MLSC 483 Comprehensive Review & Written Examination

Urinalysis & Body Fluids Study Worksheets

Adapted from Graeter: Elsevier’s Medical Laboratory Science Examination Review, 1st Edition

INSTRUCTIONS: Complete study worksheets are part of your urinalysis & body fluids review. Submit to the
appropriate dropbox in LearningHub no later than the last day of the urinalysis & body fluids rotation. You may
ADD columns/rows as needed.

1. Chemical Analysis
Confirmatory Test and Clinical Significance
Analyte Test Principle
Principle (If Applicable) (When will it be abnormal?)
Specific gravity the ratio of the weight of a used to measure the concentrating and
volume of urine to the weight diluting ability of the kidney in its effort to
of the same volume of maintain homeostasis in the body. The
distilled water at a constant concentrating
temperature. ability of the kidney is one of the first
The test is based on the pKa functions to be lost as a result of tubular
change of certain damage.
pretreated polyelectrolytes in
relation to ionic
concentration;
therefore, the procedure is
actually measuring the ionic
concentration
of the urine, which relates to
the specific gravity.
pH It analysis the acidity of the Litmus paper or Nitrazine It measures the pH of the body, which
urine through a change of paper. Same principle as changes through diet, breathing, and kidney
color depending on the the reagent test strips. function. There is no abnormal results. Other
acidity or alkalinity. The H+ A pH meter with a glass information along with the urine pH needs to
reacts with methyl red and electrode. be used together to determine the issue
bromothymol blue.
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Blood A qualitative measurement of Microscopic examination Hemolyzed blood in the patient due to
RBCs, hemoglobin, and electrophoresis transfusion reactions end up in the urine.
myoglobin in the urine. With this test, we can tell if the red colored
The dipstick procedure is urine is due to blood or other things to act
based on the peroxidase-like fast to treat the patient. Alsom
activity
of hemoglobin and myoglobin
which catalyzes the oxidation
of
a chromogen by organic
peroxide
Leukocyte Neutrophils contain enzymes Microscopic examination Increased numbers of
esterase known as esterases. These neutrophils usually indicate the presence of
esterases can be detected by a urinary tract
reagent strips that contain an infection; and their presence is indicated by
appropriate substrate such a positive leukocyte
as indoxylcarbonic acid ester esterase test.
Nitrite Reagent strips for the For the early detection of significant and
detection of nitrite in the asymptomatic
urine commonly bacteriuria. Common organisms that can
use p-arsanilic acid and a cause urinary
quinoline compound. Nitrite tract infections, such as Escherichia coli,
reacts with p-arsanilic acid to Enterobacter,
form a diazonium compound. Citrobacter, Klebsiella, and Proteus species,
This compound then couples produce enzymes
with the quinoline compound that reduce urinary nitrate to nitrite.
to produce a pink color
Protein It is based on the concept heat and acid tests cause Proteinuria, the presence of increased
known as the "protein error the protein to precipitate amounts of protein in urine, can be an
of indicators;' a phenomenon important indicator of renal disease.
which means that the point
of calor change of some pH
indicators is different in the
presence of protein from that
observed in the absence of
protein, because proteins act
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 as hydrogen ion acceptors at
a constant pH. Usually, the
indicator changes from
yellow to blue (or green)
between pH 3 and pH 4, but
in the presence of protein,
this color change will occur
between pH 2 and pH 3.
Glucose The procedures that use the Blood glucose test It can be used for the diagnoses of diabetes,
enzyme glucose oxidase are but it can only be used with other tests to
specific for glucose, while the specifically determine the diagnosis.
copper reduction test will When the blood glucose exceeds the renal
detect any reducing threshold, the tubules cannot reabsorb all of
substance (a chemical that the filtered glucose, and so glycosuria
loses an electron to a occurs.
different chemical during an
oxidation-reduction
reaction).
Ketones Multistix contains the The first step in the Krebs cycle is the
reagents sodium reaction of acetyl CoA with oxaloacetate to
nitroprusside and yield citrate. When carbohydrate is not
an alkaline buffer, which available or is not being properly utilized, all
react with diacetic acid in available oxaloacetate will be used to form
urine to glucose, and so there will be none available
form a maroon color for condensation with acetyl CoA. CoA
cannot enter the Krebs cycle; therefore, it is
diverted to the formation of ketone bodies.
Diagnosis for Type 1 Diabetes
Bilirubin Coupling reaction of a Lctotest The detection of small quantities is very
diazonium important in the early diagnosis of
salt with bilirubin in an acid obstructive and hepatic jaundice. This test is
medium also useful in the differential
diagnosis of obstructive (positive) and
hemolytic (negative) jaundice.
Urobilinogen This is a simple color Screening for urobilinogen is useful in the
development reaction in
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 which diagnosis of liver function disorders.
aldehyde or diazonium
compounds react with
urobilinogen
to produce a pink to red color
in an acid environment
2. Renal Disorders
Significant Expected
Disease/Disorder Pathogenesis Chemical Urinalysis Microscopic Other Important Facts
Lab Findings Findings
Acute An autoimmune condition proteinuria, dysmorphic RBCs, The patient may also have
poststreptococcal that may arise after a hematuria with RBCs WBCs, RBC casts, positive
glomerulonephritis Streptococcus pyogenes and possibly an Anti-Streptolysin 0
(group A) infection of the occasional serological results.
throat or skin. This occurs hyaline or granular
approximately 7 to 12 cast.
days postinfection. It is
not arising from the
organism but rather from
an immunological
poststreptococcal
infection reaction.
Rapidly progressive A form of acute kidney proteinuria, dysmorphic RBCs, This disease often
glomerulonephritis disease that causes hematuria with RBCs WBCs, RB C casts, progresses to chronic
damage to the glomeruli and possibly an glomerulonephritis.
and progressive loss of occasional hyaline
kidney function over or granular cast.
weeks to months.
Membranous caused by pronounced Elevated protein and hematuria This glomerulonephritis is
glomerulonephritis thickening of the foamy urine one of the most common
glomerular basement causes of nephrotic
membrane. The syndrome.
glomerular basement
membrane is a part of
the kidneys that helps

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 filter
waste and extra fluid
from the blood. This
thickening results from
deposition of immune
complexes of
immunoglobulin G.
Minimal change not associated with much proteinuria Increased Minimal change disease
disease cellular change in the microscopic fat, usually
glomerulus, hence its which can include responds well to
name, although the fat globules, oval corticosteroids within a
podocytes appear to be fat bodies, or fatty month.
less tightly fitting. casts.
Chronic is the advanced stage of proteinuria, slight dysmorphic RBCs, Causes include diabetic
glomerulonephritis several kidney disorders, hematuriawith few WBCs, mixed casts nephropathy/sclerosis,
resulting in inflammation RBCs with many focal segmental g
and slowly worsening reflecting the lomerulosclerosis,
destruction of glomeruli, chronic and severe IgA nephropathy (Berger
with progressive loss of nature of the disease), lupus nephritis,
kidney disease, membranous
function. such as waxy and glomerulonephritis,
broad casts mesangial proliferative
disorder, nephritis
associated with disorders
such as amyloidosis,
multiple myeloma, or
immune disorders,
including AIDS.
Nephrotic caused by various proteinuria Increased Treatment may be required
syndrome disorders that damage microscopic fat, for life for adults with this
kidneys, particularly which can include condition.
those that damage the fat globules, oval
basement membrane of fat bodies, or fatty
the glomerulus causing casts.
abnormal glomerular
permeability to plasma
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 proteins and excretion of
that protein in the urine.
Acute tubular a condition with rapid increased BUN and casts, kidney Acute tubular necrosis is
necrosis onset caused by lack of serum creatinine tubular epithelial one of the most common
oxygen to the kidney levels cells, structural changes that
tissues (ischemia and RBCs can lead to acute renal
of the kidneys) or by failure and is one of the
exposure to materials most common causes of
that are nephrotoxic. kidney failure in
hospitalized
patients.
Fanconi syndrome caused by faulty genes, glycosuria, mild cystine crystals Common causes of Fanconi
or it may result later in proteinuria syndrome in children are
life due to kidney genetic inborn errors of
damage, or the cause metabolism.
may be unknown
Cystinosis Cystine crystal deposits a lack of ability to Cystine crystal Depending on the time of
are found in the kidneys, concentrate urine onset of symptoms, this
eyes, bone marrow, liver, resulting in a constant condition may be life-
spleen, and specific gravity known threatening.
macrophages. Thus this by the term
condition is considered a isosthenuria.
lysosomal storage
disorder resulting from a
defect in the transport
passage of cysteine
across lysosomal
membranes.
Cystinuria Cystinuria is an inherited urinary crystal In the past
renal tubular disorder. cystine. a cyanide-nitroprusside
Transport by the carrier Formation of renal test was positive but
protein of the amino calculi composed of current testing
acids arginine, cytosine, cystine may also utilizes chromatography
lysine, and/or ornithine is occur. methods.
defective.

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Renal tubular inherited as an increased urine levels Patients with this disorder
acidosis autosomal recessive of glucose cannot reabsorb glucose to
trait. These patients will the typical capacity of 160
exhibit glycosuria and to 180 mgldL.
elevated specific
gravity in their
urinalysis.
Lower urinary tract Infections can arise in the mild proteinuria, WBCs, RBCs, If white blood cell (WBC)
infection lower urinary tract via increased pH. bacteria casts are present, this is
the urethra and ascend positive leukocyte an indication of kidney
the urinary tract or can esterase infection rather than a
arise through infections bladder infection, as casts
in the bloodstream are formed in the nephron,
seeding the kidney with not below the kidney.
organisms
deposited in the upper
urinary tract and descend
the urinary tract.
Upper urinary tract as a result of UTI, proteinuria, increased WBCs, RBCs, It’s called pyelonephritis
infection particularly in the pH bacteria, WBC
presence of occasional or casts; granular,
persistent backflow of waxy, broad casts
urine from the bladder
into the ureters or kidney
pelvis (vesicoureteric
reflux) or obstructions.
These infections most
often arise
as a result of ascending
movement of bacteria
from a lower UTI but may
also be of a descending
type, seeded from
bacteria in the blood.

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3. Microscopic Analysis of Urine Sediment
Crystal Pathogenesis pH (at which it’s found) Distinguishing Shape/Feature
Amorphous urates urate salts of sodium, potassium, Acidic a yellow-red granular appearance and
magnesium, and calcium that are are soluble in alkali and at 60°C.
frequently present in the urine in a
noncrystalline, amorphous form.
Calcium oxalates Calcium oxalate crystals can be acidic and neutral colorless octahedral (double pyramid)
present normally in the urine urine, and crystals and appear to look like an
especially after the ingestion of occasionally they are "envelope'' -small squares crossed by
various oxalate-rich food. Increased also found in alkaline intersecting diagonal lines suggest the
amounts of calcium oxalates, urine. possibility of oxalate calculi
particularly if they are present in
freshly voided urine, suggest the
possibility
of oxalate calculi.
Calcium sulfate rarely seen in the urine and they acidic urine long, thin, colorless needles or prisms
have no that are identical in appearance to
clinical significance. calcium phosphates.
Cholesterol Indicates excessive tissue Acidic large, flat, transparent plates with
breakdown, and these crystals are notched corners. Under polarized light
seen in nephritis and nephritic they exhibit a variety of colors.
conditions.
Cystine They occur in patients with either Acidic colorless, refractile, hexagonal plates
congenital cystinosis or congenital with
cystinuria equal or unequal sides. They may
appear singly, on top of each other
(resembling a spiral staircase), or in
clusters. Cystine crystals frequently
have a layered or laminated
appearance
Hippuric acid rarely seen in the urine and have Acidic or neutral. yellow-brown or colorless elongated
practically no clinical significance. Some times it can be prisms or plates. They may be so thin
found in alkaline as to resemble needles, and they
urine often cluster together.
Leucine found in the urine of patients with Acidic oily, highly retractile, yellow or brown

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 maple syrup urine disease, spheroids with radial and concentric
oasthouse urine disease, and in striations, which often resemble the
serious liver disease such as sections of a grapefruit surrounded by
terminal cirrhosis of the liver, severe a thick rind
viral hepatitis, and acute yellow
atrophy of the liver.
Sodium urate no clinical significance Acidic colorless or yellowish needles or
slender prisms occurring in sheaves or
clusters.
Sulfonamides Caused by taking Sulfonamide drugs Acidic sheaves of needles, usually with
eccentric binding, and they may be
clear or brown in color
Tyrosine can be seen in tyrosinosis and Acidic very fine, highly refractile needles
oasthouse urine disease. occurring
in sheaves or clusters. The needle
clusters of
tyrosine often appear to be black,
especially in the center, but they may
take on a yellow col or in the presence
of bilirubin.
Tyrosine crystals polarize light
Uric acid Usually normal but pathologic Acidic occur in many different shapes, but
conditions in which uric acid crystals the
are found in the urine include gout, most characteristic forms are the
high purine metabolism, acute diamond or rhombic prism, and the,
febrile conditions, chronic nephritis, which consists of many crystals
and Lesch-Nyhan syndrome. clustered together. Uric acid crystals
may occasionally have six sides,
which sometimes causes this
form to be erroneously identified as
cystine. However, cystine crystals are
colorless.
X-ray dye Hypaque and Renografin dyes are Acidic pleomorphic needles that can occur
diatrizoate meglumine plus singly or in sheaves. These needles
diatrizoate may be quite large, are often seen
with brown spheres. Radiographic dye
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 sodium and can crystallize out in crystals and will polarize light
acidic urine following intravenous
injection of the drug for x-ray studies
Ammonium Ammonium biurates are abnormal alkaline and neutral yellow-brown spherical bodies with
biurates only if urine. long, irregular spicules. Their
found in freshly voided urine. appearance is often described with
the term "thorn apple:'
Amorphous no clinical significance. Alkaline Has no definite shape and they are
phosphates usually visibly indistinguishable from
amorphous urates. The pH of the
urine helps distinguish between these
two amorphous deposits as well as
does their solubility properties.
Calcium carbonate no clinical significance. Alkaline small, colorless crystals appearing in
dumbbell or spherical forms and rarely
rhombohedral forms, or in large
granular masses. Calcium carbonate
crystals are larger than amorphous
and, when in clumps, they may
appear to have a dark
color. The mass of calcium carbonate
crystals, as opposed to a clump of
amorphous phosphates, will also be
connected together around the edges.
Calcium may be present in normal urine, but Alkaline long, thin, colorless prisms and can
phosphates they may also form calculi. have one pointed end, be arranged as
rosettes or stars (stellar phosphates),
or appear as needles. Calcium
phosphate crystals may also form
large, thin, irregular plates that may
float on the surface of the urine
Triple phosphates frequently found in normal urine but neutral and alkaline Triple phosphate crystals are colorless
can also form urinary calculi. urines. prisms with from three to six sides
that
frequently have oblique ends. Triple

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 phosphate crystals have been
described as resembling coffin lids or
picture frames. Triple phosphates may
sometimes precipitate as feathery or
fernlike crystals. Both forms polarize
light. Triple phosphate crystals are
soluble in acetic acid.
Cast
Hyaline Hyaline casts can be seen in even Any colorless, homogeneous, and
the mildest kind of renal disease and transparent, and usually have
are not associated with any one rounded ends, and a smooth surface
disease in particular. A few hyaline
casts may be found in the normal
urine, and increased amounts are
frequently present following
physical exercise and physiologic
dehydration.
RBC casts usually diagnostic of glomerular Any appear brown to almost colorless. The
disease being found in acute cast may contain only a few RBCs in a
glomerulonephritis, lupus nephritis, protein
Goodpasture syndrome, subacute matrix, or there may be many cells
bacterial endocarditis, and renal packed close together with no visible
trauma. Red cell casts can also be matrix. If the red cells are still intact
present and the outlines are still detectable,
in renal infarction, severe then the cast is termed a red cell cast.
pyelonephritis, right-sided If the cast has degenerated to a
congestive heart failure, renal vein reddish-brown granular cast, then the
thrombosis, and periarteritis nodosa. cast is a hemoglobin or blood cast.

WBC casts present in renal infection and in appear in casts are

noninfectious inflammation, such as polymorphonuclear neutrophils; and
acute pyelonephritis, interstitial may be few in number, or there may
nephritis, and lupus nephritis. They be many cells tightly packed together.
may also be present in glomerular If the cells are still intact, the nuclei
disease. may be clearly visible, but disappear,

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 as the cast becomes granular in
appearance.
Epi casts form as the result of stasis and the may either be arranged in parallel
desquamation of renal tubular rows
epithelial cells. These casts are only in the cast or may be arranged
rarely seen in the urine because of haphazardly and vary in size, shape,
the infrequent occurrence of renal and stage of degeneration. The cells
diseases which primarily affect the in the former type
tubules (necrosis). of arrangement are believed to come
Epithelial cell casts may be present from the same segment of the tubule,
in urine after exposure to whereas the irregular arrangement
nephrotoxic agents or viruses (e.g., seems to indicate
cytomegalovirus, hepatitis virus), that the cells came from different
which cause damage that portions of the tubule.
accompanies glomerular injury, and
in the rejection of a kidney allograft.
Course granular may be the result of the Initially, the granules are large and
casts degeneration of cellular casts or coarse, but when urine stasis is
they may represent the direct prolonged, these granules break down
aggregation of serum proteins into a to fine granules.
matrix of Tamm-Horsfall Coarsely granular casts contain larger
mucoprotein. Granular casts almost granules that are darker in color and
always indicate significant renal often appear black because of the
disease, however, granular casts density of
may be present in the urine for a the granules
short time following strenuous
exercise.
Fine granular casts Same as above Finely granular casts contain fine
granules
which may appear gray or pale yellow
in color
Waxy casts It has been postulated that waxy have a very high refractive index, are
casts yellow, gray, or colorless, and have a
result from the degeneration of smooth homogeneous appearance.
granular casts. Waxy casts are found Waxy casts frequently occur as short

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 in patients with severe chronic renal broad casts
failure, malignant hypertension, with blunt or broken ends, and they
renal amyloidosis, and diabetic often have cracked or serrated edges
nephropathy.
They may also be found in acute
renal disease, tubular inflammation
and degeneration, and during renal
allograft rejection.
Cell
RTE Increased numbers of tubular slightly larger than leukocytes and
epithelial contain a large round nucleus. They
cells suggest tubular damage. This may be flat, cuboidal, or columnar.
damage can occur in pyelonephritis,
acute tubular necrosis, salicylate
intoxication,
and kidney transplant rejection.
Squamous occur principally in the urethra and large, flat, irregularly shaped cells.
vagina. Many of the squamous cells They contain small central nuclei and
present in the female urine are abundant cytoplasm. The cell edge is
the result of contamination from the often folded
vagina or vulva, and as such, they over and the cell may be rolled up into
have little diagnostic significance. a cylinder.
Transitional Transitional cells line the urinary two to four times as large as white
tract from the pelvis of the kidney to cells. They may be round, pear-
the upper portion of the urethra. shaped, or may have tail-like
projections. Occasionally, these cells
may contain two nuclei.
WBC An increase of WBCs in urine is White blood cells are approximately
associated with an inflammatory 10 to 12 microns in diameter and are
process in or adjacent to the urinary larger than
tract. Leukocytes are attracted to RBCs but smaller than renal epithelial
any area of inflammation and, cells. White blood cells are usually
because of their amoeboid spherical and can appear dull gray or
properties, can penetrate the areas greenishyellow
adjacent to the inflammatory site. in color. WBCs may appear singly or in

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 clumps
RBC Normally, RBCs do not appear in the When the urine specimen is fresh, the
urine, although the presence of 1 to red cells have a normal, pale, or
2 RBC/HPF is usually not considered yellowish appearance and are smooth,
abnormal. The mechanism whereby biconcave
red cells enter the urine is not disks approximately 7 microns in
entirely clear. Unlike white cells, red diameter and 2 microns thick. They
cells do not possess contain no nuclei and, when viewed
amoeboid characteristics and, from the side, they have an hourglass
therefore, they must stay within the appearance.
blood vessels. Injury or rupture of In dilute or hypotonic urine, the red
the blood vessels of the kidney or cells swell up and can lyse, thus
urinary tract releases RBCs into the releasing their hemoglobin into the
urine, but this does not account for urine. Lysed cells, which are referred
the acceptance of the normal to as "ghost" or "shadow" cells, are
presence of a few RBCs in the urine. faint, colorless circles and are actually
Hematuria the empty red cell membranes. Lysing
is the presence of an increased will also occur in alkaline urine. Red
number of RBCs in the urine and the blood cells will crenate in hypertonic
blood reagent pad will reflect the urine and sometimes the crenations
presence of RBCs or free may resemble granules.
hemoglobin.
Misc.
Mucus Mucous threads are present in long, thin, wavy threads of ribbon-like
normal urine in small numbers, but structures which may show faint
they may be very abundant in the longitudinal striations
presence of
inflammation or irritation of the
urinary tract. Some of the wider
threads may be confused with
cylindroids or hyaline
casts. Heavy mucous threads tend to
incorporate WBCs.
Parasites Parasites may occasionally be found Depends on parasite
in the urine, either because they are
indigenous to the urinary tract or as
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 the result of vaginal or fecal
contamination.
Yeast Yeast may be found in urinary tract smooth, colorless, usually ovoid cells
infections, especially in patients with with doubly refractile walls. They can
diabetes. Yeast may also be present vary in size and often show budding.
in the urine as a result of skin or They may sometimes be mistaken for
vaginal contamination. red cells, but unlike RBCs, they are
insoluble in acid and alkali, and they
will not stain with eosin.
Sperm may be present in the urine of men have oval bodies and long, thin,
after epileptic convulsions, nocturnal delicate tails
emissions, diseases of the genital
organ, and in spermatorrhea. Sperm
may also be found in the urine of
both sexes after coitus.
Oval fat body Fat may be present in the urine as Fat may be present in the urine as
the result of fatty degeneration of free droplets or globules, within
the tubules. It is frequently found in degenerating or necrotic cells (oval fat
the nephrotic syndrome and may bodies), or incorporated in a cast.
also be present in diabetes mellitus,
eclampsia, toxic
renal poisoning, chronic
glomerulonephritis, lipoid nephrosis,
fat embolism, and following
extensive superficial injuries with
crushing of the subcutaneous fat.
Lipiduria may also
occur following fractures of the
major long bones or pelvis, and in
multiple fractures in which fat may
be released
from the bone marrow into the
circulation and then filtered through
the glomerulus.

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4. Microscopic Analysis of Other Body Fluids
Collection Clinical Significance
Body Fluid Test performed Interfering substances
method (When will it be abnormal?)

CSF Lumbar puncture Laboratory tests that may Indications for performing a Bacterial contamination
Contraindication to be performed on CSF lumbar puncture and CSF
performing include, but are not examination include
this puncture is the limited to, macroscopic suspicions of encephalitis,
presence of evaluation, meningitis, multiple sclerosis,
infection at the microscopic evaluation of neurosyphilis, and
puncture site. cell count and type, subarachnoid hemorrhage,
chemical analysis, among other disorders. This
microbiology cultures, procedure is usually
and immunologic and performed on patients with
molecular analyses. unexplained seizures or on
those who have fever of
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 unknown origin. Dementia
and acute states of confusion
may also prompt the
physician to perform a
lumbar puncture and CSF
examination.
Serous Pleural Fluid: Laboratory tests that may The accumulation of serous Transudates and Exudates
Collected by be fluid is called an effusion.
thoracentesis performed on serous body Effusions may result from a
Pericardial Fluid: fluids include, but are not disruption in the balance of
Collected by limited to, macroscopic these pressures
pericardiocentesis evaluation of fluid (transudates) or in response
Peritoneal Fluid: appearance, microscopic to infection and inflammatory
Collected by evaluation of cell count processes (exudates).
Paracentesis and type, chemical
analysis, microbiology
cultures, and
immunologic and
molecular analyses.
Synovial Aspiration of Color Analysis of synovial fluid is
joint fluid through Viscosity important in the diagnosis of
arthrocentesis Cell count joint disease. Aspiration of
Differential joint fluid is indicated for any
Crystal identification patient with a joint effusion
Microbiology or inflamed joints. Aspiration
of asymptomatic joints is
beneficial
for patients with gout and
pseudogout as these fluids
may
still contain crystals.
Gastric Excretion Macroscopic, microscopic, Examination of gastric Contamination
and chemical testing of contents aids in the
feces are routinely differential diagnosis of
performed in the core gastric and duodenal ulcers,
laboratory for detection of and to evaluate the presence
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 colon cancer, steatorrhea of hyper- or hypochlorhydria.
and other malabsorptive Fecal testing provides
digestive important information related
disorders, or maldigestion to gastrointestinal disorders,
disorders. Tests are also infections, and several other
performed in the medical conditions.
microbiology department
for various stool
pathogens;
bacterial, viral, and
parasitic, as well as for
their toxins.
Amniotic obtained by Macro and microscopic The lab oratory performs
amniocentesis, examination several crucial tests on
Spectrophotometric amniotic fluid to assess the
analysis status of the fetus. These
serum a-fetoprotein tests can be divided into
Acetylcholinesterase these groups: (a) tests to
Immunologic diagnose genetic and
agglutination test congenital disorders before
birth, (b) tests to detect fetal
distress from hemolytic
disease of the newborn
(HDN) or from infection, (c)
tests to assess fetal lung
maturity, and (d) assessment
of the ability of the fetus to
survive early delivery.
Semen Masturbation Semen volume, viscosity, for the evaluation of an Urine
pH, and sperm infertile couple. Skin, bacterial
concentration, Other indications for contamination
motility, viability, and performing a semen analysis Saliva
morphology. include
Macroscopic examination determining the
effectiveness of a vasectomy,

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 rape-case forensic
studies, sperm donor
evaluation, and paternity
cases.
Vaginal A swap is used for Fern Test Noticeable changes in the Urine
secretions collection. The type Placental Alpha color, consistency, or amount Period blood
of swap depends on Macroglobulin-1 (PAMG- of vaginal secretions may be
the test performed 1) linked to various conditions
Insulin-like Growth Factor and infections. Vaginal
Binding Protein-1 secretions are also examined
Fetal Fibronectin for the presence of amniotic
fluid as evidence
of fetal membrane rupture.

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