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TitleEssentials of Medical Laboratory Practice - Lieseke, Constance L. [SRG]
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Table of Contents
                            Copyright
Dedication
Preface
Contributors
Reviewers
Acknowledgments
List of Procedures
Abbreviations
Contents in Brief
Contents
Section I: 
Overview of the Laboratory
	Chapter 1: 
The Clinical Laboratory
		Learning Outcomes
		KEY TERMS
		THE CLINICAL LABORATORY
			Physician Office Laboratories
			Hospital Laboratories
			Reference Laboratories
		LABORATORY DEPARTMENTS
		WHY IS LABORATORY TESTING PERFORMED?
		THE ROLE OF THE MEDICAL ASSISTANT IN THE CLINICAL LABORATORY
		INFORMATION FLOW IN THE CLINICAL LABORATORY
			Laboratory Requisitions
			Advance Beneficiary Notice of Noncoverage
			Laboratory Directory
			Laboratory Reports
		THREE PHASES OF LABORATORY TESTING
		Summary
		Time to Review
	Chapter 2: 
Regulations Governing Laboratory Personnel
		Learning Outcomes
		KEY TERMS
		LABORATORY PROFESSIONALS
			Personnel in the Laboratory Setting
			Medical Assistants in the Laboratory
		CLINICAL LABORATORY IMPROVEMENT AMENDMENTS OF 1988
			History of the Regulation
			Levels of Laboratory Testing Defined by CLIA ’88
			Employee Qualifications for Performance of CLIA Testing
			Oversight of CLIA Laboratories
		Summary
		Time to Review
	Chapter 3: 
Laboratory Safety and Preventing the Spread of Disease
		Learning Outcomes
		KEY TERMS
		INFECTION CONTROL AND LABORATORY SAFETY
		CORE CONCEPTS OF INFECTION CONTROL
			Microorganisms
				Types of Microorganisms
			Chain of Infection
			Standard Precautions
			Centers for Disease Control and PreventionHand-Washing Recommendations
			Acceptable Medical Hand-Washing Procedures
			Proper Use of Personal Protective Equipment
		LABORATORY SAFETY
			Chemical Safety
			Physical Safety
				Fire Safety
				Electrical Safety
				Body Mechanics
			Bloodborne Pathogen Safety
				Universal Precautions
				Bloodborne Pathogens Standard
		DISEASES CAUSED BY BLOODBORNE PATHOGENS IN THE LABORATORY SETTING
			Hepatitis
				Hepatitis B Virus (HBV)
				Hepatitis C Virus (HCV)
				Hepatitis A Virus (HAV)
			Human Immunodeficiency Virus
		POSTEXPOSURE FOLLOW-UP PROCEDURE
		Summary
		Time to Review
	Chapter 4: 
Assuring Quality
		Learning Outcomes
		KEY TERMS
		ASSURING QUALITY IN THE LABORATORY
		QUALITY CONTROL AND QUALITY ASSURANCE
		WHAT IS QUALITY?
			The Medical Assistant’s Role in Assuring Quality Results
				Types of Quality Control Specimens
			What Happens When Things Are “Out of Control”?
			Documentation of Quality Control Results
			Accuracy and Precision
		OTHER METHODS OF ASSURING LABORATORY QUALITY
		Summary
		Time to Review
	Chapter 5: 
Legal and Ethical Issues
		Learning Outcomes
		KEY TERMS
		LEGAL AND ETHICAL ISSUES IN THE LABORATORY ENVIRONMENT
		LAWS AND ETHICS
		LEGAL CONCEPTS AFFECTING PATIENT INTERACTIONS
			Consent
			Release of Information and Patient Rights and Responsibilities
			Tort Law
			Liability
			Scope of Practice
		HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT
			The Impact of the Health Insurance Portability and Accountability Act on the Medical Assistant
		ETHICS
			Professional Behaviors
		RISK MANAGEMENT AND THE MEDICAL ASSISTANT
		Summary
		Time to Review
	Chapter 6: 
Laboratory Equipment
		Learning Outcomes
		KEY TERMS
		LABORATORY EQUIPMENT
			Microscopes
			Centrifuges
			Laboratory Refrigeration
			Incubators
		EQUIPMENT USED FOR AUTOMATED CLIA–WAIVED LABORATORY TESTING
			Testing Methodology
			Instruments Used for Chemical Testing of Urine Specimens
			Instruments Used for Coagulation Testing
			Instruments Used for Chemistry Testing
			Instruments Used for Hemoglobin Measurements
			Other Hematology Instruments
			Glassware and Other Miscellaneous Laboratory Equipment
		Summary
		Time to Review
	Section I: Overview of the Laboratory: What Does It All Mean?
Section II: 
Specimen Collection and Processing
	Chapter 7: 
Overview of Specimen Collection and Processing
		Learning Outcomes
		KEY TERMS
		SPECIMEN ORDERING
			Required Items for All Laboratory Tests
			Test Specifics
				Medicare-Approved Panels
				Standing Orders
				Reflexive Testing
		PATIENT IDENTIFICATION
			Verification of Patient Identity
				Acceptable Patient Identifiers
				Electronic Bar Codes
		PATIENT PREPARATION
		SPECIMEN COLLECTION AT HOME
		ITEMS THAT MUST BE DOCUMENTED WITH SPECIMEN COLLECTION
		LABELING INFORMATION
		CHAIN OF CUSTODY
		Summary
		Time to Review
	Chapter 8: 
Collection and Processing of Blood Samples
		Learning Outcomes
		KEY TERMS
		ANATOMY AND PHYSIOLOGY OF THE CARDIOVASCULAR SYSTEM
			The Heart
			Blood Vessels
				Arteries
				Veins
				Capillaries
		SITE SELECTION
			Most Commonly Used Veins
			Appropriate Capillary Puncture Sites
		CONTRAINDICATIONS AND AREAS TO AVOID
			Scars and Tattoos
			Mastectomy Considerations
			Intravenous Fluids
			Bruising and Hematomas
			Varicose Veins
			Central Lines and Fistulas
			Edematous Areas
			Obese Patients
		VENIPUNCTURE EQUIPMENT
			Tourniquets
			Gloves
			Sharps Biohazardous Waste Containers
			Alcohol and Gauze Pads
			Needles
			Additional Supplies
		METHODS USED FOR VENIPUNCTURE
			Evacuated Tube System
			Syringe Method
			Winged Infusion or Butterfly Method
		BLOOD COLLECTION TUBES
			Color Coding of Tubes
			Types of Additives
		ORDER OF DRAW FOR VENIPUNCTURE
		CAPILLARY PUNCTURES
			Order of Draw for Capillary Puncture
		PREPARATION FOR BLOOD COLLECTION
		SPECIMEN PROCESSING
			Obtaining Serum for Testing
			Obtaining Plasma for Testing
			Whole Blood Specimens
			Unacceptable Specimen Types
		POTENTIAL NEGATIVE OUTCOMES OF VENIPUNCTURE AND CAPILLARY PUNCTURE
			Inability to Draw Blood
			Fainting Patients
			Rolling Veins
			Hematoma Formation
			Collapsing Veins
			Nerve Damage
			Infection
		OTHER PROCESSING PROCEDURES
		PREPARATION OF A PERIPHERAL BLOOD SMEAR FOR STAINING
		WRIGHT’S STAIN PROCEDURE
		Summary
		Time to Review
	Chapter 9: 
Collection and Processing of Urine Samples
		Learning Outcomes
		KEY TERMS
		TYPES OF URINE SPECIMENS
			Clean-Catch Midstream Urine Specimen Collection
			Catheterized Specimens
			Suprapubic Aspiration
			Prostatitis Specimen Collection
			Timed Urine Specimen Collections
			Urine Collection Procedures for Infants and Pediatric Patients
		URINE SPECIMEN PROCESSING
			Refrigeration and Preservation
			Proper Disposal of Urine and Supplies
		Summary
		Time to Review
	Chapter 10: 
Collection and Processing of Samples for Microbial Studies
		Learning Outcomes
		KEY TERMS
		MICROBIOLOGY SAMPLE COLLECTION GUIDELINES
			Types of Media
			Microbiology Terms
		DETAILED MICROBIOLOGY SAMPLE COLLECTION PROCEDURES
			Throat Sample Collections for Culture or Strep Screens
			Sputum Samples
			Urine Samples for Culture
			Blood Culture Collection
			Cerebrospinal Fluid Samples
			Genital Samples
			Wound Cultures
			Stool Specimens
			Nasopharyngeal Specimens
			Eye Cultures
			Ear Cultures
		SPECIAL SAMPLE COLLECTION AND PROCESSING PROCEDURES
			Fungal Sample and Culture Collection Procedures
			Wet Mount Procedure
			Sample Collection Procedures for Detection of Parasites
				Ova and Parasite Examination
				Pinworm Collection Procedures
		PROCESSING MICROBIOLOGY SAMPLES
			Slide Preparation and Gram-Staining Procedure
			Plating and Inoculation of Media
			Antibiotic Sensitivity Testing
		MICROBIOLOGY TEST RESULTS
		Summary
		Time to Review
	Section II: Specimen Collection and Processing: What Does it All Mean?
Section III: 
Hematology and Coagulation On the Horizon
	Chapter 11: 
Overview of Hematology
		Learning Outcomes
		KEY TERMS
		HEMATOPOIESIS—BLOOD CELL FORMATION
		TYPES OF BLOOD CELLS IN THE CIRCULATING BLOOD
			Erythrocytes—Red Blood Cells
			Leukocytes—White Blood Cells
				Granular White Blood Cells
				Agranular White Blood Cells
			Thrombocytes—Platelets
		ANALYSIS OF THE FORMED ELEMENTS
		Summary
		Time to Review
	Chapter 12: 
Complete Blood Count With Differential
		Learning Outcomes
		KEY TERMS
		COMPLETE BLOOD COUNT
			Complete Blood Count Specimen Requirements
			White Blood Cell Count
			Red Blood Cell Count
			Hemoglobin and Hematocrit
			Red Blood Cell (Erythrocyte) Indices
			Platelet Count
			Leukocyte Differential Count
				Peripheral Blood Smear
				Manual Leukocyte Differential
				Red Blood Cell Morphology
				Platelet Morphology and Estimated Count
			Manual Blood Cell Counts
		AUTOMATED ANALYZERS FOR COMPLETE BLOOD COUNT TESTING
		Summary
		Time to Review
	Chapter 13: 
Hemoglobin and Hematocrit
		Learning Outcomes
		KEY TERMS
		HEMOGLOBIN
		HEMOGLOBINOPATHIES
		HEMOGLOBIN TESTING
			CLIA–Waived Hemoglobin Testing
			Potential Errors in Hemoglobin Testing
		HEMATOCRIT
			CLIA–Waived Hematocrit Testing
			Potential Errors in Hematocrit Testing
		THE RELATIONSHIP OF HEMOGLOBIN AND HEMATOCRIT VALUES
		ANEMIA
		Summary
		Time to Review
	Chapter 14: 
Erythrocyte Sedimentation Rate
		Learning Outcomes
		KEY TERMS
		ERYTHROCYTE SEDIMENTATION RATE
		PLASMA PROTEINS AFFECTING THE ERYTHROCYTE SEDIMENTATION RATE
		THE INFLUENCE OF THE RED BLOOD CELLS ON THE ERYTHROCYTE SEDIMENTATION RATE
		REFERENCE RANGES
		CLINICAL SIGNIFICANCE OF ERYTHROCYTE SEDIMENTATION RATE TESTING
		ERYTHROCYTE SEDIMENTATION RATE DETERMINATION
			CLIA-Waived Erythrocyte Sedimentation Rate Methods
			Automated Erythrocyte Sedimentation Rate Methods
		POTENTIAL SOURCES OF ERROR FOR THE ERYTHROCYTE SEDIMENTATION RATE PROCEDURE
		Summary
		Time to Review
	Chapter 15: 
Coagulation Studies
		Learning Outcomes
		KEY TERMS
		PURPOSE OF COAGULATION STUDIES
		MECHANISMS OF BLOOD CLOTTING
		DISORDERS DIAGNOSED OR MONITORED WITH LABORATORY COAGULATION TESTS
			Thrombosis
			Atrial Fibrillation
			Postsurgical Prophylaxis
			Disseminated Intravascular Coagulation
			Thrombocytopenia
			Antiphospholipid Syndrome
			Hemophilia
		LABORATORY TESTS USED TO DIAGNOSE COAGULATION DISORDERS OR MONITOR ANTICOAGULANT THERAPY
			Prothrombin and International Normalized Ratio
			Activated Partial Thromboplastin Time/ Partial Thromboplastin Time
			Platelet Count
			Fibrinogen
			Fibrin Degradation Products
			D-Dimer
			Bleeding Time Test
			Other Tests Used to Assess Platelet Function
		SPECIMEN REQUIREMENTS FOR COAGULATION TESTING
		Summary
		Time to Review
	Section III: Hematology and Coagulation: What Does It All Mean?
Section IV: 
Clinical Chemistry On the Horizon
	Chapter 16: 
Overview of Clinical Chemistry
		Learning Outcomes
		KEY TERMS
		CLINICAL CHEMISTRY
		SPECIMEN TYPES USED FOR CLINICAL CHEMISTRY ANALYSIS
			Plasma
			Serum
			Other Specimen Types Used for Clinical Chemistry Testing
		CLIA–WAIVED CLINICAL CHEMISTRY TESTS
			Glucose Testing
			Cholesterol and Lipid Testing
			Electrolytes
		OTHER COMMON CLINICAL CHEMISTRY TESTS
			Blood Urea Nitrogen
			Creatinine
			Thyroid Panels
			Comprehensive Metabolic Panel and Basic Metabolic Panel
			Cardiac Enzymes
			Hepatic or Liver Profile
		REFERENCE RANGES
		POTENTIAL SOURCES OF ERROR
		Summary
		Time to Review
	Chapter 17: 
Glucose Testing
		Learning Outcomes
		KEY TERMS
		GLUCOSE UTILIZATION AND CONTROL MECHANISMS
		PATHOPHYSIOLOGY OF GLUCOSE METABOLISM
			Prediabetes
			Diabetes
		TYPES OF GLUCOSE TESTS PERFORMED
			Fasting Blood Glucose Test
			Random Glucose Test
			Postprandial Glucose Test
			Oral Glucose Tolerance Testing Procedures
			Glycosylated Hemoglobin
			Blood Ketone Testing
			Capillary Sample Testing and Correlation to Plasma Glucose Levels
			Urine Testing for Diabetics
		GLUCOSE TESTING METHODS
			Home Glucose Testing Instruments
				Quality Control and Common Errors
			Laboratory Glucose Testing and Potential Sources of Error
		Summary
		Time to Review
	Chapter 18: 
Other Select Chemistry Tests
		Learning Outcomes
		KEY TERMS
		LIPID TESTING
			Cholesterol
				Cholesterol Metabolism Within the Body
				Types of Cholesterol
				Risk Factors, Desired Ranges, and ClinicalInterpretation of Abnormal Lipid Results
			Triglycerides
				Metabolic Syndrome
				Reference Ranges and Clinical Interpretationof Abnormal Results
			Lipid Panels
		ELECTROLYTES
			Function of Electrolytes and Consequences of Electrolyte Imbalances
			Testing Preparation and Common Testing Methods
			Reference Ranges
		Summary
		Time to Review
	Section IV: Clinical Chemistry: What Does It All Mean?
Section V: 
Urinalysis
	Chapter 19: 
Urinalysis
		Learning Outcomes
		KEY TERMS
		HISTORICAL PERSPECTIVE OF URINALYSIS
		ANATOMY AND PHYSIOLOGY OF THE URINARY SYSTEM
			The Kidneys
			Ureters
			Bladder
			Urethra
		SEQUENCE OF URINE PRODUCTION AND EXCRETION
		CLINICAL SIGNIFICANCE OF URINE TESTING RESULTS
			Physical Examination
			Chemical Examination
			Microscopic Examination
		QUALITY ASSURANCE FOR URINE TESTING PROCEDURES
		STANDARD PRECAUTIONS USED WHEN ANALYZING URINE SPECIMENS
		TYPES OF URINE SPECIMENS
		Summary
		Time to Review
	Chapter 20: 
Physical Characteristics of Urine
		Learning Outcomes
		KEY TERMS
		PHYSICAL CHARACTERISTICS OF URINE
			Urine Color
			Urine Clarity
			Specimen Volume
			Urine Odor
			Specific Gravity
				Refractometer Measurement Technique
				Urinometer Measurement Technique
				Reagent Strip Methodology
		POTENTIAL SOURCES OF ERROR
		Summary
		Time to Review
	Chapter 21: 
Chemical Examination of Urine and Feces
		Learning Outcomes
		KEY TERMS
		URINE ANALYTES AND THEIR CLINICAL SIGNIFICANCE
			Bilirubin
			Blood
			Glucose
			Ketones
			Leukocytes
			Nitrite
			pH
			Protein
			Urobilinogen
			Specific Gravity
		POTENTIAL SOURCES OF ERROR
		SAFETY PRECAUTIONS
		QUALITY CONTROL PROCEDURES
		URINE TESTING METHODS
		CONFIRMATORY URINE TESTING
		FECAL OCCULT BLOOD TESTING
		Summary
		Time to Review
	Chapter 22: 
Microscopic Examination of Urine
		Learning Outcomes
		KEY TERMS
		REASONS FOR PERFORMING URINE MICROSCOPIC EXAMINATIONS
		COMMON FORMED ELEMENTS IN THE URINE AND THEIR CLINICAL SIGNIFICANCE
			Epithelial Cells
			Mucus
			Blood Cells
			Spermatozoa
			Artifacts
			Casts
			Crystals
			Microorganisms
		METHODS USED FOR URINE MICROSCOPIC EXAMINATION
		REPORTING URINE MICROSCOPIC RESULTS
		ROLE OF THE MEDICAL ASSISTANT IN MICROSCOPIC URINE PROCEDURES
		QUALITY CONTROL AND QUALITY ASSURANCE PROCEDURES FOR URINE MICROSCOPIC EXAMINATIONS
		Summary
		Time to Review
	Section V: Urinalysis: What Does It All Mean?
Section VI: 
Immunology
	Chapter 23: 
Immunology
		Learning Outcomes
		KEY TERMS
		IMMUNITY AND IMMUNOLOGY
		THE IMMUNE PROCESS
			The First Line of Defense: Nonspecific Mechanical and Chemical Barriers
			The Second Line of Defense: Internal Nonspecific Response
			The Third Line of Defense: Acquired or Adaptive Immunity
		HOW IMMUNITY IS ACQUIRED
		FAILURE OF OUR IMMUNE SYSTEMS
		BLOOD TYPES
		ERYTHROBLASTOSIS FETALIS
		IMMUNOLOGY TESTING METHODS
		COMMON SEROLOGY TESTS PERFORMED IN REFERENCE OR HOSPITAL LABORATORIES
		CLIA–WAIVED TESTS COMMONLY PERFORMED IN THE PHYSICIAN OFFICE LABORATORY
		Summary
		Time to Review
	Chapter 24: 
Immunological Based Rapid Testing
		Learning Outcomes
		KEY TERMS
		IMMUNOLOGY METHODS AND PROCEDURES
		RAPID TESTING
			Advantages of Rapid Testing
			Common Procedural Elements of Rapid Testing
			CLIA–Waived Regulations and Their Application to Immunology-Based Rapid Testing
		COMMON CLIA–WAIVED RAPID TESTS AND THEIR CLINICAL SIGNIFICANCE
			Group A Streptococcal Screening
			Mononucleosis Testing
			Pregnancy Testing
			Helicobacter pylori Testing
			Influenzas A and B
			HIV Testing
		Summary
		Time to Review
	Section VI: Immunology: What Does it All Mean?
Appendix A: 
Reference Ranges
Appendix B: 
Test Your Knowledge Answers
Appendix C: 
Tube Guide for BD Vacutainer Venous Blood Collection
Glossary
INDEX
                        
Document Text Contents
Page 2

ESSENTIALS OF
MEDICAL LABORATORY

PRACTICE

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Page 282

257

Section III

Hematology and Coagulation
On the Horizon

The fundamental concepts associated with hematology and coagulation are
covered in six chapters that make up this section of the text, as outlined below.

Chapter 11: Overview of Hematology introduces the reader to the formation,
description, and analysis of the three key types of cells in the circulating blood: red
blood cells (RBCs), white blood cells (WBCs), and platelets.

Chapter 12: Complete Blood Count With Differential explores the key components
of the most commonly ordered battery of hematology tests, known as a complete
blood count (CBC).

Chapter 13: Hemoglobin and Hematocrit examines the description, theory, and test-
ing (with emphasis on CLIA-waived procedures) of these two important hematology
tests: hemoglobin (Hgb) and Hematocrit (Hct). An independent examination of each
test as well as an investigation of the relationship between them are made, because
of their importance in the diagnosis and monitoring of hemoglobinopathies, ane-
mia, and polycythemia.

Chapter 14: Erythrocyte Sedimentation Rate covers the description, theory, and test-
ing (with emphasis on CLIA-waived tests) of the erythrocyte sedimentation rate (ESR)
test. This test, often in combination with other laboratory tests, is of importance in
instances of inflammation changes and in monitoring pregnancies.

Chapter 15: Coagulation Studies introduces the reader to the purpose of coagula-
tion studies, the mechanism of blood clotting, disorders associated with abnormal
coagulation test results, and commonly performed coagulation tests. Select coagu-
lation laboratory tests that are useful in the diagnosis of disorders and monitoring
of anticoagulant therapy as well as specimen requirements for testing are covered.

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258

Complete Blood Count (CBC)
Patient Reference Range

Test Result for Adult Males

WBC count 10.0 4,000–11,000/mm3

RBC count 3.0 5.5–6.5 � 106/mm

Hgb 9.0 14–18 g/dL

Hct 30 42%–54%

RBC Indices >>>>>>>>> >>>>>>>>>

MCV 86 80–96 femoliters

MCH 31 27–33 picograms

MCHC 35 33–38 g/dL

Platelet count 28 140–400 � 103/mm3

Differential >>>>>>>>> >>>>>>>>>

Neutrophils 65 50%–70%

Bands 5 3%–5%

Lymphocytes 23 23%–30%

Monocytes 6 3%–7%

Eosinophils 1 1%–3%

Basophils 0 0%–1%

Cell Few
morphology schistocytes

present

Coagulation Studies
Test Patient Result Reference Range

Prothrombin 18 seconds 10–14 seconds
time (PT)

Activated partial 47 seconds 20–35 seconds
thromboplastin
time (APTT)

LABORATORY REPORT
PATIENT: M.J.

Questions for Consideration:
• What type and color of blood-drawing tube should be

used for this patient so that the laboratory can perform
the complete blood count (CBC) test?

• What type/color of blood-drawing tube should be used
for this patient so that the laboratory can perform the
coagulation studies?

• Examine the patient’s laboratory results. Which of these
results is/are considered as “abnormal” (that is, out of
the reference range)?

• What laboratory results obtained most likely account for
the patient’s being pale?

• What is the purpose of the coagulation studies tests
(PT & APTT)?

Case in Point
You are the primary medical assistant working at Mid-
town Medical. In the midst of a very busy Monday,
Margie, the receptionist, informs you that a new pa-
tient, M.J., has been worked into the schedule and is
here now to be evaluated. After greeting M.J. and
recording his weight and height, you take him into the
examination room. While preparing to take his blood
pressure and pulse, you ask M.J. what brings him in to
see the doctor today. You find out that up until a few
weeks ago, this 38-year-old male had been in the best

of health. The symptoms he has been experiencing con-
sist of an overall feeling of being tired and weak, and
every time he brushes his teeth his gums bleed. After
questioning M.J. further, you find out that he was re-
cently hospitalized after a tractor accident and had re-
ceived a blood transfusion at that time. You notice while
talking to him that he looks very pale. The doctor orders
blood to be drawn for a complete blood count (CBC),
and coagulation studies (PT and APTT). The following
results are obtained:

Continued from page 256.

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Page 563

T
Tachometer, 104
Target cells, 278
Tattoos, drawing blood and, 140
T cells, 463
Thalassemias, 288
Thayer Martin agar, 235
Thermometer, 107
Third line of defense (immune process),

462–464, 463f–464f
Throat sample collections for culture or strep

screens, 223–227
Thrombin, 319
Thrombocytes (platelets). See Platelets

(thrombocytes)
Thrombocythemia, 274
Thrombocytopenia, 274, 317
Thrombocytosis, 274
Thrombopoietin, 262
Thrombosis, 316
Thrombus, 266
Thyroid panels, 341
Thyroid-stimulating hormone (TSH), 341
Thyroxine (T4), 341
Timed urine specimen collections, 204–209

first morning void specimen, 204–205
24-hour urine collection, 205–209, 206f,

206t
Tort law, 86–87
Tourniquets, 143
Trans fats, 378
Transfer pipette, 181
Transient bacteria, 42
Transmissible, definition of, 38
Trends, definition of, 72
Trichomoniasis, 234
Triglycerides, 339, 377

metabolic syndrome, 377
reference ranges and clinical interpretation

of abnormal results, 377
Triiodothyronine (T3), 341
Troponin, 341
Troubleshooting, 67, 67f, 70–71
Trough collection level, 126
TSH (thyroid-stimulating hormone), 341
Tuberculosis, 246–247
Tularemia, 222
24-hour urine collection, 205–209, 206f, 206t
Type 1 diabetes, 354
Type 2 diabetes, 354–355

U
Unintentional tort, 87
Universal Precautions, 42, 53
Ureters, 393, 395
Urethra, 393, 396
Urinalysis, 198, 391–400, 396

anatomy and physiology of the urinary
system, 393–396, 393f–395f
bladder, 395

kidneys, 393–394
ureters, 395
urethra, 396

bladder cancer testing, 396–397
clinical significance of urine testing results,

396–397
chemical examination, 397. See also

Urine, chemical examination of
microscopic examination, 397. See also

Urine, microscopic examination of
physical examination, 397. See also

Urine, physical characteristics of
historical perspective, 392–393
HIV urine testing, 397–398
key terms, 392
overview, 392–393, 399
quality assurance, 398
review questions, 399
sequence of urine production and

excretion, 396
standard precautions, 398
types of specimens, 398–399

Urinalysis department, 9, 9t
Urinary frequency, 405
Urinary incontinence, 405
Urinary meatus, 198, 396
Urinary system, anatomy and physiology of

system, 393–396, 393f–395f
bladder, 395
kidneys, 393–394
ureters, 395
urethra, 396

Urine, chemical examination of, 109–110,
109f, 413–430, 437–438
CLIA-waived drug screening tests,

420
confirmatory testing, 424, 430
key terms, 414
overview, 414, 415f, 437
potential sources of error, 420–421
quality control procedures, 422
review questions, 437–438
safety precautions, 422
testing methods, 422–429

automated reagent strip method,
427–429

manual reagent strip method,
425–427

reference ranges, 423t
urine analytes and their clinical

significance, 414–419
bilirubin, 415
blood, 416
glucose, 416
ketones, 417
leukocytes, 417–418
nitrite, 418
pH, 418
protein, 418–419
specific gravity, 419
urobilinogen, 419

Urine, microscopic examination of,
439–454
common formed elements in urine

and their clinical significance,
440–446
artifacts, 443
blood cells, 441–442, 442f
casts, 443–444, 444f
clue cells, 443
crystals, 444–446, 445f
epithelial cells, 440–441, 441f
microorganisms, 446, 446f
mucus, 441, 442f
spermatozoa, 442–443

key terms, 440
methods, 447–451
overview, 440, 453
quality control and quality assurance

procedures, 452–453
reasons for performing, 440
reporting results, 447, 452, 452t
review questions, 453–454
role of medical assistant in microscopic

urine procedures, 452
Urine, physical characteristics of, 401–412

clarity, 404, 404f
color, 402–403, 402f, 403t
key terms, 402, 411–412
observation and documentation,

408–410
odor, 405
overview, 402, 411
potential sources of error, 407, 411
specific gravity, 405–407

reagent strip methodology, 407
refractometer measurement technique,

406–407, 406f
urinometer measurement technique,

407, 407f
volume, 404–405

Urine drug screens, 197–198
Urine loops, 228f
Urine samples, collection and processing of,

195–213
catheterized specimen, 198, 203–204
clean-catch midstream specimens,

198–203
instructing patient, 199–204

glucose testing specimens, 206–207
infants and pediatric patients, 209–210,

210f
key terms, 196
overview, 196–197, 196t, 212
processing urine specimens, 210–212

proper disposal of urine and supplies,
211–212

refrigeration and preservation, 210–211,
211t

prostatitis specimen collection, 204
review questions, 212
samples for culture, 228, 228f

538 Index

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