Graff's Textbook of Urinalysis and Body Fluids

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© JonesLillian & Bartlett Learning,A. Mundt, LLC EdD, MLS(ASCP)SH© Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONAdventist Health SystemsNOT FOR SALE OR DISTRIBUTION Hinsdale Hospital, Hinsdale, IL LaGrange Memorial Hospital, LaGrange, IL

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© Jones & Bartlett Learning, LLC Reviewers© Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION The authors would like to thank the following for reviewing current and previous editions.

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9781284221404_FMxx_i_xxxii.indd 8 20/05/20 2:49 PM © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Preface © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Sister Graff’s A Handbook of Routine Urinalysis had served ination including 17 new images (Chapter 9), ending with the clinicalNOT laboratory FOR SALE profession OR as DISTRIBUTION a classic reference text of the central chapterNOT FOR and jewel SALE of Graff’s OR DISTRIBUTION Textbook of Urinaly- urine testing and atlas of urinary sediment from 1983 to 2011, sis and Body Fluids, the atlas of urinary sediment containing when it was revised for the second edition to add chapters on (Chapter 10). Instructors, students, and clinicians will find body fluid analysis. Our goal for the third edition of this text is that no other text includes a comparable atlas. © Jones continually& Bartlett to preserveLearning, the integrity LLC and importance of Sister© JonesSection & Bartlett III contains Learning, revised information LLC as well as new Graff’s work while expanding its use as a valuable resource for information about various body fluid analyses beginning NOT FORstudents, SALE instructors, OR DISTRIBUTION and laboratory professionals. NOTwith FOR an SALEintroduction OR DISTRIBUTION(Chapter 11) and goes into further The second edition had substantially revised and enhanced the depth about: cerebrospinal fluid (Chapter 12), serous body content to bring it up-to-date and expanded the text by including fluids (Chapter 13), synovial fluid (Chapter 14), gastric fluid other body fluids, Chapter Objectives, Key Terms, Terms, Study and fecal analysis (Chapter 15), semen analysis (Chapter 16), Questions, Case Studies, ©and Jones a Glossary & toBartlett make the Learning, text more LLCamniotic fluid (Chapter 17), ©vaginal Jones secretions & Bartlett (Chapter Learning, 18), LLC user friendly in the classroom. These updates and additions were and miscellaneous body fluids (Chapter 19). Several new reflected in the new title,NOT Graff’s FORTextbook SALE of Urinalysis OR DISTRIBUTIONand Body images have been added to thisNOT section FOR to provideSALE for OR better DISTRIBUTION Fluids. comprehension of the information presented. This, the third edition continues to provide students, instruc- The book wraps up with a chapter on automated methods tors, and laboratory professionals with updated information and equipment (Chapter 20); Appendices provide answers to concerning© Jones urine and& Bartlettbody fluid Learning, analyses. The LLC expanded uri- the study and© Jonescase questions, & Bartlett historically Learning, relevant urinalysis LLC nalysis and body fluids coverage in this text is comprehensive, information, reagent strip color chart, and a detailed expla- clearlyNOT presented, FOR and SALE explained OR inDISTRIBUTION easy-to-understand lan- nation of manualNOT FORhemocytometer SALE ORcell count.DISTRIBUTION A glossary of guage. Continuing the standard set by Sister Graff, the book terms that is ideal for study and review summaries key terms uses numerous color photomicrographs to familiarize readers highlighted in chapter; and for those who rely on the text as a with both the normal and abnormal structures found in the reference, a complete index. urinary sediment and body fluids while tables and illustrations We note that the information concerning reactions of the © Jones help& Bartlett clarify concepts. Learning, The third LLC edition is divided into three© Jonesvarious & reagent Bartlett strip Learning, methods is up-to-dateLLC at the time of NOT FORsections SALE for ORbetter DISTRIBUTION grouping of content. NOTpublication, FOR SALE but becauseOR DISTRIBUTION manufacturers continually improve Section I includes foundational information about renal their products, the reagents, sensitivities, detection ranges, anatomy (Chapter1) and disorders that may be detected by and timings may change. Therefore, following manufacturers’ analyzing urine (Chapters 2 and 3), as well as introductory most recent directions is of utmost importance. information regarding clinical laboratory operations includ- We are grateful for the thoughtful suggestions of our ing safety (Chapter 4) and© microscopyJones & (Chapter Bartlett 5). Learning, LLCreviewers and readers, to which© weJones have given & Bartlett consideration Learning, LLC Section II focusses NOTon the FOR urinalysis, SALE beginning OR DISTRIBUTION with when revising and updating NOTthe current FOR textSALE to meet OR theDISTRIBUTION urine specimen collection and preservation (Chapter 6), needs of our audience. then progressing through physical examination (Chapter Graff’s Textbook of Urinalysis Body Fluids will continue to 7), chemical analysis (Chapter 8), and microscopic exam- serve the medical laboratory profession © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

9781284221404_FMxx_i_xxxii.indd 9 20/05/20 2:49 PM © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

9781284221404_FMxx_i_xxxii.indd 10 20/05/20 2:49 PM © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Content Highlights © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC SECTION I FOUNDATIONAL INFORMATION Harmonized System for labeling chemicals. Five new images NOT FOR SALE OR DISTRIBUTION have beenNOT added FORto this SALEchapter, forOR a totalDISTRIBUTION of seven. ● Chapter 1, Urinary System Anatomy and Physiology and ● Chapter 5, Microscopy is a new chapter for this edition Urine Formation, contains the basic information on anat- drawing from the work of Landy McBride. This chapter omy and physiology that is key to understanding the uri- includes the basics of microscope handling along with prin- nary system and urinalysis. While retaining the previous © Jones & Bartlett Learning, LLC © Jonesciples & ofBartlett illumination Learning, and how to LLC achieve the best contrast anatomy sections and the 17 related illustrations, the revised for proper viewing. Several types of microscopy are pre- NOT FOR SALEchapter hasOR more DISTRIBUTION information on urinary tract functionsNOT FORsented. SALE This chapter OR DISTRIBUTION contains 25 images new to this text. and on assessing renal function than the previous edition. The chapter has added information on creatinine clearance SECTION II THE URINALYSIS and calculating and estimating the glomerular filtration rate ● and using that information© Jones to assess & chronicBartlett kidney Learning, disease LLCChapter 6 pulls out the ©Collection Jones &and Bartlett Preservation Learning, LLC stages. It also has included information on additional test- of Urine information that was contained in Chapter 3 of ing to assess renal functionNOT and FOR basic SALE information OR on DISTRIBUTION assess- the second edition, CollectionNOT and FOR Physical SALE Examination OR DISTRIBUTION ing tubular reabsorption and secretion. of Urine, into its own chapter. The previous edition only ● Chapter 2, Renal and Urinary Tract Diseases and Related included one image for the collection and preservation Urinalysis Findings, has been split from the metabolic dis- information. The third edition contains seven additional eases© that Jones were together & Bartlett in Chapter Learning, 7 of the previous LLC edition. images, including© Jones illustration & Bartlett of suprapubic Learning, puncture LLC for This chapter includes expanded and updated information on the collection on urine directly from the bladder, collection acuteNOT kidney FOR injury SALE (AKI), ORwhich DISTRIBUTION is a common problem in containers,NOT methods FOR of transferSALE from OR collection DISTRIBUTION container to hospitalized patients, and recognizing the AKI stages. AKI urine testing tubes, and an assortment of urine preservative has poor prognosis with a high associated mortality in hos- tubes. This chapter now contains eight images (seven new pitalized patients, particularly in the intensive care unit. This plus one reused as a chapter review question). chapter also has expanded information and images on uro- ● Chapter 7 pulls out the Physical Examination of Urine © Jones &lithiasis, Bartlett which Learning, is a relative common LLC and frequently recurring© Jonesinformation & Bartlett that was Learning, contained inLLC Chapter 3 of the second NOT FOR SALEmalady that OR occurs DISTRIBUTION in the urinary tract. This is often a painNOT- FORedition, SALE Collection OR andDISTRIBUTION Physical Examination of Urine, into ful condition that has been found to have comorbidities with its own chapter. The third edition contains images of abnor- other conditions that affect the urinary tract. mal urines, and an example of a “flow-through” set up for ● Chapter 3, Metabolic Diseases and Related Urinalysis refractometry. This chapter now contains eight images (four Findings has been split from the renal diseases that were new plus one reused as a chapter review question). © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC together in Chapter 7 of the previous edition. This chapter ● Chapter 8, Chemical Examination of Urine, the third edi- provides an overview NOTof the FORmost common SALE metabolicOR DISTRIBUTION dis- tion contains tables, chemicalNOT reactions, FOR andSALE images OR from DISTRIBUTION eases that are detectable with urine testing such as amino- the previous edition and clarifies procedures by enclosing acidurias, and carbohydrate metabolism disorders. A table this information in “boxes.” In addition, urine reagent strip explaining urine findings in porphyria, metabolic pathways, tests for ascorbate, calcium, creatinine, and microalbumin and five new images enhance the reader’s understanding. are included along with new images. This chapter now con- ● Chapter© Jones 4, Urinalysis & Bartlett Clinical Learning, Laboratory LLC Operations tains 23 images© Jones (12 new). & Bartlett Learning, LLC (ChapterNOT 1FOR in the SALE second edition)OR DISTRIBUTION provides an overview of ● Chapter 9,NOT Microscopic FOR SALE Examination OR DISTRIBUTION of Urinary Sediment various regulatory agencies that have an influence labo- continues to detail the observance of urinary sediment and ratory operations and explains levels of testing as catego- includes 17 new images, some of rarely seen sediment. This rized in CLIA’88. The fundamentals of quality assessment chapter now contains 97 images. are also covered as are principles for safe practices in the ● Chapter 10, Atlas of Urinary Sediment continues to be © Jones &medical Bartlett laboratory Learning, including LLC an explanation of the Globally© Jonesone &of Bartlettthe most complete Learning, resources LLC for urinary sediment NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION xi

9781284221404_FMxx_i_xxxii.indd 11 20/05/20 2:49 PM xii Content Highlights

© Jones &images. Bartlett Most Learning, of the 190 images LLC have been resized, while© Joneschapters & Bartlett include AmnioticLearning, Fluid LLC and Vaginal Secretions. NOT FOR threeSALE have OR been DISTRIBUTION replaced. NOT FORThe informationSALE OR remaining DISTRIBUTION from the previous Chapter 14, Urine Pregnancy Testing, and Bronchoalveolar Lavage and Bronchial Washings, is found in this chapter and includes SECTION III BODY FLUIDS ANALYSIS six new images including an illustration to help students visualize the collection of bronchial fluid. New informa- ● Chapter 11, Introduction to Body Fluids, along with its six © Jones & Bartlett Learning, LLCtion not contained in the© second Jones edition, & Bartlett includes Learning,sec- LLC images, is a basic overview of the types of fluids in the body, tions on Urine Eosinophils, Ear Fluidand Vitreous Fluid, the formation of effusionsNOT andFOR the SALEmethods OR for enumeratDISTRIBUTION- NOT FOR SALE OR DISTRIBUTION along with three new images. The chapter now contains 18 ing cells in these fluids. images (10 new). ● Chapter 12, Cerebrospinal Fluid contains a brief overview ● Chapter 20, Automation of Urinalysis and Body Fluid of the anatomy and physiology of CSF. Laboratory testing is Examination, presents up-to-date information and images detailed, and conditions affecting CSF test results are out- © Jones & Bartlett Learning, LLC from several© manufacturersJones & Bartlett of instrumentation Learning, for the LLC analy- lined. Eight new images have been added to this chapter for sis of urine and body fluids, including semen. In addition, 11 a totalNOT of 29. FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION new images, screen shots from automated microscopic anal- ● Chapter 13, Serous Body Fluids contains information ysis of urine, are included for common urinary sediments. about laboratory analysis of pleural, pericardial, and perito- This chapter includes 32 images. neal fluids. Five new images have been added to this chapter for a total of 22. © Jones & ● Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Chapter 14, Synovial Fluid contains a brief overview of APPENDICES NOT FOR SALEthe composition OR DISTRIBUTION and function of synovial fluid. LaboratoryNOT FOR SALE OR DISTRIBUTION analysis of synovial fluid is explained along with interpreta- ● Appendix A, Answers to Study Guide Questions and Case tion. This chapter contains 22 images. Studies, allows students to verify their comprehension of ● Chapter 15, Gastric Fluid and Fecal Analysis has been the material presented in the end of chapter questions. expanded to include gastric© Jones fluid information, & Bartlett which Learning, was not LLC ● Appendix B, Reagent Strip© Color Jones Chart &, givesBartlett students Learning, to LLC included in the second edition. An image of gastric fluid col- NOT FOR SALE OR DISTRIBUTIONopportunity to view the colorNOT chart FOR for manual SALE interpreta OR DISTRIBUTION- lection is included as well as an image for the testing of gas- tion of urine chemistry analysis prior to hands on labora- tric fluid. An image has been added to the physiology section tory sessions. at the beginning of the chapter to provide students with an ● Appendix C, Hemocytometer Cell Counts, details manual overview or review of the digestive system; and an additional cells counting principles. Seven new images are included to image© isJones added to & the Bartlett fecal analysis Learning, section. This LLC chapter con- enhance understanding.© Jones & Bartlett Learning, LLC tains nine images (three new). ● Appendix D, Historically Relevant Urinalysis Informa- ● NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Chapter 16, Semen Analysis provides information about tion, preserves methods used in the past as it provides for the composition of semen and sperm formation, classifica- an understanding of the evolution of current methods. In tion of semen by using various test parameters, and macro- addition, this appendix includes procedures that may still scopic and microscopic evaluation of semen. This chapter be performed by some laboratories. contains 27 images. ● Glossary, now contains over 180 additional words. Watch © Jones & ● Chapter Bartlett 17, Learning,Amniotic Fluid LLC contains information moved© Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FORfor crossword SALE puzzlesOR DISTRIBUTION to be made available on the Navig ate 2 from the chapter on miscellaneous body fluids in the sec- Companion Website. ond edition into its own chapter. Three of this chapter’s six images are new to this edition. ● Chapter 18, Vaginal Secretions contains information ANCILLARY MATERIALS moved from the chapter© Jones on miscellaneous & Bartlett body Learning, fluids in LLC © Jones & Bartlett Learning, LLC the second edition into its own chapter and now covers the Ancillary materials for users of Graff’s Textbook of Urinalysis detection of fetal substancesNOT FOR in vaginal SALE secretions OR DISTRIBUTION at the and Body Fluid 3e are availableNOT through FOR the NavigateSALE OR2 Com DISTRIBUTION- time of fetal membrane rupture prior to delivery. Six of this panion Website. chapter’s ten mages are new to this edition. ● PowerPoint Presentations ● Chapter 19, Miscellaneous Body Fluids, is the most ● Flashcards ● revised© Jones of all the & Bartlettchapters in Learning, the third edition. LLC Sections Crossword© Puzzles Jones & Bartlett Learning, LLC from the second edition Chapter 14, Miscellaneous Body ● Additional Case Studies Fluids,NOT that FOR were SALE removed OR and DISTRIBUTION made into their own NOT FOR SALE OR DISTRIBUTION

9781284221404_FMxx_i_xxxii.indd 12 20/05/20 2:49 PM © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION About the Authors © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Lillian A. Mundt, EdD, MLS(ASCP)SH, LMT (NCBMT) is a medical laboratory sci- NOT FOR SALEentist, OR DISTRIBUTION massage therapist, curriculum designer,NOT and FOR author. SALE Her ORbackground DISTRIBUTION includes a bachelor’s degree in medical technology, a master’s degree in health professions education, and a doctorate in educational leadership. For over 30 years, she has developed and taught phlebotomy programs, clinical laboratory science programs, and graduate programs at © Jones & Bartlett Learning,both LLC hospital-based and university-based© Jones & Bartlettinstitutions. Learning, She has authored LLC and developed course materials used in online education programs for colleges and universities, as well NOT FOR SALE OR DISTRIBUTIONas online continuing educationNOT companies. FOR SALE In addition,OR DISTRIBUTION Dr. Mundt has authored several articles for professional journals, and has co-authored books on urinalysis, phlebotomy, a book chapter in clinical chemistry, and has published her dissertation. Dr. Mundt has presented posters and lectures at local, state, and national conventions. Her current focus is © Joneson developing & Bartlett educational Learning, materials LLC for medical laboratory science© Jones and health& Bartlett professions Learning, LLC education. She remains professionally current maintaining licensure as a massage thera- NOTpist, FOR employment SALE OR as a DISTRIBUTIONmedical laboratory scientist at a hospitalNOT laboratory, FOR SALEand developing OR DISTRIBUTION and teaching courses on a contractual basis.

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC CM NOT FOR SALE KristyOR DISTRIBUTION L. Shanahan, MS, MLS(ASCP) , isNOT a medical FOR laboratory SALE OR scientist, DISTRIBUTION assistant professor in the Pharmaceutical Sciences department, biochemistry graduate student, and author. Her background includes a master’s degree in clinical laboratory science, as well as a master’s degree in biotechnology. She has many years of experience working in hospital and microbiology laboratories and has taught in biology, microbiology, and in medical © Jones & Bartlett Learning,laboratory LLC technician and medical© Jones laboratory & Bartlett science Learning, programs from LLC the associate degree NOT FOR SALE OR DISTRIBUTIONlevel to the graduate level. SheNOT is currently FOR SALE teaching OR full-time DISTRIBUTION in the College of Pharmacy at Rosalind Franklin University. She has developed course materials and taught in online courses for several community colleges and universities. Assistant Professor Shanahan has published articles in multiple journals, and has co-authored a book on urinalysis and a book chapter in clinical chemistry. She has presented posters and lectures at local, state, © Jonesand national & Bartlett for medical Learning, laboratory LLC science and microbiology© professional Jones & Bartlettprograms. Learning,She LLC NOTis anFOR active SALE member OR of DISTRIBUTION several professional groups in medicalNOT laboratory FOR sciences,SALE ORmicro DISTRIBUTION- biology, and pharmacy.

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9781284221404_FMxx_i_xxxii.indd 14 20/05/20 2:49 PM © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Acknowledgments © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Thank you to Landy James McBride PhD, MT(ASCP), Professor Emeritus of Biology (1983–2002) NOT FOR SALECalifornia OR DISTRIBUTION State University, Bakersfield, CA for contentNOT and FOR images SALE that comprise OR DISTRIBUTION most of Chapter 5: Microscopy.

We thank our reviewers for their insightful suggestions for improving the third edition of this text. © Jones & Bartlett Learning,We LLC greatly appreciate the expertise,© Jones cooperation, & Bartlett and patience Learning, of the publisher LLC and editing managers who assisted us. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION In addition, we thank the various manufacturers for images of their instruments.

Finally, we thank the Pathology Laboratory at Adventist Hinsdale Hospital and Adventist LaGrange © JonesMemorial & Hospital,Bartlett IL, Learning, for supplying LLCspecimens from which new images© Jones were created; & Bartlett and Learning, LLC co-worker for her modeling of laboratory procedures. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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9781284221404_FMxx_i_xxxii.indd 16 20/05/20 2:49 PM © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION List of Figures © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

1-1. Male© Jones urinary tract—lateral & Bartlett view. Learning, (Adapted with LLC permission 2-3. Hydronephrosis© Jones and Kidney& Bartlett Stone Labeled Learning, Asset provided LLC by fromNOT Anatomical FOR Chart SALE Company, OR Inc., DISTRIBUTION Skokie, IL, USA.) 3 AnatomicalNOT Chart Co.FOR 21 SALE OR DISTRIBUTION 1-2. Female urinary tract—lateral view. (Adapted by permission 2-4. Vesicle Kidney Stones Labeled. 21 from Anatomical Chart Company, Inc., Skokie, IL, USA.) 3 2-5. Glomerulus with single well-developed Kimmelstiel–Wilson 1-3. The urinary system. (Asset provided by Anatomical nodule at 12 o’clock. Also note uniform thickening of GBM. Chart Co.) 4 (PAS, ×390.) 30 © Jones 1-4.& Bartlett Structures Learning,of the urinary tract LLC (A), and cross-section of the © Jones2-6. RBC& Bartlettcast: urine sediment; Learning, 400×. (University LLC of Washington NOT FOR SALEkidney (B). OR 5 DISTRIBUTION NOT FORDepartment SALE of LaboratoryOR DISTRIBUTION Medicine, with permission.) 31 1-5. The kidney. 5 2-7. Broad finely granular cast becoming waxy cast with mixed 1-6. The sectioned left kidney. 6 cellular background. (Courtesy of McBride LJ. Textbook of 1-7. The nephron. (Asset provided by Anatomical Chart Co.) 7 Urinalysis and Body Fluids: A Clinical Approach. Philadelphia, PA: Lippincott, 1998.) 31 1-8. In this view the nephron has been stretched out and the surrounding blood vessels removed to illustrate the different 2-8. Fatty casts, urine sediment; 400×. (University of Washington sections of the tubule. The© Jonesreabsorption & ofBartlett sodium and Learning, water LLCDepartment of Laboratory Medicine,© Jones with permission.) & Bartlett 32 Learning, LLC is indicated. (From CohenNOT BJ, Taylor FOR JJ. (2005).SALE Memmler’s OR DISTRIBUTION The 2-9. Fatty casts; polarized light (POL);NOT urine FOR sediment; SALE 400 OR×. DISTRIBUTION Human Body in Health and Disease, 10th ed. Burlington, MA: (University of Washington Department of Laboratory Medicine, Jones & Bartlett Learning, LLC.) 8 with permission.) 32 1-9. Renal arterial and venous blood flow through the kidney. 8 2-10. Granular casts, urine sediment. SM stain; 200×. (Courtesy 1-10. The renal pyramid with corresponding blood vessels. (Asset of McBride LJ. Textbook of Urinalysis and Body Fluids: A Clinical Approach. Philadelphia, PA: Lippincott, 1998.) 32 provided© Jones by Anatomical & Bartlett Chart Co.) Learning, 9 LLC © Jones & Bartlett Learning, LLC 1-11. Bowman capsule, the glomerular tuft, and the 2-11. WBC cast, urine sediment. SM stain; 400×. (Courtesy of juxtaglomerularNOT FOR apparatus. SALE (From OR GartnerDISTRIBUTION H. Color Atlas of McBride LJ.NOT Textbook FOR of Urinalysis SALE and OR Body DISTRIBUTION Fluids: A Clinical Histology, 3rd ed. Philadelphia, PA: Lippincott Williams & Wilkins, Approach. Philadelphia, PA: Lippincott, 1998.) 32 2001.) 9 2-12. Direct Gram stain of urine showing gram-negative rod 1-12. The glomerulus (renal corpuscle) and the filtration barrier of bacteria and three WBCs (neutrophils); 1000×. (Courtesy of the glomerulus. (Asset provided by Anatomical Chart Co.) 9 McBride LJ. Textbook of Urinalysis and Body Fluids: A Clinical Approach. Philadelphia, PA: Lippincott, 1998.) 33 © Jones 1-13.& Bartlett Formation Learning, of urine via filtration, LLC reabsorption, secretion, © Jones & Bartlett Learning, LLC and hormonal effects. (From Premkumar K. The Massage 3-1. A: Diaper with urine from normal infant. B: Diaper with urine NOT FOR SALEConnection OR Anatomy DISTRIBUTION and Physiology. Baltimore, MA: LippincottNOT FORfrom infantSALE with OR Hartnup DISTRIBUTION syndrome. Williams & Wilkins, 2004.) 10 3-2. The normal metabolic pathway of phenylalanine 1-14. Filtration and tubular processing of the glomerular metabolism. 36 ultrafiltrate. 10 3-3. Increased formation of phenylalanine metabolites resulting 1-15. The countercurrent mechanism and antidiuretic hormone from the deficiency of phenylalanine hydroxylase. 36 in urine concentration. (From© Jones Premkumar & Bartlett K. The Massage Learning, LLC3-4. Types of tyrosinemia depend© on Jones the enzyme & Bartlettthat is Learning, LLC Connection Anatomy andNOT Physiology FOR. Baltimore, SALE MA:OR Lippincott DISTRIBUTION deficient. 37 NOT FOR SALE OR DISTRIBUTION Williams & Wilkins, 2004.) 11 3-5. Tyrosine also has another metabolic pathway, the 1-16. The renin–angiotensin–aldosterone cycle and hypertension. production of melanin. Albinism results from a deficiency in (Asset provided by Anatomical Chart Co.) 12 tyrosinase. 37 1-17. Renal cell becoming an oval fat body. Note the Maltese-cross 3-6. Alkaptonuria results from a deficiency in homogentisic acid formations inside the cell, indicating the lipid droplets contained oxidase. 38 in this© Jonescell. Eventually, & Bartlett the cell will Learning, become unrecognizable LLC as 3-7. Biosynthesis© Jones of heme. & (Porphyrins Bartlett are Learning, underlined). 39LLC a cellNOT as it takesFOR on SALEmore lipids, OR and DISTRIBUTION it will become an oval fat 3-8. Urine containingNOT FOR porphyrins SALE under OR ultraviolet DISTRIBUTION light. 40 body. 13 3-10. Diaper with urine from infant with Lesch–Nyhan disease. 2-1. Comparison of different types of kidney stones: Clinical Note the “red brick dust” appearance of the urine acid crystal manifestations of kidney stones include hematuria and flank clumps. 40 pain. 20 3-11. Image for Case study 3-1. 42 © Jones 2-2.& Bartlett Magnesium Learning, ammonium Phosphate LLC (Struvite) Stones in Kidney© Jones3-12. &Image Bartlett for Case Learning,study 3-3. 43 LLC Labeled Asset provided by Anatomical Chart Co. 21 NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION xvii

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© Jones4-1. & BartlettCommon safety Learning, symbols. (Courtesy LLC of McBride L. Textbook © JonesA’ and & B’).Bartlett (From James Learning, J. Light Microscope LLC Techniques in of Urinalysis and Body Fluids. Philadelphia, PA: Lippincott; Biology and Medicine. Dordrecht: Kluwer Academic Publishers; NOT FOR SALE1998.) 49 OR DISTRIBUTION NOT FOR1976.) SALE 59 OR DISTRIBUTION 4-2. Global Harmonization System pictograms used for chemical 5-9. Correction of chromatic aberration for two colors by the hazard communication (as found on the OSHA web site). 50 combination of a positive and a negative lens of materials with 4-3. National Fire Protection Agency (NFPA) symbol. 50 different dispersion; both image points come to coincide, but it entails an increase in the focal distance of the refractive complex. 4-4. Hazardous Materials Identification System (HMIS) label. 50 © Jones & Bartlett Learning, LLC(From James J. Light Microscope© TechniquesJones &in BiologyBartlett and Learning, LLC 4-5. A table-top safety shield is one engineering device that Medicine. Dordrecht: Kluwer Academic Publishers; 1976.) 60 can be used to protect personnelNOT FOR when SALEhandling specimensOR DISTRIBUTION or NOT FOR SALE OR DISTRIBUTION 5-10. A: Brightfield does not allow for viewing of cellular details, chemicals. 51 however (B) adjusting the aperture does allow for observation 4-6. A chemical spill cleanup kit contains the materials needed to of details. (Modified from Hoffman R, Drewry J. A Comparison of clean up various types of chemical spills. 51 Four Types of Light Microscopy. 5th ed. Dayton, OH: Educational 4-7. Sinks designated as (A) “clean” for hand washing and (B) Materials for Health Professionals; 2002.) 60 “dirty”© Jones for processing & Bartlett of specimens Learning, should be clearly LLC marked and 5-11. Phase© contrast Jones microscopy & Bartlett intensifies Learning, subtle contrasts. LLC their uses enforced. 52 NOT FOR SALE OR DISTRIBUTION (Modified NOTfrom Hoffman FOR R,SALE Drewry J.OR A Comparison DISTRIBUTION of Four 5-1. Ray diagram of a simple microscope. The object is imaged on Types of Light Microscopy. 5th ed. Dayton, OH; Educational the retina of the eye by the lens. This appears to the eye as if it Materials for Health Professionals; 2002.) 61 were from an object at the position of the virtual image. (From 5-12. Schematic view of the practical realization of the phase Richardson H. Handbook for the light microscope: A user’s guide. contrast principle; (A) phase annulus under the condenser (B) Park Ridge, NJ: Noyes Publications; 1991.) 56 the corresponding phase plate in the objective. (From James J. © Jones 5-2.& Bartlett Ray diagram Learning, of a compound LLC microscope; the object is just © JonesLight & Microscope Bartlett Techniques Learning, in Biology LLC and Medicine. Dordrecht: NOT FOR SALEoutside of OR the firstDISTRIBUTION focal plane of the objective (FOB); the NOT FORKluwer SALE Academic OR Publishers; DISTRIBUTION 1976.) 61 intermediary image is just within the focal plane of the eyepiece 5-13. A: Using a polarizing filter produces a blackened field of FOC; compare with 8-1. (From James J. Light Microscope view; materials that polarize allow light to pass. B: A first order Techniques in Biology and Medicine. Dordrecht: Kluwer red compensation applied after polarization produces a red Academic Publishers; 1976.) 56 field of view, while polarized materials appear yellow or blue 5-3. Schematic relationship between the virtual image as depending upon the orientation of the compensation filter. In perceived by the eye and© the Jones real image & thatBartlett exists above Learning, the LLCthis image the orientation of the© compensatorJones & isBartlett in a neutral Learning, LLC eyepiece; this latter imageNOT is the FOR one used SALE for photomicrography. OR DISTRIBUTION position. C: After adjusting theNOT axis of FORthe compensator SALE filter,OR DISTRIBUTION (From Richardson crystals aligned with the compensation filter appear yellow if H. Handbook for the light microscope: A user’s guide. Park negatively birefringent while crystals lying perpendicular to the Ridge, NJ: Noyes Publications; 1991.) 56 filter appear blue, showing their positive birefringence. 5-4. Ray diagram of a compound microscope. (From James J, D: When the axis of the filter is flipped, the colors of the crystals Tanke HJ, eds. Biomedical Light Microscopy. Dordrecht: Kluwer reverse. Academic© Jones Publishers; & Bartlett 1976.) 57 Learning, LLC 5-14. Schematic© Jones view of the& developmentBartlett Learning, of a path difference LLC 5-5. SphericalNOT FOR aberration. SALE When OR the objectDISTRIBUTION is a luminous point when a lightNOT ray traverses FOR SALEa doubly refractingOR DISTRIBUTION material, o, emitting monochromatic light, a bright circle with darker border ordinary ray; e, extraordinary ray; Γ, path difference. (From James will be seen on a screen held in the object space at A; at plane J, Tanke HJ, eds. Biomedical Light Microscopy. Dordrecht: Kluwer B a bright ring with a darker center will be seen. AP-angular Academic aperture of the lens. (From James J. Light Microscope Techniques Publishers; 1991.) 62 in Biology and Medicine. Dordrecht: Kluwer Academic Publishers; 5-15. Schematic representation of the ray path in a light © Jones & 1976.)Bartlett 57 Learning, LLC © Jonesmicroscope & Bartlett adapted Learning, for modulation-contrast LLC microscopy after NOT FOR5-6. SALE Chromatic OR aberration. DISTRIBUTION As a consequence of different NOT FORHoffman. SALE (From OR James DISTRIBUTION J, Tanke HJ, eds. Biomedical Light refractions of rays of various wavelengths coming from a Microscopy. Dordrecht: Kluwer Academic Publishers; 1991.) 63 luminous point emitting mixed light, dispersion occurs for which 5-16. Modulation contrast microscopy creates a three- the distance D is a measure. On the optical axis, a spectrum of dimensional image. (Modified from Hoffman R, Drewry J. image points will be formed, with points for violet (V) and red (R) A Comparison of Four Types of Light Microscopy. 5th ed. at the extremities. (From James J. Light Microscope Techniques in Dayton, OH: Educational Materials for Health Professionals; Biology and Medicine. Dordrecht:© Jones Kluwer & Bartlett Academic Publishers; Learning, LLC2002.) 63 © Jones & Bartlett Learning, LLC 1976.) 57 NOT FOR SALE OR DISTRIBUTION5-17. Scheme of the course of interferingNOT FOR rays in SALE differential OR DISTRIBUTION 5-7. Basic components of a compound light microscope. (From interference contrast. W I and W II, Wollaston prisms; C, James J. Light Microscope Techniques in Biology and Medicine. condenser; OB, object; 0, objective; EP, eyepiece. A polarizer Dordrecht: Kluwer Academic Publishers; 1976.) 58 in front of W I and analyzer behind W II are not shown. (From 5-8. The effect of oil immersion. In situation I, without immersion, James J. Light Microscope Techniques in Biology and Medicine. of three rays with an ever increasing angle toward the optical Dordrecht: Kluwer Academic Publishers; 1976.) 64 axis,© only Jones ray A reaches & Bartlett the objective Learning, in such a way LLC that it can 5-18. Darkfield© Jones microscopy & produces Bartlett a bright Learning, image on a LLCdark be NOTpresumed FOR to take SALE part in imageOR DISTRIBUTIONformation, whereas ray C background.NOT (Modified FOR from SALE Hoffman OR R, DrewryDISTRIBUTION J. A Comparison does not even reach the upper part of the object space, being of Four Types of Light Microscopy. 5th ed. Dayton, OH: totally reflected at the surface of the cover glass. In situation Educational Materials for Health Professionals; 2002.) 64 II, the same three rays reach the object space (virtually without 5-19. Schematic view of the course of the rays in a vertical being refracted) and both rays A’ and B’ probably can take part fluorescence illuminator with dichroic in image formation C’, reaching at least the upper part of the mirror. OB, object plane; BF, barrier filter; at right, a dark © Jones & objectBartlett space. Learning,It should be noted LLC that the angles of ray A and B © Joneslayer & absorbing Bartlett unused Learning, excitation light LLC that has passed the NOT FOR SALEwith the opticalOR DISTRIBUTION axis are greater than those of their counterpartsNOT FOR SALE OR DISTRIBUTION

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© Jones &dichroic Bartlett mirror. Learning, (From James J. LLC Light Microscope Techniques in © Jones8-3. The& Bartlettreagent strip Learning, is dipped into aLLC specimen and removed Biology and Medicine. Dordrecht: Kluwer Academic Publishers; quickly, dragging the edge of the strip along the lip of the NOT FOR SALE1976.) 64 OR DISTRIBUTION NOT FORcontainer SALE to remove OR excessDISTRIBUTION urine. 90 5-20. Images show a high level of contrast when confocal 8-4. Follow the manufacturer’s required times for reading of microscopy is used in conjunction with fluorescence reagent strip test results. 91 techniques. 65 8-5. Many companies exist worldwide who manufacture urine 5-21. Red blood cells as seen using a scanning electron chemistry reagent strips. 91 microscope. 65 © Jones & Bartlett Learning, LLC8-6. pH color chart. Note: This chart© Jones is for color & demonstration Bartlett Learning, only LLC 5-22. White blood cell asNOT seen using FOR a transmission SALE ORelectron DISTRIBUTION and should not be used for interpretingNOT FOR reagent SALE strip reactions OR DISTRIBUTION microscope (call out shows this cell type viewed in brightfield for diagnostic testing. (Modified from Siemens Healthcare microscopy with Wright stain). 65 Diagnostics Inc. Tarrytown, NY; 2010). 91 5-23. Adjusting Kohler illumination (A) slide in focus for the 8-7. The discoloration on the pH pad, due to improver removal of objective to be used (B) misalignment of the condenser is excess urine from the reagent test strip, causes a run-over effect made obvious when the field diaphragm is closed (C) properly of color change in the pH pad. 92 centered© Jones condenser & withBartlett closed field Learning, diaphragm (D)LLC when the 8-8. Protein© color Jones chart. Note: & Bartlett This chart is Learning, for color demonstration LLC fieldNOT diaphragm FOR is opened,SALE the OR light DISTRIBUTION coming through a properly only and shouldNOT not FOR be used SALE for interpreting OR DISTRIBUTION reagent strip centered condenser fills the field evenly. 66 reactions for diagnostic testing. (Modified from Siemens 5-24. Proper microscope maintenance includes cleaning of lenses Healthcare Diagnostics Inc. Tarrytown, NY; 2010). 93 of the (A) oculars, (B) objectives, and (C) substage condenser with 8-9. Glucose color chart Note: This chart is for color demonstration manufacturer recommended lens cleaner and lens paper. 67 only and should not be used for interpreting reagent strip © Jones 6-1.& Bartlett Clean-catch Learning, urine collection LLC kits include cleansing wipes. 73© Jonesreactions & Bartlett for diagnostic Learning, testing. (Modified LLC from Siemens 6-2. Suprapubic aspiration of urine directly from the bladder. 74 Healthcare Diagnostics Inc. Tarrytown, NY; 2010). 94 NOT FOR6-3. SALE The transfer OR DISTRIBUTION of urine from collection containers (A) to testingNOT 8-10. FOR Clinitest SALE reactions: OR DISTRIBUTION Negative, 1+, 2+, 3+, and 4+. 95 tubes is made easy with the inclusion of a stopper-piercing port 8-11 Ketone color chart. Note: This chart is for color (B and C). Always ensure the transfer tube is labeled with the demonstration only and should not be used for interpreting same patient identifiers as the primary specimen. 74 reagent strip reactions for diagnostic testing. (Modified from 6-4. Transfer of urine from collection cups not having a port in their Siemens Healthcare Diagnostics Inc. Tarrytown, NY; 2010). 96 caps is made easier with ©the Jones use of a sterile & Bartlett transfer device. Learning, 74 LLC8-12. Acetest color chart. Note: ©This Jones chart is for & color Bartlett Learning, LLC 6-5. Use appropriate PPEsNOT when transferringFOR SALE specimens OR from DISTRIBUTION demonstration only and shouldNOT not be FOR used for SALE interpreting OR DISTRIBUTION primary container to aliquot tubes. Always label the aliquot with reactions for diagnostic testing. (Modified from Siemens the same patient identifiers as the primary container before [formerly Elkhart, IN: Bayer HealthCare LLC]; 2006.) 97 transferring specimens. 74 8-13. Blood color chart. Note: This chart is for color demonstration 6-6. Becton Dickensen urine tubes: (A) no additive urine tube; (B) only and should not be used for interpreting reagent strip chlorhexidine, along with other chemicals, is used to stabilize urine reactions for diagnostic testing. (Modified from Siemens for ©routine Jones testing & for Bartlett up to 72 hours; Learning, (C) boric acid LLC is used for Healthcare© Diagnostics Jones Inc.& BartlettTarrytown, NY; Learning, 2010). 99 LLC urineNOT cultures; FOR (D) special SALE urine OR preservative DISTRIBUTION tube (UPT) containing 8-14. A: NormalNOT pathway FOR of SALE bilirubin ORand urobilinogen DISTRIBUTION trademarked preservative suitable for molecular testing. 75 metabolism; (B) pathway in hepatic jaundice; (C) pathway in 6-7. Male infant urine collection bag. 75 obstructive jaundice; (D) pathway in hemolytic jaundice. 100 6-8. Cloth fibers (160×). 75 8-15. Bilirubin color chart. Note: This chart is for color 7-1. Urine specimens of varying normal colors. 80 demonstration only and should not be used for interpreting reagent strip reactions for diagnostic testing. (Modified 7-2. Urine specimens from a patient with alkaptonuria © Jones & Bartlett Learning, LLC © Jonesfrom & Siemens Bartlett Healthcare Learning, Diagnostics LLC Inc. Tarrytown, NY; (A) near fresh specimen; (B) turns black over time. 82 2010). 102 NOT FOR7-3. SALE Urine specimensOR DISTRIBUTION of varying abnormal colors and clarity. 82 NOT FOR SALE OR DISTRIBUTION 8-16. Ictotest color reactions. A: negative, (B) moderate, and (C) 7-4. Urine containing protein may produce a foam when large. 103 agitated. 82 8-17. ICTERO-CHECK test for urine bilirubin. (Courtesy of Biorex 7-5. Schematic diagram of the total solids refractometer. (Courtesy Labs LLC Cleveland, OH.) 103 of the American Optical Company, New York, NY, USA.) 85 8-18. Urobilinogen color chart. Note: This chart is for color 7-6. Total solids refractometer© Jones using flow-through & Bartlett setup. Learning, 85 LLCdemonstration only and should© not Jones be used for& Bartlettinterpreting Learning, LLC 7-7. Schematic representationNOT of theFOR refractometer SALE ORscales DISTRIBUTION of reagent strip reactions for diagnosticNOT testing.FOR (ModifiedSALE fromOR DISTRIBUTION measurement. This measurement represents a reading of Siemens Healthcare Diagnostics Inc. Tarrytown, NY; 2010). 104 1.014. 85 8-19. Nitrite color chart. Note: This chart is for color 7-8. Specific gravity color chart. (Modified from Tarrytown, NY: demonstration only and should not be used for interpreting Bayer Corporation Diagnostics Division, 1996.) Note: this chart reagent strip reactions for diagnostic testing. (Modified is for color demonstration only and should not be used for from Siemens Healthcare Diagnostics Inc. Tarrytown, NY; interpreting© Jones reagent & Bartlett strip reactions Learning, for diagnostic LLC testing. 86 2010). 105© Jones & Bartlett Learning, LLC 7-9. NOTImage for FOR questions SALE 1 to 7.OR 86 DISTRIBUTION 8-20. LeukocyteNOT esterase FOR color SALE chart. ORNote: DISTRIBUTIONThis chart is for color 8-1. A: Multistix 10 SG. B: Illustration of Multistix 10 SG with pad demonstration only and should not be used for interpreting identification labels. (Modified from Siemens [formerly Bayer reagent strip reactions for diagnostic testing. (Modified from Corporation, Tarrytown NY]; 1996.) Siemens Healthcare Diagnostics Inc. Tarrytown, NY; 2010). 107 8-2. Notice the discoloration of reagent pad (arrow) on this test 8-21. Ascorbic acid color chart. (Modified from Combi-Screen ® © Jones & stripBartlett that was Learning, exposed to moisture LLC during storage (compare with© JonesPLUS & [colorBartlett chart]. AnalyticonLearning, Biotechnologies LLC AG, Lichtenfels, Germany; 2008.) 107 NOT FOR SALEFig. 8-1A). OR 90 DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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© Jones8-22. & Bartlett Calcium colorLearning, chart. (Modified LLC from UriTest 13G® Urine © Jones9-31. &Cystine Bartlett crystal (1,000Learning,×). 122 LLC Reagent Strips [color chart]. Uritest Medical Electronic Co., Ltd. NOT FOR SALE OR DISTRIBUTION NOT9-32. FOR Cystine SALE crystals. OR Several DISTRIBUTION have laminated surfaces (160×). 122 GuiLin, PR China; 2.) 107 9-33. Leucine spheroid. Note the radiating and concentric ® 8-23. Creatinine color chart. (Modified from UriTest 13G Urine striations as well as the brown coloring typical of these Reagent Strips [color chart]. Uritest Medical Electronic Co., Ltd. crystals. 123 GuiLin, P.R China; 2006.) 108 9-34. Leucine spheroid under polarized light. Notice the Maltese ® 8-24. Microalbumin color chart. (Modified from URS-3ACC cross. (Modified from The Roche Historical Collection and Reagent Strips for Urinalysis© Jones [color chart]. & Bartlett Jilin Shenhua Learning, Economic LLCArchive.) 123 © Jones & Bartlett Learning, LLC Trade Co., Ltd. 1188 Jinxin Street, Changchun, China.) 108 NOT FOR SALE OR DISTRIBUTION9-35. Tyrosine crystals (160×). 123NOT FOR SALE OR DISTRIBUTION 9-1. Kova system: (A) Kova Petter is inserted into a tube of 9-36. Tyrosine crystals under polarized light. (Modified from The centrifuged urine; and is used to decant, resuspend, and Roche Historical Collection and Archive.) 123 deliver sediment into one of the counting chambers; (B) Kova 9-37. Cholesterol crystal with typical notched edges (250 ). 124 slide. Some models of Kova slides have 3-mm × 3-mm grids (as × indicated by the call out). 112 9-38. Cholesterol crystal DIT microscopy. (Modified from The 9-2. Amorphous© Jones phosphates & Bartlett and hyaline Learning, cylindroid. LLC The cylindroid Roche Historical© Jones Collection & andBartlett Archive.) Learning, 124 LLC is notNOT visible FOR in A but SALE appears ORin B when DISTRIBUTION the focus is adjusted 9-39. EsterifiedNOT cholesterol FOR polarizesSALE lightOR into DISTRIBUTION a Maltese cross. (200×). 113 Polarized light. (Modified from The Roche Historical Collection 9-3. Red blood cells. The field also contains a white cell and several and Archive.) 124 “ghost” cells (400×). 113 9-40. Bilirubin crystals (500×). 124 9.4 A: RBCs and WBCs. B: Changing the focus causes the red cells 9-41. Sulfonamide crystals, yeast, and WBCs. This photograph © Jones & toBartlett appear as blackLearning, circles (400 LLC×). © Jonesdemonstrates & Bartlett two typicalLearning, formations LLC of sulfa crystals: the 9-5. White blood cells in a hypotonic urine. The nuclei and fan or sheaf formation and sheaves with eccentric bindings (400 ). 125 NOT FOR SALEgranules areOR easily DISTRIBUTION recognized (800×). 114 NOT FOR× SALE OR DISTRIBUTION 9-42. X-ray dye crystals: Hypaque (160 ). 125 9-6. White cell clumps (200×). 115 × 9-7. Numerous white cells. Acetic acid (2%) was added to 9-43. X-ray dye crystals: Renografin (400×). 125 accentuate the nuclei (400×). 115 9-44. X-ray dye crystals may polarized light (160×). 125 9.8 A: Transitional cell. B: Renal epithelial cells. C: WBCs (800×). 9-45. Aspirin crystals—prismatic form. (Modified from The Roche Historical Collection and Archive.) 126 9-9. Transitional epithelial© cells Jones (500×). &116 Bartlett Learning, LLC © Jones & Bartlett Learning, LLC 9-10. Transitional epithelialNOT cell ( largeFOR arrow SALE), several OR DISTRIBUTION9-46. Aspirin crystals—stellate form.NOT (Modified FOR fromSALE The RocheOR DISTRIBUTION Historical Collection and Archive.) 126 squamous epithelial cells, and white cells (200×) 116 9-47. Acetophenetidin—stellate or “fir tree” forms. (Modified 9-11. Squamous epithelial cells (160×). 116 from The Roche Historical Collection and Archive.) 126 9-12. Spermatozoa (500×). 116 9-48. Ascorbic acid-spherulites (polarized light). (Modified from 9-13. Bacteria (rods, cocci, and chains) (500×). 117 © Jones & Bartlett Learning, LLC The Roche© Historical Jones Collection & Bartlett and Archive.) Learning, 126 LLC 9-14. Yeast. Note the budding and doubly refractile walls 9-49. Caffeine crystals (bright field) (Modified from The Roche (1,000NOT×) 117 FOR SALE OR DISTRIBUTION Historical NOTCollection FOR and Archive.) SALE OR126 DISTRIBUTION 9-15. Schistosoma haematobium ovum. (Courtesy of Dr. Kenneth 9-50. Crystals found in alkaline urine. 127 A. Borchardt, San Francisco State University, San Francisco, CA.) 117 9-51. Triple phosphate crystals. Note the oblique ends of the prisms (200×). 127 9-16. Trichomonas vaginalis. Note the four flagella (1,000×). 117 9-52. Amorphous phosphate (400×). 127 9-17. Enterobius vermicularis ovum and WBCs (500×). 118 © Jones & Bartlett Learning, LLC © Jones9-53. &Calcium Bartlett carbonate Learning, crystals, spheroid LLC and rhombohedral 9-18. Head of Enterobius vermicularis adult female worm NOT FOR SALE OR DISTRIBUTION NOT FORforms. SALE (Modified OR from DISTRIBUTION The Roche Historical Collection and (1,000×) 118 Archive.) 127 9-19. Crystals frequently found in acidic urine. 118 9-54. Calcium carbonate crystals. The small arrow points out the 9-20. Crystals less frequently found in acidic urine. 120 typical “dumbbell” form which is next to a large mass of calcium 9-21. Calcium oxalate crystal (400×). 120 carbonate crystals (400×). 128 9-22. Calcium oxalate crystals. The “X” of each crystal is very 9-55. Calcium phosphate crystals (400×). 128 prominent (500×). 120© Jones & Bartlett Learning, LLC9-56. Calcium phosphate plate or© phosphate Jones sheath& Bartlett (200×). 128Learning, LLC 9-23. Calcium oxalate crystalsNOT can FOR sometimes SALE appear OR as oval, DISTRIBUTION 9-57. Ammonium biurate crystalsNOT (500× ).FOR 128 SALE OR DISTRIBUTION dumbbells, and rosettes. 120 9-58. Ammonium biurate crystals without spicules (500×). 128 9-24. Uric acid: diamond or rhombic forms may also be referred to 9-59. Sequence of urinary cast degeneration: (1) cellular casts; as “lemon-shaped” (500×). 121 (2) coarse granular cast; (3) fine granular cast; (4) waxy cast. 9-25. Uric acid crystals in rosette formation (500×). 121 (Courtesy of Neil O. Hardy, Westpoint, CT.) 129 9-26. ©Uric Jones acid: six-sided & Bartlett crystal may Learning, be confused with LLC cystine 9-60. Hyaline© castJones and red & blood Bartlett cells. Note Learning, the low refractive LLC (400NOT×). 121 FOR SALE OR DISTRIBUTION index of theNOT cast (400FOR×). SALE130 OR DISTRIBUTION 9-27. Uric acid: may display many colors under polarized light. 9-61. Hyaline cast. (DIT microscopy) (600×). (Modified from The Note the layered or laminated surface (400×). 121 Roche Historical Collection and Archive.) 130 9-28. Amorphous urates (200×). 121 9-62. Red cell cast and RBCs (400×). 130 9-29. Hippuric acid crystal (400×). 122 9-63. Red cell cast and RBCs (DIT microscopy) (400×). (Modified © Jones 9-30.& Bartlett Sodium urateLearning, crystals. These LLC needle-like crystals are not © Jonesfrom & The Bartlett Roche Historical Learning, Collection LLC and Archive.) 130 pointed at the ends (400×). 122 9-64. White cell cast and WBCs (500×). 130 NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

9781284221404_FMxx_i_xxxii.indd 20 20/05/20 2:49 PM List of Figures xxi

© Jones9-65. & Bartlett Epithelial Learning, cell cast. (Phase) LLC (800×). (Modified from The Roche© Jones10-1. &Hypotonic Bartlett urine Learning, containing an RBC,LLC several WBCs, two renal Historical Collection and Archive.) 131 epithelial cells, and a transitional epithelial cell (500 ). 143 NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION × 9-66. Epithelial cell cast. (DIT microscopy) (800×). (Modified from 10-2. Renal epithelial cells, WBCs, RBCs, and bacteria (500×). 143 The Roche Historical Collection and Archive). 131 10-3. Many RBCs and a squamous epithelial cell (160×). 143 9-67. Coarsely granular cast (200×). 131 10-4. SM-stained RBCs, some crenated (400×). (Courtesy of 9-68. Finely granular casts. Note the RBCs between the two casts McBride LJ. Textbook of Urinalysis and Body Fluids: A Clinical (500 ). 131 Approach. Philadelphia, PA: Lippincott; 1998.) 143 × © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC 9-69. Waxy cast, WBCs, and bacteria (400×). 132 10-5. Same field of view as previous under phase contrast 9-70. Waxy cast and WBCsNOT (200× ).FOR 132 SALE OR DISTRIBUTIONmicroscopy (400×). (Courtesy ofNOT McBride FOR LJ. Textbook SALE of OR DISTRIBUTION Urinalysis and Body Fluids: A Clinical Approach. Philadelphia, PA: 9-71. Fatty cast (400×). 132 Lippincott; 1998.) 143 9-72. Fatty cast. (Polarization computer added) (400×). 132 10-6. WBCs, a few RBCs, and bacteria (500×). 143 9-73. Oval fat body and fiber (500×). 133 10-7. SM-stained WBCs and bacteria under phase contrast 9-74. Fat droplets. Field also contains WBCs (500 ). 133 © Jones & Bartlett Learning,× LLC microscopy© (400 Jones×). (Courtesy & Bartlett of McBride Learning,LJ. Textbook of LLC 9-75. Polarized anisotropic fat droplets. Note the “Maltese-cross” Urinalysis and Body Fluids: A Clinical Approach. Philadelphia, PA: formationNOT (160FOR×). SALE133 OR DISTRIBUTION Lippincott;NOT 1998.) FOR144 SALE OR DISTRIBUTION 9-76. Neutral fats and triglycerides stain with Sudan III, while 10-8. Large clump of WBCs and many squamous epithelial cells esterified cholesterol remains colorless (400×). 133 (400×). 144 9-77. Cylindroid. Note the tapering tail (400×). 134 10-9. SM-stained RBCs, WBCs, and squamous epithelial cells (400×). 9-78. Mucus (100×). 134 (Courtesy of McBride LJ. Textbook of Urinalysis and Body Fluids: © Jones 9-79.& Bartlett Starch crystal Learning, (500×). 134 LLC © JonesA Clinical & Bartlett Approach .Learning, Philadelphia, PA: LLC Lippincott; 1998.) 144 NOT FOR9-80. SALE Starch OR crystals. DISTRIBUTION (Polarized light). Note the “Maltese-cross” NOT10-10. FOR DistortedSALE WBCs.OR DISTRIBUTION Acetic acid (2%) was added to the slide to formation (400×). 134 accentuate the nuclei, thereby confirming that the distorted cells are WBCs. The reason for this distortion is unknown (400 ). 144 9-81. Cloth fibers (160×). 135 × 9-82. Fibers. Debris from a diaper. This squeezed-out specimen 10-11. Clump of WBCs, stained by bilirubin (200×). 144 rendered microscopic examination useless. Note the various types 10-12. WBCs and squamous epithelial cells (400×). 144 of fibers present (200×).© 135 Jones & Bartlett Learning, LLC10-13. Renal epithelial cells (500©×). Jones 145 & Bartlett Learning, LLC 9-83. This fiber is a commonNOT contaminant FOR SALE (400×). OR135 DISTRIBUTION10-14. Sheet of squamous epithelialNOT cells; FOR most SALElikely vaginal OR DISTRIBUTION 9-84. This field of view shows an oil droplet (center), contamination (160×). 145 several WBCs and part of squamous cell (400×). 135 10-15. Numerous WBCs and few transitional cells (arrow) 9-85. Hair (right) and coarsely granular cast (left), viewed using an (200×). 145 80A filter (400×). 136 10-16. SM-stained WBCs and transitional epithelial cells (200×). 9-86. Glass fragments are frequently present if a glass pipette is (Courtesy of McBride LJ. Textbook of Urinalysis and Body Fluids: used© to Jones transfer sediment & Bartlett to the slideLearning, (400×). 136 LLC A Clinical ©Approach Jones. Philadelphia, & Bartlett PA: Lippincott; Learning, 1998.) LLC145 9-87. NOTAir bubble FOR and SALE amorphous OR urates DISTRIBUTION (160×). 136 10-17. SquamousNOT epithelial FOR SALE cells. 145 OR DISTRIBUTION 9-88. Talcum powder particles (160×). 136 10-18. WBCs and bacteria. (Courtesy of Smith B, Foster KA. The 9-89. Fecal contamination. The field also contains triple phosphate Urine Microscopic. 5th ed. Educational Material for Health Professionals Inc.; 1999.) 145 crystals (100×). 136 9-90. Image for Question 21. 137 10-19. SM-stained WBCs and bacteria (400×). (Courtesy of McBride LJ. Textbook of Urinalysis and Body Fluids: A Clinical Approach. © Jones 9-91.& Bartlett Image for Learning, Question 22. LLC138 © JonesPhiladelphia, & Bartlett PA: Lippincott; Learning, 1998.) LLC146 NOT FOR9-92. SALE Image OR for CaseDISTRIBUTION Study 9-1. (Courtesy of Smith B, Foster KA. NOT10-20. FOR SameSALE field OR of view DISTRIBUTION as previous figure under phase The Urine Microscopic. 5th ed. Educational Material for Health contrast microscopy (400×). (Courtesy of McBride LJ. Textbook of Professionals Inc; 1999.) 138 Urinalysis and Body Fluids: A Clinical Approach. Philadelphia, PA: 9-93. Image for Case Study 9-2. (Courtesy of Smith B, Lippincott; 1998.) 146 Foster KA. The Urine Microscopic. 5th ed. Educational Material 10-21. Amorphous urates (100×). 146 for Health Professionals Inc; 1999.) 139 10-22. Amorphous urates. The urates in this field are clumped 9-94. Image for Case Study© 9-2. Jones (Courtesy & ofBartlett Smith B, Foster Learning, KA. LLC © Jones & Bartlett Learning, LLC close together. Note the characteristic color (100×). 146 The Urine Microscopic. 5thNOT ed. Educational FOR SALE Material OR for DISTRIBUTIONHealth NOT FOR SALE OR DISTRIBUTION Professionals Inc; 1999.) 139 10-23. Uric acid crystals, diamond or rhombic form. These crystals are very thin and almost colorless (400×). 146 9-95. Image for Case Study 9-3. (Courtesy of Smith B, Foster KA. The Urine Microscopic. 5th ed. Educational Material for Health 10-24. Uric acid crystals in the urine of a patient with a kidney Professionals Inc; 1999.) 139 stone. Note the heavy clumps of crystals that were present, even in the fresh specimen (400×). 146 9-96. Image for Case Study 9-4. Unstained sediment. (Courtesy of Smith© B,Jones Foster KA. & TheBartlett Urine Microscopic Learning,. 5th ed. LLC Educational 10-25. WBC© cast Jones and uric & acid Bartlett crystals. Same Learning, patient as in LLCprevious MaterialNOT for FOR Health SALE Professionals OR Inc; DISTRIBUTION 1999.) 140 figure (400NOT×). 147 FOR SALE OR DISTRIBUTION 9-97. Image for Case Study 9-4 Sudan III-stained sediment. 10-26. Uric acid crystals in rosette formation (400×). 147 (Courtesy of Smith B, Foster KA. The Urine Microscopic. 5th ed. 10-27. Uric acid crystals, atypical form (400×). 147 Educational Material for Health Professionals Inc; 1999.) 140 10-28. Uric acid crystals, layered formation (500×). 147 9-98. Image for Case Study 9-5. (Courtesy of Smith B, Foster KA. 10-29. Uric acid crystals, thick rosette formation (200×). 147 © Jones & TheBartlett Urine Microscopic Learning,. 5th ed. LLC Educational Material for Health © Jones10-30. &Uric Bartlett acid, thick Learning, rosette formation LLC under higher power. Note Professionals Inc; 1999.) 140 NOT FOR SALE OR DISTRIBUTION NOT FORthe many SALE layered OR crystals DISTRIBUTION (500×). 147

9781284221404_FMxx_i_xxxii.indd 21 20/05/20 2:49 PM xxii List of Figures

© Jones10-31. & Bartlett Uric acid Learning, and calcium oxalate LLC crystals (500×). 148 © Jones10-59. &Tyrosine Bartlett crystals. Learning, Note the fine, LLC very pointy needles (1,000 ). 152 NOT FOR10-32. SALE Uric OR acid crystalsDISTRIBUTION under polarized light. Note the small NOT FOR SALE× OR DISTRIBUTION crystal (400×). 148 10-60. Tyrosine crystals (1,000×). 152 10-33. Uric acid under polarized light (400×). 148 10-61. Tyrosine crystals under polarized light. (Courtesy of Smith 10-34. Uric acid crystals (100×). (Courtesy of McBride LJ. Textbook B, Foster KA. The Urine Microscopic. 5th ed. Educational Material of Urinalysis and Body Fluids: A Clinical Approach. Philadelphia, for Health Professionals Inc.; 1999.) 153 PA: Lippincott; 1998.) 148 10-62. Tyrosine crystals (1,000 ). 153 © Jones & Bartlett Learning, LLC × © Jones & Bartlett Learning, LLC 10-35. Uric acid crystals (100×). (Courtesy of McBride LJ. Textbook 10-63. Cholesterol crystals from “kidney fluid” (200×). (Courtesy of Urinalysis and Body Fluids:NOT A FORClinical ApproachSALE .OR Philadelphia: DISTRIBUTION of McBride LJ. Textbook of UrinalysisNOT andFOR Body SALE Fluids: A ORClinical DISTRIBUTION Lippincott, 1998.) 148 Approach. Philadelphia: Lippincott, 1998.) 153 10-36. Uric acid crystals under polarized light (100×). (Courtesy 10-64. Same specimen as the previous figure under polarized of McBride LJ. Textbook of Urinalysis and Body Fluids: A Clinical light. (Courtesy of McBride LJ. Textbook of Urinalysis and Body Approach. Philadelphia, PA: Lippincott, 1998.) 148 Fluids: A Clinical Approach. Philadelphia: Lippincott, 1998.) 153 10-37.© Uric Jones acid crystals & Bartlett under polarized Learning, light (100 ×LLC). (Courtesy 10-65. X-ray© dye Jones crystals. &Specific Bartlett gravity ofLearning, the specimen LLCwas of McBride LJ. Textbook of Urinalysis and Body Fluids: A Clinical 1.070 (160 ). 153 NOT FOR SALE OR DISTRIBUTION NOT× FOR SALE OR DISTRIBUTION Approach. Philadelphia, PA: Lippincott; 1998.) 149 10-66. X-ray dye crystals (400×). 153 10-38. Uric acid crystals in pseudocast formation (400×). 149 10-67. X-ray dye crystals under polarized light (160×). 154 10-39. Uric acid, barrel shape, and yeast in the background (200×). 10-68. Bilirubin crystals and bilirubin-stained WBC and granular (Courtesy of McBride LJ. Textbook of Urinalysis and Body Fluids: cast (500×). 154 A Clinical Approach. Philadelphia, PA: Lippincott; 1998.) 149 10-69. Bilirubin crystals and bilirubin-stained sediment © Jones 10-40.& Bartlett Sodium Learning,urate crystals. Note LLC the square ends on each © Jones(500 &×). Bartlett154 Learning, LLC needle-like crystal (400 ). 149 NOT FOR SALE OR DISTRIBUTION× NOT10-71. FOR SulfonamideSALE OR crystals DISTRIBUTION (400×). (Courtesy of McBride LJ. 10-41. Sodium urates. Notice how narrow these crystals are Textbook of Urinalysis and Body Fluids: A Clinical Approach. (400×). 149 Philadelphia, PA: Lippincott; 1998.) 154 10-42. Sodium urate crystals (400×). 149 10-70. Bilirubin crystals. (Courtesy of Smith B, Foster KA. The Urine 10-43. Uric acid, needle shape under polarized light with red Microscopic. 5th ed. Educational Material for Health Professionals compensator (400×). (Courtesy© Jones of McBride & Bartlett LJ. Textbook Learning, of LLCInc.; 1999.) 154 © Jones & Bartlett Learning, LLC Urinalysis and Body Fluids: A Clinical Approach. Philadelphia, PA: 10-72. Sulfonamide crystals under polarized light with red Lippincott; 1998.) 150 NOT FOR SALE OR DISTRIBUTIONcompensator. (Courtesy of McBrideNOT LJ. FORTextbook SALE of Urinalysis OR andDISTRIBUTION 10-44. Calcium oxalate crystals (200×). 150 Body Fluids: A Clinical Approach. Philadelphia, PA: Lippincott; 10-45. Calcium oxalate crystals. Even under low-power 1998.) 154 magnification, the characteristics of the crystals are easily 10-73. Triple phosphate crystals. Many of these prisms are six- recognized (160×). 150 sided (200×). 155 10-46.© CalciumJones oxalates, & Bartlett amorphous Learning, urates, and a pieceLLC of debris. 10-74. Triple© phosphate Jones crystals& Bartlett and amorphous Learning, phosphates LLC SomeNOT of the FOR crystals SALE cracked whenOR theDISTRIBUTION coverslip was touched (200×). 155NOT FOR SALE OR DISTRIBUTION (200×). 150 10-75. Triple phosphate crystals (400×). 155 10-47. Calcium oxalate crystals clustered around a piece of debris. 10-76. Triple phosphate crystals (500×). 155 The field also contains squamous epithelial cells as well at many 10-77. Triple phosphates crystal and amorphous phosphates calcium oxalates (100 ). 150 × (200×). 155 10-48. Calcium oxalate forms seen in ethylene glycol 10-78. Triple phosphate crystals under polarized light. (Courtesy © Jones & poisoning.Bartlett 150Learning, LLC © Jonesof Smith & Bartlett B, Foster KA. Learning, The Urine Microscopic LLC . 5th ed. Educational NOT FOR10-49. SALE More OR forms DISTRIBUTION of calcium oxalate seen in ethylene glycol NOT FORMaterial SALE for Health OR Professionals DISTRIBUTION Inc.; 1999.) 155 poisoning. 151 10-79. Triple phosphates crystal and amorphous phosphates. 10-50. Hippuric acid crystals (400×). 151 When crystals take on this grayish-black color, it usually means 10-51. Cystine crystals (160×). 151 that they are beginning to dissolve (200×). 156 10-52. Cystine crystal with unequal sides (1,000×). 151 10-80. Triple phosphates crystal and amorphous phosphates. Note 10-53. Cystine crystals. Note© Joneshow these &crystals Bartlett can form Learning, clusters LLCthe unique formation of the center© Jones crystal (200 & ×Bartlett). 156 Learning, LLC (160×). 151 NOT FOR SALE OR DISTRIBUTION10-81. Triple phosphates crystalNOT and mucus FOR (400 SALE×). 156 OR DISTRIBUTION 10-54. Cystine crystal with layered or laminated surface 10-82. Triple phosphate crystal. This crystal could be mistaken (1,000×). 151 to be calcium oxalate, but the “X” does not cross exactly in the 10-55. Cystine crystals and a squamous epithelial cell. Some middle (400×). 156 crystals have laminated surfaces and others are quite thick. 10-83. Triple phosphate crystals under polarized light with red The arrow shows a thick crystal that is turned on its edge compensator (200×). (Courtesy of McBride LJ. Textbook of (400©×). Jones 152 & Bartlett Learning, LLC Urinalysis ©and Jones Body Fluids: & ABartlett Clinical Approach Learning,. Philadelphia, LLC PA: 10-56.NOT Leucine FOR crystals. SALE Note what OR appears DISTRIBUTION to be a thick double Lippincott;NOT 1998.) FOR156 SALE OR DISTRIBUTION wall and a striated center. 152 10-84. Calcium phosphate crystals (400×). 156 10-57. Leucine crystals under interference contrast 10-85. Calcium phosphate plates and amorphous phosphates. microscopy. (Courtesy of Smith B, Foster KA. The Urine Notice the thin granular plates (200×). 157 Microscopic. 5th ed. Educational Material for Health 10-86. Calcium phosphate plate (or phosphate sheath) and Professionals Inc.; 1999.) 152 © Jones & Bartlett Learning, LLC © Jonesamorphous & Bartlett phosphates Learning, (200×). 157 LLC 10-58. Tyrosine crystals. Note how black the crystals appear on low 10-87. Ammonium biurate crystals (200×). 157 NOT FOR SALEpower (160 OR×). DISTRIBUTION152 NOT FOR SALE OR DISTRIBUTION

9781284221404_FMxx_i_xxxii.indd 22 20/05/20 2:49 PM List of Figures xxiii

© Jones10-88. & Bartlett Ammonium Learning, biurate crystals LLC (200×). 157 © Jones10-120. & BartlettMixed cast, yeast,Learning, and a WBC. LLC This cast is also half hyaline and half granular (500 ). 163 NOT FOR10-89. SALE Ammonium OR DISTRIBUTION biurate crystals (500×). 157 NOT FOR SALE OR DISTRIBUTION× 10-90. Ammonium biurate crystals (500×). 157 10-121. Mixed cast. Note bacteria in one-half of the cast. Bacterial casts are not very common (500 ). 163 10-91. Ammonium biurate crystals (500×). 158 × 10-92. Ammonium biurate crystal and a squamous epithelial cell 10-122. Many casts, WBCs, RBCs, and amorphous sediment, all of which are stained with bilirubin (200 ). 163 (500×). 158 × 10-93. Ammonium biurate crystals. These are the spheroid form of 10-123. Broad mixed granular and RBC cast, and a broad granular © Jones & Bartlett Learning, LLCcast. Higher magnification of previous© Jones figure. & This Bartlett specimen Learning,is LLC the crystal (500×). 158 from a patient with Wilson disease (500×). 163 10-94. Ammonium biurateNOT crystals. FOR Spheroid SALE form ORwithout DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 10-124. SM-stained hyaline cast, granular cast, mixed cellular cast, spicules (400×). 158 and partially degenerated renal tubule epithelial cells (200×). 10-95. Ammonium biurate crystals (500×). 158 (Courtesy of McBride LJ. Textbook of Urinalysis and Body Fluids: 10-96. Hyaline cast, WBCs, RBCs, and bacteria. Can you see the A Clinical Approach. Philadelphia, PA: Lippincott; 1998.) 163 bent cast? (500 ). 159 × 10-125. Broad granular cast (400×). 163 10-97.© Hyaline Jones casts. & How Bartlett many casts Learning, can you find? LLC (200 ). 159 © Jones & Bartlett Learning, LLC × 10-126. Fine granular cast, WBCs, and RBCs (500×). 164 10-98.NOT Hyaline FOR cast that SALE is bent OR back DISTRIBUTIONupon itself and many RBCs. 10-127. FineNOT granular FOR casts SALEand WBCs. OR Note DISTRIBUTION the smaller cast Viewed with an 80A filter (400 ). 159 × (500×). 164 10-99. Hyaline casts. Viewed with an 80A filter (400 ). 159 × 10-128. SM-stained granular cast (200×). (Courtesy of McBride 10-100. Hyaline casts using phase contrast microscopy. (Courtesy LJ. Textbook of Urinalysis and Body Fluids: A Clinical Approach. of Smith B, Foster KA. The Urine Microscopic. 5th ed. Educational Philadelphia, PA: Lippincott; 1998.) 164 Material for Health Professionals Inc.; 1999.) 159 © Jones & Bartlett Learning, LLC © Jones10-129. & BartlettFine granular Learning, casts and WBCs LLC (400×). 164 10-101. Many hyaline casts and WBC casts and rare RBC NOT FOR SALE OR DISTRIBUTION NOT10-130. FOR SALECoarse granular OR DISTRIBUTION cast (500×). 164 (200×). 159 10-131. Coarse granular cast (400×). 164 10-102. Hyaline cast, WBCs, RBCs, and epithelial cells 10-132. Coarse granular cast, calcium phosphate plate, and (200×). 160 amorphous phosphates (200×). 165 10-103. Hyaline cast with a few granular inclusions (500×). 160 10-133. Broad and narrow coarse granular casts (200×). 165 10-104. Convoluted red blood cell cast (500×). 160 © Jones & Bartlett Learning, LLC10-134. Coarse granular cast (400©× Jones). 165 & Bartlett Learning, LLC 10-105. Red blood cell cast and many RBCs. The cells in the cast 10-135. Bilirubin-stained granular cast (500 ). 165 are still intact (500×). 160NOT FOR SALE OR DISTRIBUTION NOT FOR× SALE OR DISTRIBUTION 10-106. Red blood cell cast. There are still some intact cells in 10-136. Fine granular cast (400×). 165 the cast (arrow), although many of the cells have begun to 10-137. Fine granular cast, WBCs, and bacteria (400×). 165 degenerate (500×). 160 10-138. Waxy cast and amorphous urates. Note the indentations 10-107. Red blood cell cast. When the cast in the previous figure is on the sides of the cast (500×). 166 viewed© Jones under low & power, Bartlett the color Learning, of the cast is moreLLC prominent 10-139. Bilirubin-stained© Jones &waxy Bartlett cast, granular Learning, cast, WBCs, andLLC (200NOT×). 160 FOR SALE OR DISTRIBUTION amorphousNOT sediment. FOR Note SALE the convolutions OR DISTRIBUTION near the center of 10-108. Red blood cell cast and amorphous urates (500×). 161 the waxy cast (500×). 166 10-109. White blood cell cast, WBCs, squamous epithelial cells, 10-140. Long waxy cast, WBCs, and an epithelial cell. The and mucus (400×). 161 surface of this cast is more refractile than that of a hyaline cast 10-110. White blood cell cast. The protein matrix is clearly visible (200×). 166 (500×). 161 10-141. Fine granular cast becoming a waxy cast. This cast would best be classified as a waxy cast, because of the typical cracks on © Jones 10-111.& Bartlett SM-stained Learning, WBC cast (400LLC×). (Courtesy of McBride LJ. © Jones & Bartlett Learning, LLC NOT FOR SALETextbook ORof Urinalysis DISTRIBUTION and Body Fluids: A Clinical Approach. NOT FORthe sides SALE of this ORcast, evenDISTRIBUTION though the surface is still granular Philadelphia: Lippincott, 1998.) 161 (500×). 166 10-142. Convoluted waxy cast. This field also contains WBCs, rare 10-112. White blood cell cast (400×). 161 RBC, and bacteria (500×). 166 10-113. Bilirubin-stained casts, fibers, and sediment (200×). 161 10-143. Convoluted waxy cast. This is the same image as the 10-114. Mixed cell cast, WBCs, and RBCs. This cast contains previous figure, but when the fine adjustment is turned slightly, degenerating WBCs and© several Jones RBCs (500& Bartlett×). 162 Learning, LLCthe cast seems to develop a dark© edgeJones because & ofBartlett the high Learning, LLC 10-115. Bilirubin-stained WBC cast. Bilirubin staining can cause refractive index of the cast (500×). 166 problems in identifying NOTstructures, FOR but you SALE can see OR some DISTRIBUTION cell NOT FOR SALE OR DISTRIBUTION 10-144. SM-stained waxy cast (100×). (Courtesy of McBride LJ. outlines. In addition, the WBCs are beginning to degenerate, Textbook of Urinalysis and Body Fluids: A Clinical Approach. creating a granular cast appearance (500×). 162 Philadelphia, PA: Lippincott; 1998.) 167 10-116. Many WBC casts and many WBCs (200×). 162 10-145. Same field as previous figure using phase contrast 10-117. SM-stained mixed cellular cast including renal tubular microscopy (100×). (Courtesy of McBride LJ. Textbook of epithelial© Jones cells (400 &× ).Bartlett (Courtesy of Learning, McBride LJ. Textbook LLC of Urinalysis ©and Jones Body Fluids: & ABartlett Clinical Approach Learning,. Philadelphia, LLC PA: UrinalysisNOT and FOR Body SALE Fluids: A ORClinical DISTRIBUTION Approach. Philadelphia, PA: Lippincott;NOT 1998.) FOR167 SALE OR DISTRIBUTION Lippincott; 1998.) 162 10-146. SM-stained waxy-granular cast (200×). (Courtesy of 10-118. Epithelial cell cast. The nuclei are visible in some of the McBride LJ. Textbook of Urinalysis and Body Fluids: A Clinical cells (500×). 162 Approach. Philadelphia, PA: Lippincott; 1998.) 167 10-119. Mixed cast. This cast is half hyaline and half granular. 10-147. Granular cylindroid (500×). 167 Report as “hyaline” and/or “granular,” but not “mixed” cast 10-148. Hyaline cylindroid. Note the tapering tail (160×). 167 © Jones & (400Bartlett×). 162 Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT10-149. FOR SALEFine granular OR castDISTRIBUTION and yeast (400×). 168

9781284221404_FMxx_i_xxxii.indd 23 20/05/20 2:49 PM xxiv List of Figures

© Jones10-150. & Bartlett Bacteria. Learning, This field contains LLC rods, cocci, and chains © Jones10-179. & BartlettFiber. Note the Learning, dark edges (400 LLC×). 173 (500 ). 168 NOT FOR SALE× OR DISTRIBUTION NOT10-180. FOR SALEFiber. This OR fiber DISTRIBUTION could be confused with a waxy cast, but 10-151. Yeast, WBCs, rare RBC, and bacteria (500×). 168 the structure is determined to be flat because of the part of the 10-152. Yeast (1,000×). 168 fiber that is turned on its side (400×). 173 10-153. SM-stained yeast with pseudohyphae and WBCs 10-181. Fiber. Note the thick rolled edges of this fiber (400×). 173 (200×). (Courtesy of McBride LJ. Textbook of Urinalysis and 10-182. Debris from a diaper. This squeezed-out specimen was Body Fluids: A Clinical Approach. Philadelphia, PA: Lippincott; worthless for microscopic analysis. Note the various types of 1998.) 168 © Jones & Bartlett Learning, LLCfibers present (200×). 173 © Jones & Bartlett Learning, LLC 10-154. Yeast under phaseNOT contrast FOR microscopy SALE (400 OR×). (Courtesy DISTRIBUTION 10-183. Fibers. The striations (seenNOT only FOR under low-powerSALE OR DISTRIBUTION of McBride LJ. Textbook of Urinalysis and Body Fluids: A Clinical magnification) and dark edges are characteristics of these fibers Approach. Philadelphia, PA: Lippincott; 1998.) 168 (400×). 174 10-155. Pinworm ovum and WBCs (100×). The characteristics of 10-184. Fibers. These are the same fibers as in the previous the pinworm ovum are easily recognized, even under low-power figure. Note the indentations in the surface of the center fiber magnification.© Jones 169 & Bartlett Learning, LLC (400×). 174© Jones & Bartlett Learning, LLC 10-156. Enterobius vermicularis or pinworm ovum (400×). 169 10-185. Fiber. Note the nodular indentations and nodular end of 10-157.NOT Tail ofFOR the adult SALE female OR pinworm. DISTRIBUTION The tail of the female is this very commonNOT FORcontaminant SALE (400 ×OR). 174 DISTRIBUTION straight and very pointed, whereas the tail of the male is curved 10-186. Fibers. The center fiber shows a thick nodular border (40×). 169 (500×). 174 10-158. Pinworm ovum and WBCs (500×). 169 10-187. Fiber, calcium oxalate crystals, and amorphous urates. 10-159. Schistosoma haematobium ovum under interference Note the nodular ends on the fiber (400×). 174 © Jones & contrastBartlett microscopy. Learning, (Courtesy LLC of Smith B, Foster KA. The Urine © Jones10-188. & BartlettFiber. This is theLearning, same field as LLC in the previous figure but NOT FOR SALEMicroscopic OR. 5th DISTRIBUTION ed. Educational Material for Health ProfessionalsNOT FORon a differentSALE focal OR plane. DISTRIBUTION Changing the focus brings out the Inc.; 1999.) 169 nodular indentations on the side of the fiber (400×). 174 10-160. Trichomonas vaginalis with mixed cellular background 10-189. Air bubbles, phosphate plate, and amorphous viewed under phase contrast microscopy. (Courtesy of McBride phosphates. Air bubbles can assume a variety of shapes, LJ. Textbook of Urinalysis and Body Fluids: A Clinical Approach. especially if the coverslip is moved or depressed (200×). 175 Philadelphia: Lippincott, 1998.) 169 10-190. Coverslip defects. (Courtesy of Smith B, Foster KA. The 10-161. Sperm and epithelial© Jones cells (500 ×&). Bartlett170 Learning, LLCUrine Microscopic. 5th ed. Educational© Jones Material & Bartlettfor Health Learning, LLC 10-162. Sperm (wet-mount).NOT 170 FOR SALE OR DISTRIBUTIONProfessionals Inc.; 1999.) 175NOT FOR SALE OR DISTRIBUTION 10-163. Mucus. (Courtesy of Smith B, Foster KA. The Urine 11-1. Forces governing the exchange of fluid at the capillary Microscopic. 5th ed. Educational Material for Health Professionals level. 179 Inc.; 1999.) 170 11-2. Exchanges through capillary membranes in the formation 10-164. Mucus containing WBCs and RBCs (200×). 170 and removal of interstitial fluid. 180 10-165.© JonesFat droplets & andBartlett epithelial Learning, cells (160×). 170 LLC 11-3. Neubauer© Jones hemocytometer & Bartlett diagrams. Learning, (Modified from LLC Spahn 10-166.NOT Oval FOR fat body, SALE granular OR cast, DISTRIBUTION and amorphous urates. The MA, BrackmanNOT E. ManualFOR CellSALE Counting OR Techniques DISTRIBUTION. Dayton, OH: oval fat body contains only a few fat droplets, thus, having a Educational Materials for Health Professional Inc.; 1987) 181 smaller size than other fat bodies (500×). 170 11-4. Cytocentrifuge. 182 10-167. Oval fat body (400×). 171 11-5. Cytocentrifugation method of body fluid concentration. An 10-168. Oval fat body. The cell is bulging with fat droplets, so the assembly of a special cuvette, with attached filter paper, and a glass slide are clipped into place in the cytocentrifuge. One to cell membrane is not visible (500×). 171 © Jones & Bartlett Learning, LLC © Jonestwo & drops Bartlett of well-mixed Learning, fluid are pipetted LLC into the cuvette. The 10-169. Oval fat bodies and WBCs (500×). 171 lids are closed and the sample is centrifuged at 500 rpm for 5 NOT FOR10-170. SALE Oval OR fat DISTRIBUTION body. This field also contains a cell with a few NOT FORminutes. SALE 182 OR DISTRIBUTION small fat droplets in it (arrow) (400×). 171 11-6. Cytocentrifuge-prepared smears are marked with a wax 10-171. Sudan III-stained fat droplets. (Courtesy of Smith B, Foster pencil to outline the area of cell deposit. Smears are stained with KA. The Urine Microscopic. 5th ed. Educational Material for Wright stain for microscopic evaluation. 182 Health Professionals Inc.; 1999.) 171 12-1. Anatomy of the central nervous system. From Snell R. Clinical 10-172. Starch granules (200© Jones×). 171 & Bartlett Learning, LLCNeuroanatomy. Burlington, MA:© JonesJones & Bartlett & Bartlett Learning, LLC; Learning, LLC 10-173. Starch crystals. TheNOT indentation FOR inSALE the center OR of eachDISTRIBUTION 2001. 186 NOT FOR SALE OR DISTRIBUTION crystal is very distinguishable (500×). 172 12-2. Detail of meninges. From Cormack DH. Ham’s Histology. 9th 10-174. Starch granules. (Courtesy of McBride LJ. Textbook of ed. Philadelphia, PA: J. B. Lippincott; 1987:367. 186 Urinalysis and Body Fluids: A Clinical Approach. Philadelphia, PA: 12-3. Placement of the needle for CSF collection. (Courtesy of Lippincott; 1998.) 172 Wolters Kluwer, Skokie, IL.) 187 10-175. Starch crystals under polarized light demonstrating the 12-4. Specimen containers for cerebral spinal fluid typical© Jones “Maltese-cross” & Bartlett formation Learning, (400×). 172 LLC specimens.© 187Jones & Bartlett Learning, LLC 10-176.NOT Talcum FOR powder SALE particles OR and DISTRIBUTION a few squamous epithelial 12-5. ComparisonNOT ofFOR cerebral SALE spinal fluidOR appearance DISTRIBUTION between cells (160×). 172 (A) normal CSF, (B) red CSF from fresh hemorrhage, (C) 10-177. Debris from a diaper. The piece of debris in the center of xanthochromic CSF from old hemorrhage, and (D) CSF from a the field is a common contaminant (400×). 172 traumatic tap. 188 10-178. A: Fine granular cast and WBCs. Note the detail of the 12-6. Cells that can normally be found in cerebral spinal fluid. (A) © Jones & cast.Bartlett B: Fiber. Learning,Note the dark edges LLC and the difference in texture © JonesNeutrophil, & Bartlett (B) monocyte, Learning, and (C) lymphocytes. LLC Red blood cells between this piece of debris and the cast in (A) (200×). are not normally present in CSF (Wright stain 1,000×). 188 NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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© Jones12-7. & Bartlett Neutrophilic Learning, pleocytosis inLLC cerebral spinal fluid (Wright stain© Jones13-5. &Cytospin Bartlett preparation Learning, of peritoneal LLC fluid containing RBCs, 1,000 ). 189 lymphocytes, monocytes, and mesothelial cells. Wright stain NOT FOR SALE× OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 12-8. Lymphocytic pleocytosis in cerebral spinal fluid (Wright stain (200×). (Image courtesy of McBride LJ. Textbook of Urinalysis and 1,000×). 190 Body Fluids: A Clinical Approach. Philadelphia, PA: Lippincott; 12-9. Plasma cells in cerebral spinal fluid (Wright stain 1998.) 201 1,000×). 190 13-6. Cytospin preparation of pericardial fluid containing RBCs, 12-10. Eosinophils in cerebral spinal fluid (Wright stain WBCs, and cells resembling adenocarcinoma. Wright stain (200 ). (Image courtesy of McBride LJ. Textbook of Urinalysis and 1,000×). 190 © Jones & Bartlett Learning, LLC × © Jones & Bartlett Learning, LLC Body Fluids: A Clinical Approach. Philadelphia, PA: Lippincott; 12-11. Cerebral spinal fluidNOT with FORmixed pleocytosis SALE OR(Wright DISTRIBUTION stain 1998.) 202 NOT FOR SALE OR DISTRIBUTION 1,000×). 190 13-7. Cytospin preparation of pleural fluid containing RBCs, 12-12. Macrophage in cerebral spinal fluid (Wright stain macrophages. Wright stain (800×). 202 1,000×). 191 13-8. Cytospin preparation of pleural fluid containing neutrophils. 12-13. Macrophage demonstrating erythrophagocytosis Wright stain (800×). 202 in cerebral spinal fluid can be seen 12 to 48 hours following CNS © Jones & Bartlett Learning, LLC 13-9. Cytospin© Jonespreparation & of Bartlett ascites fluid Learning, containing RBCs, LLC hemorrhage (Wright stain 1,000×). 191 plasmacells from a patient with multiple myeloma. Wright stain 12-14.NOT Macrophage FOR demonstratingSALE OR erythrophagocytosis DISTRIBUTION in NOT FOR SALE OR DISTRIBUTION (800×). 202 cerebral spinal fluid can be seen along with siderotic granules 2 13-10. Cytospin preparation of ascites fluid containing RBCs, to 4 days following CNS hemorrhage (Wright stain 1,000×). 191 mesothelial cells. Wright stain (800×). 202 12-15. Macrophage with iron inclusions (siderophage) in cerebral spinal fluid can be seen from 1 to 8 following CNS hemorrhage 13-11. Cytospin preparation of peritoneal fluid containing RBCs, WBCs, and many bacteria. Identified by culture as Escherichia © Jones & (WrightBartlett stain Learning,1,000×). 192 LLC © Jones & Bartlett Learning, LLC coli. Wright stain (1,000×). (Image courtesy of McBride LJ. NOT FOR12-16. SALE Macrophage OR DISTRIBUTION with hematin inclusions (arrows) in cerebral NOT FORTextbook SALE of Urinalysis OR DISTRIBUTION and Body Fluids: A Clinical Approach. spinal fluid (Wright stain 1,000×). 192 Philadelphia, PA: Lippincott; 1998.) 202 12-17. Macrophages with possible fat inclusions (lipophage) in 13-12. Cytospin preparation of peritoneal fluid containing WBCs cerebral spinal fluid (Wright stain 1,000×). 192 and few bacteria. Identified by culture as Staphylococcus. Wright 12-18. Ependymal cells in cerebral spinal fluid (Wright stain stain (1,000×). (Image courtesy of McBride LJ. Textbook of 1,000×). 192 © Jones & Bartlett Learning, LLCUrinalysis and Body Fluids: A Clinical© Jones Approach &. BartlettPhiladelphia, Learning, PA: LLC 12-19. Clumped choroid plexus in cerebral spinal fluid (Wright Lippincott; 1998.) 203 stain 1,000×). 192 NOT FOR SALE OR DISTRIBUTION13-13. Cholesterol crystals in pleuralNOT fluid. FOR Bright SALE light OR DISTRIBUTION 12-20. Cells of lymphocyte lineage may be seen in CSF from (400×). 203 patients with lymphocytic leukemias (Wright stain 1,000×). 192 13-14. Cholesterol crystals in pleural fluid. A: Polarized light. B: 12-21. Nucleated red blood cells in cerebral spinal fluid are usually Polarized, compensated light (400×). 204 due to a traumatic tap (Wright stain 1,000×). 193 13-15. The heart and pericardium. (Asset provided by Anatomical 12-22.© SquamousJones epithelial& Bartlett cells are Learning, rarely found in LLC CSF and are Chart Co, ©Skokie, Jones IL.) 205 & Bartlett Learning, LLC contaminantsNOT FOR introduced SALE during OR the DISTRIBUTION lumbar puncture procedure. 13-16. AspiratingNOT pericardial FOR SALE fluid. In ORpericardiocentesis, DISTRIBUTION a This field of view also contains five neutrophils (Wright stain needle and syringe are inserted through the chest wall into 1000×). 193 the pericardial sac (as shown below). Electrocardiographic 12-23. Comparison of Wright-stained and Gram-stained bacteria monitoring, with a lead wire attached to the needle and in cerebral spinal fluid. A: Wright stain (notice bacteria stain electrodes placed on the limbs (right arm, left arm, and left leg), blue). B: Gram stain reveals that the bacteria are gram-negative helps ensure proper needle placement and avoids damage to the © Jones & (pinkBartlett). 195 Learning, LLC © Jonesheart. & (FromBartlett Nursing Learning, Procedures. 4th LLC ed. Ambler, PA: Lippincott NOT FOR12-24. SALE Positive OR India DISTRIBUTION ink stain. (Courtesy of Wolters Kluwer.) 195NOT FORWilliams SALE & Wilkins; OR 2004.) DISTRIBUTION 206 12-25. Case 12-1 Wright-stained cytocentrifuged CSF. 197 13-17. The pleural cavity with effusion. (From Cohen BJ. Medical 12-26. Case 12-2 CSF specimen tubes one, two, and three. 197 Terminology. 4th ed. Burlington, MA: Jones & Bartlett Learning, LLC; 2003). 207 12-27. Case 12-3 Wright-stained cytocentrifuged CSF. 197 13-18. Thoracentesis. A needle is inserted into the pleural space 12-28. Case 12-3 CSF specimen tubes 1, 2, and 3. 198 to withdraw fluid. (From Cohen BJ. Medical Terminology. 4th ed. 12-29. Case 12-3 Wright-stained© Jones cytocentrifuged & Bartlett CSF. 198Learning, LLCBurlington, MA: Jones & Bartlett© Learning,Jones LLC; & 2004.)Bartlett 207 Learning, LLC 13-1. Mesothelial lining ofNOT serous FOR body cavities. SALE (Image OR courtesy DISTRIBUTION of 13-19. The organs of the abdomen.NOT IVC, FOR inferior SALE vena cava. OR DISTRIBUTION Wolters Kluwer, Skokie, IL.) 200 (From Moore KL, Agur A. Essential Clinical Anatomy. 2nd ed. 13-2. Colors of serous fluids: (A) normal; (B) red/bloody; (C) milky/ Philadelphia, PA: Lippincott Williams & Wilkins; 2002.) 208 chylous; (D) greenish-brown. 200 13-20. Paracentesis of the abdominal cavity in midline. (From 13-3. Cytospin preparation of pleural fluid containing RBCs Snell RS. Clinical Anatomy. 7th ed. Lippincott Williams & Wilkins; and lymphocytes in acute inflammation. Wright stain (400×). 2003.) 208 (Image© Jones courtesy &of McBrideBartlett LJ. TextbookLearning, of Urinalysis LLC and 13-21. Wright© Jonesstain of ascites & Bartlett fluid. (Image Learning, courtesy of McBride LLC BodyNOT Fluids: FOR A Clinical SALE Approach OR . DISTRIBUTIONPhiladelphia, PA: Lippincott; LJ. TextbookNOT of Urinalysis FOR SALEand Body ORFluids: DISTRIBUTION A Clinical Approach. 1998.) 201 Philadelphia, PA: Lippincott; 1998.) 209 13-4. Cytospin preparation of pleural fluid containing RBCs, 13-22. Pleural fluid. 210 neutrophils, and a mesothelial cell in bacterial infection. 14-1. Articulated joint. (From Oatis CA. Kinesiology: The Wright stain (200×). (Image courtesy of McBride LJ. Textbook of Mechanics and Pathomechanics of Human Movement. Baltimore, Urinalysis and Body Fluids: A Clinical Approach. Philadelphia, PA: MD: Lippincott Williams & Wilkins; 2003.) 212 © Jones & Lippincott;Bartlett 1998.) Learning, 201 LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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© Jones14-2. & Bartlett Synovial membraneLearning, from LLCa normal knee joint shows © JonesClinical & BartlettLaboratory MedicineLearning,. 2nd ed. LLC Philadelphia, PA: Lippincott joint space, synovial membrane composed of synovial cells NOT FORWilliams SALE & Wilkins; OR 2002.) DISTRIBUTION 217 NOT FOR SALEembedded OR in a DISTRIBUTIONloose connective tissue stroma overlying dense 14-19. First image for Case Study 14-1. Synovial fluid. 219 collagen (hematoxylin and eosin). (From McClatchey KD. Clinical 14-20. Second image for Case Study 14-1. (From McClatchey KD. Laboratory Medicine. 2nd ed. Philadelphia, PA: Lippincott Clinical Laboratory Medicine. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2002.) 212 Williams & Wilkins; 2002.) 220 14-3. Bulge test of joint for the detection of synovial 14-21. First image for Case Study. Synovial fluid. 220 effusion. 212 © Jones & Bartlett Learning, LLC14-22. Second image for Case Study© Jones 14-2. (Courtesy & Bartlett of McBride Learning, LLC 14-4. Placement of needleNOT in arthrocentesis FOR SALE of (A) elbowOR DISTRIBUTIONand (B) LJ. Textbook of Urinalysis and NOTBody Fluids: FOR A Clinical SALE Approach OR DISTRIBUTION. knee joints. 213 Philadelphia, PA: Lippincott; 1998.) 220 14-5. Synovial fluid. A: Normal. B: Bloody. 213 15-1. Diagram of alimentary tract. 222 14-6. Synovial fluid inclusions. A: “Ground pepper” 15-2. Gastric contents collection using nasogastric intubation and ochronotic shards. B: “Rice bodies” fibrin-enriched synovium aspiration. 223 fragments. 214 © Jones & Bartlett Learning, LLC 15-3. Gastroccult© Jones test card & with Bartlett interpretation. Learning, A: Cover of LLC closed 14-7. String test showing normal synovial fluid viscosity. 214 Gastroccult card. B: Gastroccult test card opened with positive 14-8. NOTMucin clotFOR test SALEof normal OR synovial DISTRIBUTION fluid. 215 test result.NOT C: Interpretation FOR SALE of Gastroccult OR DISTRIBUTION results. (Images 14-9. Normal cellular elements found in synovial fluid include courtesy of Beckman Coulter, Inc.) 224 (A) neutrophils, (B) lymphocytes, (C) monocytes/histiocytes, and 15-4. Fecal leukocytes. A: Gram stain, (1,000×), fecal leukocytes. (D) synovial lining cells. A few red blood cells are almost always B: Wright stain (1,000×), fecal leukocytes. C: Wet preparation, present in joint effusions (Wright–Giemsa). (From McClatchey KD. Shigella dysentery or bacterial dysentery with fecal white blood © Jones & ClinicalBartlett Laboratory Learning, Medicine. LLC2nd ed. Philadelphia, PA: Lippincott© Jonescells, & red Bartlett blood cells, Learning, and bacteria. (Fig. LLC 15-4C obtained from: Williams & Wilkins; 2002.) 216 NOT FOR SALE OR DISTRIBUTION NOT FORhttp://phil.cdc.gov/phil SALE OR DISTRIBUTION image 6659.) 225 14-10. Synovial fluid with acute inflammation demonstrating 15-5. Hemoccult positive fecal occult blood test. (Courtesy of neutrophilic pleocytosis (Wright–Giemsa). (From McClatchey KD. Beckman Coulter, Inc.) 226 Clinical Laboratory Medicine. 2nd ed. Philadelphia, PA: Lippincott 15-6. Hemoccult-ICT positive fecal occult blood test. (Courtesy of Williams & Wilkins, 2002.) 216 Beckman Coulter, Inc.) 226 14-11. LE cell (arrow) is a neutrophil containing a phagocytized 15-7. Steatorrhea with fecal fat Sudan III stain for neutral fats. 227 homogeneous nucleus (Wright–Giemsa).© Jones & Bartlett(From McClatchey Learning, KD. LLC © Jones & Bartlett Learning, LLC 15-8. Steatorrhea with fecal fat Sudan III stain for fatty acids. 227 Clinical Laboratory MedicineNOT. 2nd FOR ed. Philadelphia, SALE OR PA: LippincottDISTRIBUTION NOT FOR SALE OR DISTRIBUTION Williams & Wilkins; 2002.) 216 15-9. Creatorrhea. Undigested meat fiber. Note the clearly defined muscle striations. 228 14-12. Tart cell: a macrophage containing a phagocytized nucleus that retains some nuclear detail (Wright–Giemsa). 15-10. Creatorrhea. Undigested meat fibers tangled. The clear (From McClatchey KD. Clinical Laboratory Medicine. 2nd ed. striations help identify these meat fibers. 228 Philadelphia, PA: Lippincott Williams & Wilkins; 2002.) 216 16-1. Detail of the male reproductive system. (Reprinted with 14-13.© ReiterJones cell (center) & Bartlett is a macrophage Learning, that has LLC phagocytosed permission© from Jones Cohen BJ,& WoodBartlett DL. Memmler’s Learning, the Human LLC oneNOT or more FOR neutrophils. SALE This OR finding DISTRIBUTION is not specific for Reiter Body in HealthNOT and FOR Disease SALE. 9th ed. ORBurlington, DISTRIBUTION MA: Jones & syndrome. (From McClatchey KD. Clinical Laboratory Medicine. Bartlett Learning, LLC, 2000.) 232 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 16-2. The process of spermatogenesis in the seminiferous tubules. 2002.) 217 (Courtesy of Wolter Kluwer, Skokie, IL.) 233 14-14. Lipid-laden macrophage in synovial fluid (Wright–Giemsa). 16-3. Final stages of spermatogenesis. A: Immature spermatid (From McClatchey KD. Clinical Laboratory Medicine. 2nd ed. with round shaped nucleus, early signs of acrosome and tail © Jones & Philadelphia,Bartlett Learning,PA: Lippincott Williams LLC & Wilkins, 2002.) 217 © Jonesdevelopment; & Bartlett B: Immature Learning, spermatid LLC with formation of the NOT FOR14-15. SALE Synovial OR fluidDISTRIBUTION with acute inflammation and monosodium NOT FORacrosome, SALE nuclear OR condensation DISTRIBUTION developing tail piece; C: urate crystals. (Wright–Giemsa stain and polarized light). Spermatid with acrosome covering the nucleus, developing (From McClatchey KD. Clinical Laboratory Medicine. 2nd ed. middle piece, and shrinking cytoplasmic membrane; D: Mature Philadelphia, PA: Lippincott Williams & Wilkins; 2002.) 217 spermatozoon. (Courtesy of Wolter Kluwer, Skokie, IL.) 233 14-16. Synovial fluid with acute inflammation and monosodium 16-4. Normal semen viscosity test. 235 urate crystals. The needle-shaped crystals demonstrate negative 16-5. Inclusion criteria of counting cells. Count cells (sperm heads, birefringence, because they© Jones are yellow & when Bartlett aligned withLearning, LLCnot tails) that touch the upper© and Jones left boarders & Bartlett of the counting Learning, LLC the compensator filter andNOT blue FORwhen perpendicular SALE OR to DISTRIBUTIONthe grid. Do not count cells (spermNOT heads, notFOR tails) SALE that touch OR DISTRIBUTION filter (Wright–Giemsa stain and polarized/compensated light). the lower and right boarders of the counting grid. Count only (From McClatchey KD. Clinical Laboratory Medicine. 2nd ed. complete sperm. 235 Philadelphia, PA: Lippincott Williams & Wilkins; 2002.) 217 16-6. Wet mount of semen. Many sperm are present (450×). 14-17. Synovial fluid with acute inflammation and calcium (Courtesy of Hapner and Spahn, Dayton, OH: Educational pyrophosphate dihydrate crystals (Wright–Giemsa stain and Materials for Health Professional Inc., 1981.) 236 polarized© Jones light). (From& Bartlett McClatchey Learning, KD. Clinical Laboratory LLC 16-7. Wet mount© Jones of semen. & SeveralBartlett sperm Learning, can be seen along LLC with MedicineNOT. 2ndFOR ed. Philadelphia,SALE OR PA: DISTRIBUTION Lippincott Williams & a red bloodNOT cells (R)FOR and a SALE white blood OR cell DISTRIBUTION (W) (450×). (Courtesy Wilkins; 2002.) 217 of Hapner and Spahn.) 236 14-18. Synovial fluid with acute inflammation and calcium 16-8. Viable sperm do not take up the eosin stain and pyrophosphate dihydrate crystals. The rhomboidal intracellular remain colorless, thus appearing white (eosin/nigrosin stain, crystal (center) demonstrates positive birefringence, because it is 1,000×). 237 blue when aligned with the compensator filter (Wright–Giemsa © Jones & Bartlett Learning, LLC © Jones16-9. &Nonviable Bartlett sperm Learning, take up the eosin LLC stain and appear various stain and polarized/compensated light). (From McClatchey KD. shades of red (eosin/nigrosin stain, 1,000×). 237 NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

9781284221404_FMxx_i_xxxii.indd 26 20/05/20 2:49 PM List of Figures xxvii

© Jones16-10. & Bartlett Features Learning, of a normal spermatozoon. LLC (Courtesy of Wolter © Jonesfor the& Bartlettdeveloping infant.Learning, (From Burtis LLC CA, Ashwood ER. Tietz Kluwer, Skokie, IL.) 238 Textbook of Clinical Chemistry. 2nd ed. Philadelphia, PA: WB NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 16-11. Normal sperm (Papanicolaou stain, 1,000×). 238 Saunders Company; 1994.) 251 16-12. Normal sperm. The arrow points to a sperm observed with 18-1. A: A warmed speculum allows for visualization and insertion a side view (Papanicolaou stain, 1,000×). 238 of swab. B: The swab is used to sample the vaginal pool and nontraumatically “scrape” the cervical os and walls of the vagina 16-13. Normal sperm, side view (Papanicolaou stain, 1,000×). 238 (depending on test requirements). 16-14. Double-headed sperm. Notice the excessive cytoplasmic © Jones & Bartlett Learning, LLC18-2. “Ferning” seen in vaginal ©secretions Jones is positive & Bartlett for the Learning, LLC membrane in image C (Papanicolaou stain, 1,000×). 238 presence of amniotic fluid due to ROM. 255 16-15. Double-tailed sperm.NOT Arrows FOR point SALE to both tails.OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 18-3. The TLi Analyzer, by Adeza Biomedical, is used to perform (Papanicolaou stain, 1,000×). 239 qualitative measurements of fetal fibronectin. 256 16-16. Coiled-tailed sperm. Tails may coil completely around the 18-4. Immature epithelial cells (parabasal cells) as well as mature head as seen in image A (Papanicolaou stain, 1,000×). 239 squamous epithelial cells. The immature cells are smaller and 16-17. Flat-headed sperm. One normal sperm is seen among those round. (Wet mount) 258 with flat heads, indicating the absence of the acrosomal cap © Jones & Bartlett Learning, LLC 18-5. A predominance© Jones of ¶basal Bartlett cells inLearning, vaginal secretions LLC is (Papanicolaou stain, 1,000×). 239 NOT FOR SALE OR DISTRIBUTION consistent NOTwith estrogen FOR deficiency. SALE ORIn severely DISTRIBUTION estrogen-deficient 16-18. Various sperm head sizes. A: Normal sperm. B: Large head. women, the vaginal fluid is almost acellular. (Wet mount) 258 C: Small or pinhead (Papanicolaou stain, 1,000×). 239 18-6. Purulent vaginal secretion containing increased numbers 16-19. Normal sperm shown with sperm at arrow that has of white blood cells, parabasal cells and absent lactobacilli are a constricted (or pinched) head and excessive cytoplasmic common findings in desquamative inflammatory vaginitis as well membrane (Papanicolaou stain, 1,000×). 240 © Jones & Bartlett Learning, LLC © Jonesas other & Bartlett forms of vaginitis. Learning, (Wet mount) LLC 258 16-20. Various sperm anomalies. A: Normal sperm. B: Sperm with 18-7. Gram stain (1,000×). Lactobacillus predominating in a NOT FOR SALEconstricted OR (or pinched)DISTRIBUTION head and excessive cytoplasmic. 240 NOT FORhealthy SALE vagina withOR squamous DISTRIBUTION epithelial cells. (CDC, PHIL image, 16-21. These sperm both have bent neck pieces. One has a normal http://phil.cdc.gov/phil image 10g0029_lores.jpg.). 259 head, whereas the other is a pinhead (Papanicolaou stain, 18-8. A: Wet mount and (B) Gram stain of “clue cells.” These 1,000×). 240 are squamous epithelial cells that are literally covered with 16-22. These sperm have round heads rather than oval numerous small curved bacilli. These cells slough off because (Papanicolaou stain, 1,000©× Jones). 240 & Bartlett Learning, LLCof bacterial alteration in bacterial© Jones vaginosis. &(From Bartlett Sweet RL, Learning, LLC 16-23. These sperm all have tapered heads rather than oval. Gibbs RS. Atlas of Infectious Diseases of the Female Genital Tract. Image B also shows excessiveNOT cytoplasmic FOR SALE membrane OR and DISTRIBUTION image C Philadelphia, PA: Lippincott WilliamsNOT & FOR Wilkins; SALE 2005, Asset OR 55832 DISTRIBUTION has a coiled tail (Papanicolaou stain, 1,000×). 241 c10f10.) 259 16-24. The heads of these sperm all contain vacuoles 18-9. Trophozoites of Trichomonas vaginalis obtained from in vitro (Papanicolaou stain, 1,000×). 241 culture, stained with Giemsa. (CDC, DpDx Laboratory Diagnosis of 16-25. The necks of these sperm have excessive cytoplasmic Parasites of Public Health Concern Parasite Image Library, http:// membrane© Jones remaining & Bartlett (Papanicolaou Learning, stain, 1,000× LLC). 241 www.dpd.cdc.gov/dpdx/HTML/Image_Library.htm.).© Jones & Bartlett Learning, 260 LLC 16-26.NOT Immature FOR spermatids SALE OR (Papanicolaou DISTRIBUTION stain, 18-10. WetNOT preparation FOR of CandidaSALE albicans OR DISTRIBUTION yeast and 1,000×). 241 pseudohyphae with WBCs. Yeast (including pseudohyphae), RBCs, and WBCs (200 ). (From McBride LJ. Textbook of Urinalysis and 16-27. Figure for review questions 16 to 18. 244 × Body Fluids: A Clinical Approach. Philadelphia, PA: Lippincott; 17-1. Schematic drawing of the amniotic cavity. (Nath JL. Using 1998.) 260 Medical Terminology: A Practical Approach. Burlington, MA: 19-1. ICON pregnancy test cartridge. (Image courtesy of Beckman Jones & Bartlett Learning, LLC; 2006.) 247 Coulter, Inc.) 264 © Jones 17-2.& Bartlett Potter complex Learning, results from LLC leakage of amniotic fluid, © Jones & Bartlett Learning, LLC 19-2. Eosinophils in urine. Wright stain of cytocentrifuge oligohydramnios. Congenital hydronephrosis results from urinary NOT FOR SALE OR DISTRIBUTION NOT FORpreparation SALE (400 OR). 264DISTRIBUTION tract obstruction. 248 × 19-3. This bronchoalveolar lavage is being performed with a 17-3. Amniocentesis is performed under ultrasound guidance. A protected catheter, but without the aid of a bronchoscope. needle is inserted through the mother’s abdomen into a pocket (Image courtesy of.) 265 of amniotic fluid, which is then aspirated with a syringe. 248 19-4. Normal bronchial epithelial cells in a bronchial brush 17-4. Numerous squamous epithelial cells, and other cells © Jones & Bartlett Learning, LLCspecimen are shown. Note the ©ciliated Jones columnar & Bartlett cells with Learning, LLC observed in cytocentrifuge preparation of amniotic fluid. Wright uniform and basally located nuclei. The chromatin is finely stain 200×. (Courtesy of NOTMcBride, FOR Textbook SALE of Urinalysis OR DISTRIBUTIONand Body NOT FOR SALE OR DISTRIBUTION granular and evenly dispersed, the nuclear membrane is smooth Fluids. LWW; 1998.) 249 and regular, and the nucleoli are inconspicuous. (Papanicolaou 17-5. Spectrophotometric scan of amniotic fluid indicating stain) (Image courtesy of.) 265 bilirubin and oxyhemoglobin peaks. Note the near linearity of 19-5. Squamous cell carcinoma in a bronchial brush specimen. the normal curve in A. In B, note the elevated bilirubin peak (at Highly atypical squamous cells show marked variation in 450 nm) and the oxyhemoglobin peak (at 410 nm). The base is © Jones & Bartlett Learning, LLC size and shape.© Jones The nuclei & areBartlett hyperchromatic Learning, and irregular. LLC drawn from 550 nm to 365 nm. (From Burtis CA, Ashwood ER. (Papanicolaou stain) (Image courtesy of.) 266 TietzNOT Textbook FOR of Clinical SALE Chemistry OR DISTRIBUTION. 2nd ed. Philadelphia, PA: NOT FOR SALE OR DISTRIBUTION WB Saunders Company; 1994.) 250 19-6. Adenocarcinoma cells in bronchial brush specimen. A cluster of epithelial cells with highly atypical nuclei, prominent nucleoli, 17-6. Liley graph for assessment of fetal risk. The Liley graph is and cytoplasmic vacuoles is seen. (Papanicolaou stain) (Image a three-zone chart with modification for the interpretation of courtesy of.) 266 amniotic fluid change in absorbance at 450 nm versus weeks of © Jones & gestation.Bartlett The Learning, graph divides theLLC patient’s readings into three © Jones19-7. &Pneumocystis Bartlett jiroveci Learning, pneumonia. LLC A: The alveoli are filled zones of gestational risk, with zone III posing the greatest risk with a foamy exudate, and the interstitium is thickened and NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

9781284221404_FMxx_i_xxxii.indd 27 20/05/20 2:49 PM xxviii List of Figures

© Jones &contains Bartlett a chronic Learning, inflammatory LLC infiltrate (Hematoxylin & © JonesIRIS, & the Bartlett Iris logo, iChem, Learning, iQ, iRICELL, LLC and Velocity are trademarks Eosin stain). B: A centrifuged bronchoalveolar lavage specimen NOT FORof IRIS SALE International, OR Inc.DISTRIBUTION and are registered in the USPTO. 265 NOT FOR SALEimpregnated OR with DISTRIBUTION silver shows a cluster of Pneumocystis cysts. 20-5. Close-up of the iQ barcode reader and tube carrier. 265 (Image courtesy of.) 266 20-6. CLINITEK® Status. (Used with permission from Siemens 19-8. Cytomegalovirus (CMV) infection in bronchial washings. Medical Solutions Diagnostics.) 265 Note the large basophilic nuclear inclusions surrounded by a halo 20-7. CLINITEK Advantus® Analyzer. (Courtesy of Siemens Medical and marginated chromatin, forming the typical target-shaped Solutions Diagnostics.) 265 appearance. (Papanicolaou stain) (Image courtesy of.) 267 © Jones & Bartlett Learning, LLC20-8. CLINITEK Atlas® Automated© UrineJones Chemistry & Bartlett Analyzer withLearning, LLC 19-9. Candida albicans withNOT germ FOR tube development SALE OR in a DISTRIBUTION rack. (Courtesy of Siemens MedicalNOT Solutions FOR Diagnostics.) SALE OR 265 DISTRIBUTION calcofluor white preparation. 267 20-9. CLINITEK Atlas® Automated Urine Chemistry Analyzer with 19-10. Cell block preparation of BAL showing cysts of P. jiroveci, carousel. (Courtesy of Siemens Medical Solutions Diagnostics.) 265 GMS-P stain (1,000×). (From McBride LJ. Textbook of Urinalysis and Body Fluids: A Clinical Approach. Philadelphia, PA: 20-10. Fully Automated Urine Cell Analyzer UF-1000i. (Image Lippincott; 1998:264.) 267 courtesy of Sysmex America, Inc.) 265 19-11.© Cell Jones block preparation & Bartlett of BAL Learning, showing cysts LLCof 20-11. Illustration© Jones of UF-1000i & Bartlett flow cytometry Learning, technology. LLC (Image courtesy of Sysmex America, Inc.) 266 P. jiroveci,NOT GMS-P FOR stain SALE (1,000 ×OR). (From DISTRIBUTION McBride LJ. Textbook of NOT FOR SALE OR DISTRIBUTION Urinalysis and Body Fluids: A Clinical Approach. Philadelphia, PA: 20-12. Digital images of urine sediment; white blood cells. 266 Lippincott; 1998:265.) 267 20-13. Digital images of urine sediment; red blood cells. 266 19-12. Schematic of the middle ear. (Image courtesy of.) 267 20-14. Digital images of urine sediment; transitional cells. 266 19-13. Vitreous fluid is obtained by vitrectomy using simultaneous 20-15. Digital images of urine sediment; hyaline casts. 266 © Jones & suctionBartlett and infusion. Learning, A: Infusion LLC of fluid through a 25-gauge © Jones20-16. &Digital Bartlett images Learning, of urine sediment; LLC granular casts. 266 needle secured by passing through a block of plastic sutured to 20-17. Digital images of urine sediment; calcium oxalate NOT FOR SALEthe eye. B:OR Balanced DISTRIBUTION salt solution is fed into the eye by gravity. NOT FORcrystals. SALE 266 OR DISTRIBUTION C: Illumination and observation are provided with the indirect ophthalmoscope. D: The vitreous is aspirated into the port of the 20-18. Digital images of urine sediment; triple phosphate sharp-tipped vitreous cutter. (Image modified from.) 268 crystals. 266 19-14. This image depicts histopathologic changes indicating 20-19. Digital images of urine sediment; bacteria. 266 aspergillosis of the lung© caused Jones by Aspergillus & Bartlett fumigatus. Learning, LLC20-20. Digital images of urine sediment;© Jones these & sperm Bartlett were Learning, LLC Methenamine silver stain reveals hyphae of A. fumigatus. classified by the instrument at bacteria and must be reassigned Inhalation of airborne conidiaNOT of FOR A. fumigatus SALE can OR cause DISTRIBUTION to the correct category. Not allNOT facilities FOR report SALE sperm in urineOR DISTRIBUTION aspergillosis in immunosuppressed hosts. 269 sediment. 266 19-15. Methenamine silver stain. Disseminated infection in an 20-21. Digital images of urine sediment; yeast. 266 immune-compromised host with the opportunistic fungus, A. 20-22. Squamous epithelial cells are not usually reported and are fumigatus. Note the characteristic dichotomous branching of the identified as “unclassified” urinary sediment. 266 hyphae.© Jones 269 & Bartlett Learning, LLC 20-23. Compilation© Jones of urine & Bartlettsediment digital Learning, images; artifacts. LLC A: 19-16. Bronchial washing cell block. H&E stain (1,000×). (From Air bubble. B: Amorphous material/crystals. C: Mucous strands McBrideNOT LJ. FORTextbook SALE of Urinalysis OR andDISTRIBUTION Body Fluids: A Clinical may be mistakenNOT forFOR casts, SALE especially OR if they DISTRIBUTION have debris or cells Approach. Philadelphia, PA: Lippincott; 1998:263.) 269 attached as seen in the one on the left. 266 19-17. Bronchial washing cell block. GMS-C stain (1,000×). (From 20-24. Iris iQ Body Fluid Module. Product Images © 2009 IRIS McBride LJ. Textbook of Urinalysis and Body Fluids: A Clinical International, Inc. All rights reserved. 266 Approach. Philadelphia, PA: Lippincott; 1998:263.) 269 20-25. The Sysmex Hematology-XN-100 includes a body fluid © Jones 19-18.& Bartlett Bronchial Learning, washing cell block.LLC PAP stain (1,000×). (From © Jonesmode. & (ImageBartlett courtesy Learning, of Sysmex America, LLC Inc.) 267 McBride LJ. Textbook of Urinalysis and Body Fluids: A Clinical 20-26. SQA-V Gold Sperm analyzer. (Image courtesy of Medical NOT FOR SALEApproach. OR Philadelphia, DISTRIBUTION PA: Lippincott; 1998:263.) 269 NOT FORElectronic SALE Systems.) OR 267DISTRIBUTION 20-1. Iris Automated Urinalysis iRICELL workcell. Product Images 20-27. QwikCheck Gold Sperm analyzer. (Image courtesy of © 2009 IRIS International, Inc. All rights reserved. IRIS, the Iris Medical Electronic Systems.) (Not currently available for the U.S. logo, iChem, iQ, iRICELL, and Velocity are trademarks of IRIS market.) 267 International, Inc. and are registered in the USPTO.[AS7] 265 20-28. SQAIIC-P Sperm analyzer. (Image courtesy of Medical 20-2. Iris Automated Urinalysis© Jones iRICELL workcell& Bartlett with iQ200ELITE. Learning, LLCElectronic Systems.) (Not currently© Jones available for& theBartlett U.S. Learning, LLC Product Images © 2009 IRISNOT International, FOR SALE Inc. All rightsOR DISTRIBUTIONreserved. market.) 267 NOT FOR SALE OR DISTRIBUTION IRIS, the Iris logo, iChem, iQ, iRICELL, and Velocity are trademarks 20-29. CLINITEST hCG test for use with the CLINITEK Status of IRIS International, Inc. and are registered in the USPTO. 265 family of analyzers. (Courtesy of Siemens Medical Solutions 20-3. Iris Automated Urinalysis iRICELL workcell with iQ200SELECT. Diagnostics.). 267 Product Images © 2009 IRIS International, Inc. All rights reserved. 20-30. Polymedco OC-Auto 80 FOBT analyzer; external view. 267 IRIS, the Iris logo, iChem, iQ, iRICELL, and Velocity are trademarks of IRIS© JonesInternational, & Bartlett Inc. and are Learning,registered in the LLC USPTO. 265 20-31. Polymedco© Jones FOBT sample& Bartlett collection Learning, vial/bottle. 267 LLC 20-4. NOTIris Automated FOR SALE Urinalysis OR iRICELL DISTRIBUTION workcell with iQ200SPRINT. 20-32. PolymedcoNOT FOR OC-Auto SALE 80 FOBT OR analyzer; DISTRIBUTION internal Product Images © 2009 IRIS International, Inc. All rights reserved. view. 267

9781284221404_FMxx_i_xxxii.indd 28 20/05/20 2:49 PM © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION List of Tables © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

Chapter© Jones 2 & Bartlett Learning, LLC Chapter 9© Jones & Bartlett Learning, LLC Table NOT2-1 CharacteristicsFOR SALE OR of Nephritic DISTRIBUTION and Table 9-1 NOT Properties FOR of SALE Crystalline OR DISTRIBUTION Nephrotic Syndromes 22 Compounds 119 Table 2-2 RIFLE Criteria for Acute Kidney Injury Chapter 11 (Developed by a Panel of the Acute Table 11-1 Commonly Analyzed Body Fluids Dialysis Initiative Group) 27 180 © Jones & Bartlett Learning, LLC © JonesTable &11-2 Bartlett Commonly Learning, Used Terms LLC in Table 2-3 Urinalysis Casts and Renal Disease 27 NOT FORTable SALE 2-4 OR Laboratory DISTRIBUTION Findings in Urinary and NOT FOR SALEthe OR Description DISTRIBUTION of Body Fluid Appearance Kidney Diseases 28 180 Chapter 3 Chapter 12 Table 3-1 Porphyrin and Porphyrin Precursors in Table 12-1 Causes for Pleocytosis in Cerebrospinal Fluid (CSF) by Cell Type the Urine© 39Jones & Bartlett Learning, LLC © Jones &189 Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONTable 12-2 Changes in CellsNOT Present FOR in SALE OR DISTRIBUTION Chapter 4 Cerebrospinal Fluid (CSF) Following Table 4-1 Examples of Laboratory Testing Errors 47 Hemorrhage 191 Table 4-2 Classes of Fire Extinguishers and Their Chapter 13 Uses 49 © Jones & Bartlett Learning, LLC Table 13-1© BacteriaJones &Commonly Bartlett Seen Learning, in LLC Chapter 6 Effusions 203 TableNOT 6-1 ChangesFOR SALE Occurring OR DISTRIBUTION to Unpreserved Table 13-2NOT Differentiation FOR SALE Between OR DISTRIBUTION Transudates Urine 76 and Exudates 204 Table 13-3 Laboratory Differentiation of Chapter 7 Chylous and Pseudochylous Table 7-1 Causes for Urine Color and Clarity 81 © Jones & Bartlett Learning, LLC © Jones & BartlettEffusions Learning, 205 LLC Chapter 8 Table 13-4 Causes for Various Body Cavity NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Table 8-1 Protein Indicators and Sensitivities by Effusions 206 Reagent Strip 92 Chapter 14 Table 8-2 Glucose Chromogens and Sensitivities by Table 14-1 Mucin Clot Procedure According to Reagent Strip 95 Referenced Texts 214 Table 8-3 Interpretation of Glucose Oxidase and © Jones & Bartlett Learning, LLCTable 14-2 Classification© of Jones Synovial & FluidsBartlett 218 Learning, LLC Copper ReductionNOT FOR Tests SALE 96 OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Table 8-4 Ketone Reagents and Sensitivities by Chapter 16 Reagent Strip 97 Table 16-1 Semen Classifications 234 Table 8-5 Hemoglobin Chromogens and Table 16-2 Normal Semen Analysis Ranges 234 Sensitivities by agent Strip 99 Table 16-3 Semen Biochemical Markers 242 Table 8-6 Bilirubin Indicators and Sensitivities © Jones & Bartlett Learning, LLC Chapter 18© Jones & Bartlett Learning, LLC NOT FORby Reagent SALE Strip OR DISTRIBUTION102 NOT FOR SALE OR DISTRIBUTION Table 8-7 Urobilinogen Reagents and Sensitivities Table 18-1 Toxicity of Swabs to Microorganisms by Reagent Strip 104 255 Table 8-8 Nitrite Reagents and Sensitivities Chapter 20 by Reagent Strip 105 Table 20-1 Automated Urinalysis Instruments 264 Table 8-9 Leukocyte Esterase Reagents and © Jones & Bartlett Learning, LLC © JonesTable &20-2 Bartlett Automated Learning, Body Fluid LLC Analyzers 266 NOT FOR SALE ORSensitivities DISTRIBUTION by Reagent Strip 106 NOT FOR SALE OR DISTRIBUTION xxix

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9781284221404_FMxx_i_xxxii.indd 30 20/05/20 2:49 PM © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Contents © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

© Jones & BartlettContributor Learning, LLCvii © Jones & Bartlett Learning, LLC NOT FOR SALE ORReviewers DISTRIBUTION vii NOT FOR SALE OR DISTRIBUTION Preface ix Content Highlights xi About the Authors xiii © Jones & Bartlett Learning, LLCAcknowledgments xv© Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONList of Figures xvii NOT FOR SALE OR DISTRIBUTION List of Tables xxix

SECTION ©I JonesFoundational & Bartlett Learning, Information LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

CHAPTER 1 Urinary System Anatomy and Physiology and Urine Formation 2

© JonesCHAPTER & Bartlett 2 Renal Learning, and Urinary LLC Tract Diseases and© Related Jones Urinalysis & Bartlett Findings Learning, 18 LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION CHAPTER 3 Metabolic Diseases and Related Urinalysis Findings 34

CHAPTER 4 Urinalysis Clinical Laboratory Operations 44

SECTION II The Urinalysis © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC CHAPTERNOT 6 CollectionFOR SALE and OR Preservation DISTRIBUTION of Urine 72 NOT FOR SALE OR DISTRIBUTION

CHAPTER 7 Physical Examination of Urine 79

© JonesCHAPTER & Bartlett 8 Chemical Learning, Analysis LLC of Urine 89 © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION CHAPTER 9 Microscopic Examination of Urinary Sediment 111

CHAPTER 10 Atlas of Urinary Sediment 142 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION xxxi

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CHAPTER 11 Introduction to Body Fluids 178

CHAPTER© 12 Jones Cerebrospinal & Bartlett Fluid Learning, 184 LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION CHAPTER 13 Serous Body Fluids 199

CHAPTER 14 Synovial Fluid 211 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC CHAPTER 15 Gastric Fluid and Fecal Analysis NOT FOR SALE OR DISTRIBUTION 221 NOT FOR SALE OR DISTRIBUTION

CHAPTER 16 Semen Analysis 231

CHAPTER 17 Amniotic Fluid 246 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION CHAPTER 18 Vaginal Secretions 254

CHAPTER 19 Miscellaneous Urine and Body Fluid Tests 263 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC CHAPTER 20 Automation of Urinalysis and Body Fluids Examination 271 NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

APPENDICIES © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Appendix A Answers to Study Guide Questions and Case Studies 281

Appendix B Reagent Strip Color Chart 289 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Appendix C Hemocytometer Cell Counts 291 NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Appendix D Historically Relevant Urine and Body Fluid Analysis Information 295

Glossary 303 © JonesIndex & 313Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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