objective 10X (LPF);
 Good in doing focus
 Good for searching elements
 Covers more field of view than 40X
 Magnifies elements up to 10X normal size
 Most elements are not very clear
 Always switch to 40X for better view
ECBU

43. In-Service Training
Using objective 40X (HPF);
 Not very good for focus
 Good for identification
 Covers smaller field of view than 10X
 Magnifies elements up to 40X normal size
 Most elements are very clear
 End examination with this objactive
ECBU

44. In-Service Training
Leukocytes and RBCs;
 Average of total number of cells counted
in ‘X’ fields, usually 10 fields.
 Report number of cells per HPF (40X).
 Results with decimal create a range
ECBU

45. In-Service Training
Leukocytes and RBCs - Example;
Field 1 = 4 RBCs
Field 2 = 4 RBCs
Field 3 = 5 RBCs
Result = (4+4+5)/3
= 4.3 cells
Actual result = 4 – 5 cells/HPF
ECBU

46. In-Service Training
Casts;
 The same as leukocytes and RBCs
 But reported per LPF (10X) and not HPF.
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Others;
 Rare,
 Few,
 Moderate or
 Many per HPF.
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 It is not a routine step
 Done when Combi 10 and/or
wetmount are abnormal.
 To identify bacteria type;
 Gram (+) or Gram (-)
 Read with 100X objective
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 Gram Positive bacteria  Purple colour
 Gram Negative bacteria  Pink colour
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 Plus signs (+, ++)
 Rare, few, moderate, many
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 To identify the species of bacteria.
 To select an appropriate antibiotic.
 Estimates the concentration of bacteria
 Not done routinely.
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53. In-Service Training
Biochemistry;
 Nitrite  Negative
 Leukocyte esterase  Negative(0 – 5/HPF)
Wetmount;
 Leukocytes  0 – 5/HPF
 RBCs  0 – 2/HPF
 Parasites  Negative
ECBU

54. In-Service Training
Wetmount;
 Bacteria  depends on;
 Collection method
 Level of leukocytes present
 Epithelial cells  depends on type;
 Squamous  Absent
 Transitional  Rare or few
 Renal tubular  Rare or few
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55. In-Service Training
Wetmount;
 Crystals  upto few
 Casts  Absent
Gram stain;
 Varies with wetmount
Culture;
 No growth on ‘X’ medium at T°C after ‘T’.
ECBU

56. In-Service Training
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