Analysis Of Urine And Other Body Fluids Pdf

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Metrics details. The proteomes most likely to contain clinically useful disease biomarkers are those of human body fluids. Three recent large-scale proteomic analyses of tears, urine and seminal plasma using the latest mass spectrometric technology will provide useful datasets for biomarker discovery.

Known for its clear writing style, logical organization, and vivid full-color illustrations, this renowned text covers the fundamental principles of urine and body fluids that are frequently encountered in the clinical laboratory. This includes the collection and analysis of urine, fecal specimens, vaginal secretions, and other body fluids such as cerebrospinal, synovial, seminal, amniotic, pleural, pericardial, and peritoneal fluids.

High-accuracy proteome maps of human body fluids

This retrospective study evaluated interference indices for hemolysis, icterus, and lipemia in body fluid specimens submitted for clinical chemistry testing. Hemolysis of specimens submitted for lactate dehydrogenase LD represented the most common interference for body fluid chemistries. Body fluids exhibited a higher proportion of samples with severe icterus or lipemia. LD was the test most commonly affected by interference across all body fluid types.

The possible impact of interferences on clinical chemistry testing in body fluids is an important post-analytical consideration. Analytical testing on body fluid specimens is a challenging aspect of clinical chemistry [ [1] , [2] , [3] , [4] ]. Body fluids, defined as specimens other than plasma, serum, or urine, include cerebrospinal fluid CSF , dialysate, postsurgical drain fluid, wound fluid, and other fluids often obtained using ultrasound-guided aspiration such as pancreatic, pericardial, and pleural fluid.

Analysis of body fluids is clinically relevant in specific situations. Calculation of the serum ascites albumin gradient SAAG relies on the measurement of albumin in peritoneal effusions and serum to determine whether the ascites is a result of portal hypertension [ 7 ].

Other clinically relevant tests on body fluids include measuring cholesterol and triglycerides in pleural fluid to detect chylothorax and pseudochylothorax, glucose for infectious or malignant effusions, amylase to detect postoperative pancreatic fistulas, creatinine and urea nitrogen to detect urinary leakage, and total bilirubin to detect biliary leaks [ [8] , [9] , [10] , [11] , [12] , [13] ].

Analysis of these samples is difficult for many reasons. There can be pre-analytical errors in sample labeling and collection [ 14 ]. Analytical variation has been proposed due to possible matrix effects [ 15 ].

Post-analytical errors may occur due to the absence of reference ranges, leading to variation in result interpretation. While body fluid testing has been performed for many years in clinical laboratories, laboratory accreditation agencies including the College of American Pathologists CAP have recently changed their requirements for body fluid testing to include validation methods [ 17 ]. Consequently, as these sample sources are generally not included as valid specimen types by assay manufacturers, individual laboratories must undertake responsibility for validation.

This study aimed to assess semi-quantitative estimates of hemolysis, icterus, and lipemia in body fluid specimens submitted for chemistry analysis. We utilized retrospective data from the centralized core laboratory at an academic medical center covering nearly body fluid specimens. As described in our previous studies, Reporting Workbench functionality within Epic and Healthcare Enterprise Decision Intelligence HEDI; an institutional data warehouse allowed for the collection of past laboratory results [ 18 , 19 ].

The following 12 chemistry tests were studied: albumin, alkaline phosphatase ALP , amylase, total bilirubin, blood urea nitrogen BUN , cholesterol, creatinine enzymatic , glucose, LD, lipase, TP, and triglyceride.

The hemolysis, icterus, and lipemia indices were determined on all plasma, serum, and body fluid specimens using spectrophotometry, as previously described [ 20 ].

Middleware software Instrument Manager, version 8. The chi-square test of independence was utilized for statistical analyses Microsoft Excel.

The body fluids were divided into seven anatomic site categories abdominal, dialysate, drains, pancreatic, pericardial, pleural, and miscellaneous based on sample labeling and chart review. Body fluid specimens organized by anatomic site with corresponding laboratory tests ordered.

These distributions are parsed by anatomic site in Fig. In contrast, body fluid specimens had a higher range of icterus indices, with seven samples at or above 50 Figs. Six of the seven samples were collected from postoperative drains following abdominal surgery with a history consistent with a biliary leak due to either trauma or gallbladder perforation.

The remaining sample was a respiratory secretion from a patient with concern for a hepato-bronchial fistula.

These anatomic sources are expected, as drain and pericardial specimens overall demonstrated higher mean icteric indices 2. The potentially affected chemistry tests all employ enzymatic reactions with colorimetric detection. In addition, high concentrations of bilirubin are known to cause falsely lowered enzymatic creatinine measurements due to quenching of the hydrogen peroxide intermediate [ 23 ].

Consistent with this prior finding, creatinine was low 0. Box plots illustrate the distributions of a hemolysis, b icterus, and c lipemic indices by anatomic site.

The box indicates the inter-quartile range IQR, 25thth percentile of the data , the line indicates the median, the diamond indicates the mean, the whiskers extend to the furthest data point that is within 1. The indices are plotted on a logarithmic scale.

In fact, lipemic indices for two body fluid specimens exceeded One of the lipemic samples was from a postoperative neck drain of 55 year-old male status post a neck dissection for malignancy with clinical concern for a chyle leak. The other lipemic sample was ascites from an 8-day-old preterm infant found to have extravasated total parenteral nutrition in the abdomen from a leaking umbilical venous catheter.

Some highly lipemic body fluid samples exhibit severe hemolysis, but most are relatively unaffected by hemolysis. There does not seem to be a relationship between icterus and hemolysis Fig. All axes are plotted on a logarithmic scale. The absolute number and proportion of samples with indices above the limit for at least one ordered test were plotted by anatomic site Fig. In body fluid specimens, the hemolysis limit was most commonly exceeded for LD 6. Distribution of indices exceeding the corresponding interference limit.

The absolute and relative quantity of samples with at least one index above the limit are plotted by anatomic site c and d.

The number of specimens in panel C is plotted on a logarithmic scale. The following tests are not plotted as no body fluid specimens exceeded the corresponding interference limits: ALP, total bilirubin, BUN, cholesterol, and triglyceride.

The following body fluid specimen categories are not plotted as none of the ordered testing exceeded the corresponding interference limits: dialysate and miscellaneous. Icterus and lipemia affected far fewer tests across all specimen types when compared to hemolysis. The body fluid tests that most commonly exceeded their respective icterus limit were lipase 1. When evaluating tests affected by lipemia, 0. Pericardial effusions exhibited the highest rate of samples affected by hemolysis This mimics the results from pleural fluids, in which LD accounted for 15 of the 20 hemolyzed samples.

Body fluids present a challenge for clinical chemistry analysis due to their wide variety of sources and possible matrices [ [1] , [2] , [3] , [4] ].

An additional complication is that most body fluids are not included as valid specimen types by assay manufacturers.

Thus, assay performance characteristics, including interference studies, are generally not available unless found in the published literature or determined by individual laboratories.

This manuscript reviewed the measurement of traditional interference indices i. However, these studies do not evaluate whether the frequency or severity of these interferences differs by anatomic site. We did not observe any statistical relationship between any of the spectrophotometrically estimated interferences in body fluid specimens. One of the limitations of our study was the retrospective, observatory nature, in that we did not alter the samples to determine the tolerable degree of interference in individual assays.

Another limitation of our study is that it was performed at a single center as opposed to collecting data from multiple centers, which may have resulted in a wider variety of body fluid specimens and results.

Specimens from postoperative drain, pancreatic, pericardial, and pleural sources more frequently exceeded index limits. This may be due to the type of tests ordered from these particular anatomic regions, such as frequent ordering of LD, a test with a relatively low interference limit for hemolysis.

The complex composition of the source fluid, such as a highly turbid drain fluid, may also affect the measurement of interference indices. In addition, other compounds present in body fluids may mimic hemolysis, icterus, or lipemia by absorbance in the wavelengths used by clinical chemistry analyzers for spectrophotometric determination of interference indices.

There are various ways to report chemistry results on body fluid samples in the context of possible interference. One option is to report out all laboratory values regardless of the interference severity with a comment stating that performance characteristics and reference ranges have not been verified. Consequently, this would require validation studies to define analyte- and source-specific interference thresholds.

Yet another option involves diluting the specimen to remove the interference, which may be appropriate in some scenarios, but not in others e. Finally, analyte-specific cancellation of body fluid testing is one possible strategy to mitigate interference, as described by a previous study [ 1 ].

Due to the wide variety of applications of body fluid measurements, development of thresholds for flagging or cancelling a test may need to be dependent on the clinical utility of the specific laboratory test in a particular matrix. Body fluids present a challenge for clinical laboratories due to complexities in the pre-analytical, analytical, and post-analytical phases of the total testing process.

Herein, we evaluated hemolysis, icterus, and lipemic indices in nearly body fluid specimens, including abdominal, pancreatic, pericardial, pleural, dialysate, and postoperative drain sources. LD was the test most commonly affected by interference across all specimen types, while pericardial, pancreatic and drain fluids were the most commonly affected anatomic sites.

The possible impact of hemolytic, icteric, and lipemic interferences on clinical chemistry testing in body fluids is an important post-analytical consideration. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Renee L. Eigsti: Investigation, Formal analysis, Visualization, Writing - original draft. Matthew D. Anna E. National Center for Biotechnology Information , U. Journal List Pract Lab Med v. Pract Lab Med. Published online Feb 8. Eigsti , Matthew D. Krasowski , Aditi Vidholia , and Anna E.

Author information Article notes Copyright and License information Disclaimer. Eigsti: ude. Krasowski: ude. Merrill: ude.

This article has been cited by other articles in PMC. Design and Methods This retrospective study evaluated interference indices for hemolysis, icterus, and lipemia in body fluid specimens submitted for clinical chemistry testing.

Introduction Analytical testing on body fluid specimens is a challenging aspect of clinical chemistry [ [1] , [2] , [3] , [4] ]. Open in a separate window. Results 3. Body fluid categorization The body fluids were divided into seven anatomic site categories abdominal, dialysate, drains, pancreatic, pericardial, pleural, and miscellaneous based on sample labeling and chart review.

The number of specimens is plotted on a logarithmic scale. Discussion Body fluids present a challenge for clinical chemistry analysis due to their wide variety of sources and possible matrices [ [1] , [2] , [3] , [4] ].

Review of interference indices in body fluid specimens submitted for clinical chemistry analyses

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It seems that you're in Germany. We have a dedicated site for Germany. This volume provides the essential theory as well as practice for the study of urine and body fluids other than urine. It is a concise compendium of information both of a practical as well as a clinical resource for understanding conditions of patients with whom the laboratory analyst has contact. It informs the reader not only of the how to perform certain tests but also of the why these tests are clinically important and therefore helps in obtaining the best clinical data possible.

A CLINICAL METHOD FOR THE ESTIMATION OF PROTEIN IN URINE AND OTHER BODY FLUIDS

Aids in the diagnosis of joint disease, systemic disease, inflammation, malignancy, infection, and trauma, using body fluid specimens. When abnormal cytologic features are present, the laboratory may reflex to a miscellaneous cytology test. Fee codes for that test vary depending on review process.

Bodily fluids come in all forms and although unpleasant to think about, they are all vital to our health. Bodily fluids are just like the fluids in our cars. Gas, oil, antifreeze and windshield wiper fluid all serve a role in helping our cars function properly. Bodily fluids are liquids that come from inside human bodies and help transport nutrients and expel waste from human cells.

Fundamentals of the Study of Urine and Body Fluids

Urinalysis and Body Fluids

This retrospective study evaluated interference indices for hemolysis, icterus, and lipemia in body fluid specimens submitted for clinical chemistry testing. Hemolysis of specimens submitted for lactate dehydrogenase LD represented the most common interference for body fluid chemistries. Body fluids exhibited a higher proportion of samples with severe icterus or lipemia. LD was the test most commonly affected by interference across all body fluid types. The possible impact of interferences on clinical chemistry testing in body fluids is an important post-analytical consideration. Analytical testing on body fluid specimens is a challenging aspect of clinical chemistry [ [1] , [2] , [3] , [4] ]. Body fluids, defined as specimens other than plasma, serum, or urine, include cerebrospinal fluid CSF , dialysate, postsurgical drain fluid, wound fluid, and other fluids often obtained using ultrasound-guided aspiration such as pancreatic, pericardial, and pleural fluid.

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For clinical purposes, none of the methods used in the estimation of protein in urine, plasma, serum, transudates or exudates are satisfactory. Kjeldahl determinations are accurate but require too much time. The various methods given in textbooks on clinical pathology are rapid, but they are also grossly inaccurate.

Электронная почта соединила безопасность обычной почты со скоростью телефонной связи. С тех пор как сообщения стали передаваться по подземным волоконно-оптическим линиям, а не с помощью радиоволн, они оказались полностью защищенными от перехвата - таков по крайней мере был замысел. В действительности перехват электронных писем, передвигаемых по Интернету, был детской забавой для технических гуру из АНБ. Интернет не был создан, как считали многие, в эру домашних персональных компьютеров.

 Он ничего не спрашивал про ТРАНСТЕКСТ. - Нет. Но если он посмотрит на монитор и увидит в окне отсчета значение семнадцать часов, то, будьте уверены, не промолчит.

Fundamentals of Urine and Body Fluid Analysis
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    Fundamentals of the Study of Urine and Body Fluids. Authors; (view PDF · Metabolic Origins of Urine and Other Body Fluids. John W. Ridley. Pages

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