Project 1 Task 1
Blood volume: Adults account for about 6% to 8% of body weight, with an average blood volume of about 5L.
pH：7.35～7.45
Ratio of density: 1.05～1.06
Osmotic pressure: 290～310mosm/Kg·H2O
Blood collection site
(1) Finger blood sampling:
WHO recommends taking peripheral blood from the inside of the tip of the left ring finger or middle finger
Advantages: Convenience, more blood volume and relatively constant results
Disadvantages: There are still some differences with venous blood.
Thumb, great toe or heel blood sampling - infants and young children under half a year old
Intact skin - severe burns
Task two white blood cell test
Count calculation WBC/L=N/4×10×106×20=N/20×109
Relationship between blood smear WBC density and the total number of WBC
| WBC blood smear |
Number of WBC/HP |
| (4～7)×109/L |
2～4 |
| (7～9)×109/L |
4～6 |
| (10～12)×109/L |
6～10 |
| (13～18)×109/L |
10～12 |
4. Measures to reduce errors in the counting domain
<3×109/L to expand the counting range and reduce the dilution factor
>15×109/L Increase the dilution factor and appropriately reduce the amount of blood added
Reference value: adult: (4-10) × 109/L
Children: (5-12) ×109/L
Newborn: (15-20) × 109/L
6 months - 2 years old: (11-12) × 109/L
Reasons for uneven distribution of blood film thickness:
Thickness: large blood drop, large angle, fast pushing speed
Thin: small blood drop, small angle, slow pushing speed
Uneven distribution: uneven pushing, uneven force, dirty slides
Wright's staining is good for cytoplasmic components, neutral granules, but slightly poorer for nuclei and parasites
Giemsa stain is better for nuclei and parasites, but less for cytoplasm
WBC percentage (%)
Neutral rods 1-5
Neutral segmented granulocytes 50-70
Eosinophil 0.5～5
Basophil 0～1
Lymphocytes 20-40
Monocytes 3~8
(6) Abnormal white blood cell morphology
1. Toxic changes of neutrophils:
①Inhomogeneous size ②Toxic granules ③Vacuolation ④Duchenne bodies ⑤Degeneration ⑥Nuclear spinous process
2. Rod-shaped body (Auerbody)
Toxic changes in neutrophils
Changes in the nuclear image of neutrophils
Abnormal morphology of neutrophil nuclei: multi-lobed neutrophils binucleated neutrophils circular rod-shaped neutrophils giant multi-lobed neutrophils giant rod-shaped neutrophils
1. Left shift of neutrophil nuclei : cells with more than 5% rod-shaped nuclei in peripheral blood and (or) cells before the appearance of rod-shaped nuclei are left-shifted. It is common in purulent infection, acute hemolysis, and application of cytokines, etc., and is often accompanied by toxic changes such as toxic particles, vacuole formation, and degeneration. The left shift of the nucleus is accompanied by an increase in the total number of white blood cells, but it can also be normal or even reduced.
①Regenerative nuclear left shift: left nuclear shift accompanied by an increase in the total number of white blood cells is called regenerative left shift, which indicates that the bone marrow has strong hematopoietic function and release ability, and the body's resistance is strong.
②Degenerative left shift: left nuclear shift accompanied by normal or reduced total number of white blood cells is called degenerative left shift, which indicates that the release function of bone marrow is inhibited and the body's resistance is poor.
The left nuclear shift is divided into three grades: mild, moderate and severe, which are closely related to the severity of the infection and the body's resistance.
2. Right shift of neutrophil nucleus : more than 3% of peripheral blood neutrophils with more than five lobe nuclei are called right shift.
Severe nuclear shift to the right is often accompanied by a decrease in the total number of white blood cells, indicating a decline in bone marrow hematopoietic function, which is related to a lack of hematopoietic substances, DNA synthesis disorders, and bone marrow hematopoietic dysfunction. Nuclear right shift is common in megaloblastic anemia, pernicious anemia caused by intrinsic factor deficiency, infection, uremia, MDS, etc. Nuclear right shift also occurs when anti-metabolite drugs are used to treat tumors.
lymphocyte count
1. Changes in the number of lymphocytes:
Increase: ⑴ Acute infectious diseases caused by certain viruses or bacteria ⑵ Certain chronic infections: ⑶ After renal transplantation: ⑷ LC leukemia: ⑸ Aplastic anemia, agranulocytosis:
Reduction: mainly seen in exposure to radiation and application of adrenal cortex hormones.
2. Morphological changes of lymphocytes:
(1) Abnormal lymphocytes: under the stimulation of infectious mononucleosis, viral pneumonia, epidemic hemorrhagic fever, eczema, allergic diseases and other viral infections or allergens, lymphocytes can proliferate and appear certain morphological changes .
Type I plasma cell type → the cytoplasm contains small vacuoles or is foamy.
Type II mononuclear cells → irregular nuclei like monocytes.
Type III immature cell type → chromatin is finely arranged in a network, and 1-2 nucleoli can be seen.
Eosinophils
1. Physiological changes:
① Decreased eosinophils due to labor, hunger, cold, mental stimulation, etc.
②Diurnal changes: eosinophils in normal people are lower during the day, higher at night, fluctuate more in the morning, and remain constant in the afternoon
2. Pathological changes:
(1) Eosinophilia: > 0.5×109/L
① Parasitic diseases: roundworms, hookworms, tapeworms, etc.
② Allergic diseases: Another cause of parasitic diseases, eosinophils usually (1~2)×109/L
Such as: bronchial asthma, urticaria, drug or food allergy, angioedema, hypersensitivity pneumonitis, etc.
③ Certain skin diseases: eczema, exfoliative dermatitis, psoriasis, etc.
④. Blood diseases: chronic myeloid, eosinophilic leukemia, etc.
⑤. Certain malignant tumors: gastric cancer, lung cancer, colon cancer, Hodgkin's lymphoma
⑥. Some infectious diseases: scarlet fever (beta hemolytic streptococcus)
⑦. Certain endocrine diseases: hypofunction of the pituitary gland and primary adrenal insufficiency, etc.
(2). Eosinophilia: Acute stage of infectious diseases: typhoid fever, paratyphoid fever Severe tissue damage: after the application of adrenal corticosteroid or adrenocorticotropic hormone after surgery
The principle and scope of application of coagulant
| anticoagulant |
principle |
scope of application |
Not applicable |
| EDTA salt |
Chelates with calcium |
Blood routine examination, Hct, Plt count |
Coagulation test, platelet function test |
| heparin |
Prevents thrombin formation, inhibits platelet aggregation, does not chelate with calcium ions |
RBC fragility test, Hct and cell culture, etc. |
WBC and Plt count, blood smear examination, coagulation test |
| sodium citrate |
Chelates with calcium |
Thrombosis hemostasis, blood maintenance fluid, erythrocyte sedimentation 1:4 coagulation function |
Blood count, Hct |
| Oxalate |
Oxalate and calcium ions in blood form calcium oxalate precipitate |
Ratio of 1:9 with blood |
coagulation test |
Task three red blood cell inspection
Morphology: Seedless, biconcave disc shape with an average diameter of 7.2um. In hypertonic solution, the shrinkage is zigzag; in hypotonic solution, swelling or even rupture, hemoglobin escapes and becomes shadow cells.
【Reference range (range)】
Adult female: (3.5～5.0)×1012/L
Adult male: (4.0～5.5)×1012/L
Newborn: (6.0～7.0)×1012/L
1. Pathological increase
Relative increase: Plasma water loss, relative increase in formed components, no change in absolute value
Absolute increase: secondary (heart, lung disease, abnormal hemoglobinopathy, certain tumors, etc.); primary (polycythemia vera)
2. Pathological reduction
Low bone marrow hematopoietic function (aplastic anemia); lack of hematopoietic raw materials (iron deficiency anemia, megaloblastic anemia); increased red blood cell destruction (anemia); excessive red blood cell loss
Task 4 Determination of hemoglobin
Hemoglobin is a binding protein containing pigment prosthetic groups synthesized in human nucleated erythrocytes and reticulocytes, composed of globin and heme .
HbA adult major hemoglobin over 90%
HbA2 adult minor hemoglobin 2%-3%
HbF fetal hemoglobin below 2%
The main form of Hb is HbO2
(2) Determination of Hb:
ICSH recommends cyanide methemoglobin assay (HiCN)
1. Principle: Hb is a pigment protein that exists in various forms in the blood. Potassium ferricyanide is used to oxidize Hb into methemoglobin (Hi). Hi can combine with CNˉ to form cyanide hemoglobin. There is an absorption peak at 540nm , Measure its absorbance with a spectrophotometer, and convert it into the content of hemoglobin per liter of blood.
Methodological evaluation
(1) Determination of cyanide methemoglobin
Advantages: ①Simple operation, stable color rendering, and easy promotion.
②The conversion solution is relatively stable and easy to store.
③ All Hb except SHb can be directly counted after reading A.
④HiCN reference products can be stored for a long time, which is convenient for quality control.
Disadvantages: ① KCN is highly toxic and easy to pollute the environment . Sodium hypochlorite or ferrous hydroxide is used to treat waste liquid .
② SHb cannot be measured , and the conversion of HbCO is slow .
③ In case of hyperglobulinemia or hyperglobulin reagent turbidity .
(2) Sodium dodecyl sulfate hemoglobin assay
SDS can destroy WBC, molar extinction coefficient undetermined.
(3) Alkaline hydroxyhemoglobin assay:
HbF cannot be converted, and the maximum absorption peak is at 575nm.
(4) Determination of ferric azide Hb:
It has similar advantages to the HiCN method, but there is still reagent contamination.
(5) Bromide cetyltrimethylammonium hemoglobin determination method:
The precision and accuracy are slightly lower.
- Reference
Male: 120～160g/L
Female: 110～150g/L
Newborn: 170～200g/L
Task 5 Hematocrit Determination
4. Determination of hematocrit
Hematocrit (Hct or PCV) refers to the relative proportion of RBC in a certain volume of whole blood, which is related to the number and average volume of RBC.
(1) Detection method
1. Centrifugal precipitation method: Wen's method, micro method refraction method
RCF=1.118 × 10-5x effective centrifugal radius (cm) × (r / min)2
2. Blood analyzer method:
(2) Reagents, equipment and quality control of the Wennen method
(4) Reference value
Male: 0.380～0.508 Female: 0.335～0.450
(5) Clinical significance
1. HCT reduction: ①Various anemia ②Dilution blood
2. Increased HCT: ①Plasma loss ②RBC volume increase
Task 6 red blood cell mean
1. Mean corpuscular volume: MCV. MCV unit (fL) 1fL= 10ˉ15L MCV=(Hct/RBC)×10-15fl
2. Mean red blood cell hemoglobin content: MCH MCH unit (pg) 1pg= 10-12g MCH=(Hb/RBC)×10-12pg
3. Mean corpuscular hemoglobin concentration: MCHC unit (g/L) MCHC=(Hb/Hct)
| MCV(fL) |
MCH(pg) |
MCHC(g/L) |
|
| aldult |
80－100 |
26－34 |
320－360 |
| 1 to 3 years old |
79－104 |
25－32 |
280－350 |
| newborn |
86－120 |
27－36 |
250－370 |
| the elderly |
81—103 |
27—35 |
310—363 |
| Morphological classification |
MCV |
MCH |
MCHC |
clinical significance |
| normal cellularity |
normal |
normal |
normal |
Acute blood loss, acute hemolysis, aplastic anemia, leukemia |
| macrocytic |
increased |
increased |
normal |
Folic acid, vitamin B12 deficiency or malabsorption, megaloblastic anemia |
| Simple microcytic |
reduce |
reduce |
normal |
chronic inflammation, uremia |
| microcytic hypochromia |
reduce |
reduce |
reduce |
Iron deficiency anemia, thalassemia, chronic anemia |
RBC Morphological Classification of Anemia
Task 7 Platelet Count
Cell body: round, oval or irregular
Cytoplasm: light blue or pink, with a fine purplish red in the center
Particles, non-nuclear, often clustered in groups of 3 to 5
Lifespan: 7~14 days
(3) Function
Main functions: 1. Adhesion, 2. Aggregation, 3. Release, 4. Participation in coagulation, 5. Shrinkage of blood clots, 6. Effect of platelets on fibrinolysis.
PLT/L＝N×10×100×106＝N×109
【Reference value】（100～300)×109/L Critical value<20×109/L
【Clinical Significance】
1. Physiological changes:
① For normal people, it is lower in the morning and slightly higher in the afternoon; it is lower in spring and slightly higher in winter; it is lower in plain residents and slightly higher in plateau residents.
② It is low in women before menstruation and rises after menstruation; it rises in the second and third trimesters of pregnancy and falls 1 to 2 days after delivery.
③ High after strenuous activity and a full meal, and recover after rest.
2. Pathological changes:
PLT number reduction:
① PLT formation disorders: AA, AL, malignant tumors after radiotherapy and chemotherapy, etc.
② Excessive destruction of PLT: ITP, hypersplenism
③ Excessive consumption of PLT: DIC, thrombotic thrombocytopenic purpura, etc.
④ Abnormal distribution of PLT: splenomegaly
Increase in the number of PLTs:
Congenital hyperplasia: PLT hypopenias, giant PLT syndrome
Primary polycythemia: chronic myelogenous leukemia; polycythemia vera
Increased reactivity: acute suppurative infection; acute hemorrhage; after splenectomy
abnormal platelet morphology
1. Abnormal size ①Large platelet: d 4～7μm ②Small platelet: d<1.5μm
2. Morphological abnormalities: ① reduction of platelet granules ② platelet satellite phenomenon ③ platelet "adhesion" to red blood cells
3. Distribution: Normal adult platelets are clustered or clustered, scattered rarely
Platelets not aggregating—thrombocytopenia or thrombocytopenia
Excessive aggregation of platelets - thrombocytosis or essential thrombocythemia, myelofibrosis, chronic myelogenous leukemia, etc.
Task 8 Hematology Analyzer
Hematology analyzer detection principle p70
Leukocyte classification principle Three classifications: electrical impedance method 1 electrical impedance method: volume of white blood cells after hemolysis treatment, distinguish small cell population (L), intermediate cell population (M, E, B) and large cell population (N) 2 light scattering and cell Chemical counting combined with white blood cell differential counting Peroxidase staining: activity E, N, M decreased in turn, L, B inactive 3 volume, conductance, light scattering (VCS) white blood cell classification , electrical impedance method to measure volume V , high-frequency electromagnetic The needle measures the conductance C of the internal structure of the cell , and the light scattering S distinguishes the structure of the cell granules and the quality of the granules
- Electrical impedance method (Coulter's principle, three-group blood cell analyzer) : blood cells suspended in the electrolyte solution are non-conductive particles relative to the electrolyte solution, when blood cells (or similar particles) with different volumes pass through the counting hole, it can cause The change of current or voltage inside and outside the small hole is related to the number of blood cells and the principle of white blood cell counting and differential counting:
- The instrument divides the blood cells with a volume of 35 to 450 fL into 256 pulse voltages with the same volume and volume, so as to indirectly distinguish the blood cell groups and count them separately.
Blood cell histogram (histogram): refers to the curve graph that shows the distribution of cell populations when the hematology analyzer counts the number of cells, with the volume of blood cells as the abscissa and the relative frequency of different volume cells as the ordinate.
Red blood cell mean distribution width (RDW) : It is a parameter of red blood cell volume heterogeneity and an objective indicator reflecting the uneven size of red blood cells. Its enlargement suggests the presence of a mixed cell population with heterogeneously sized RBCs.
【Reference value】RDW-CV: 11.5%~14.5%. RDW-SD: 42±5 fl.
Electrical impedance type hematology analyzer divides white blood cells into 3 groups within the range of 35~450 fl. The left side of the normal white blood cell distribution histogram is high and steep, and the channel at 35-95 fl is the peak group of small cells (mainly lymphocytes); the channel at 160-450 fl is the peak group of large cells (mainly neutrophils); There is a small peak in the relatively flat area between the two peaks, which is an intermediate cell population (mainly mononuclear cells, mainly monocytes, and also contains eosinophils/basophils)
【Abnormal change alarm】
Abnormalities to the left of the lymphocyte peak: possible platelet aggregation, giant platelets, nucleated red blood cells, unlysed red blood cells, white blood cell fragments, protein/lipid particles.
Abnormal area between lymphocyte peak and mononuclear cell peak: possible atypical lymphocytes, plasma cells, blasts, eosinophilia/basophilia.
Abnormal areas between mononuclear cells and neutrophils: possible immature neutrophils, abnormal cell subpopulations, eosinophilia/basophilia, left shift of nuclei.
Abnormal area to the right of the neutrophil peak: possible absolute increase in neutrophils.
Multi-part alarm (RM): Indicates that there are two or more abnormalities at the same time.
(2) Red blood cell histogram
The normal red blood cell histogram is a unimodal curve with approximately normal distribution, usually in the range of 36-360 fl, the abscissa indicates the RBC volume, and the ordinate indicates the frequency of red blood cells of different volumes.
Normal red blood cells are concentrated in the range of 50-200 fl, and two cell groups can be seen: one is the main red blood cell group, from 50 to 125 fl, which is a normal distribution curve that is basically symmetrical on both sides, relatively narrow, and presents an inverted bell shape; The other group is the large cell group, which is located on the right side of the main group and does not coincide with the X-axis trailing part. It is distributed in the area of 125 fl ~ 200 fl, also known as the "toe", which is the secondary of some large red blood cells, reticulocytes, and red blood cells. A mixture of aggregates, polymers, and leukocytes.
(3) Platelet histogram
The normal platelet histogram is a unimodal smooth curve with a skewed distribution, usually in the range of 2-30fl, mainly concentrated at 2-15fl.
When there are large platelets, platelet aggregates, small red blood cells, and red blood cell fragments in the blood sample, abnormal platelet histograms may appear.
Mpv mean platelet volume: thrombocytopenia, mpv increase: peripheral blood platelet destruction too much
Decreased Mpv, bone marrow lesions
project two
Task 1 Direct eosinophil count
The five-differential blood cell analyzer is currently the most effective test method for eosinophil count
If there is a major operation or a large area of burns, eosinophils do not decrease or decrease very little, indicating a poor prognosis
Task 2 lupus erythematosus cell examination
Conditions required for LE formation:
The presence of LE factor in the patient's serum
Damaged or degenerated nuclei, that is, nuclei that have been affected by LE factors
white blood cells with phagocytic activity
Task 4 Morphological examination of red blood cells
abnormal structures in red blood cells
(1) Basophilic stippling red blood cells: after Wright's staining, blue granules (RNA) with different shapes appear in the cytoplasm, which belong to immature red blood cells, and the granules vary in size and number, because heavy metals damage the cell membrane , to agglutinate basophilic substances, or denature basophilic substances, or block the combination of protoporphyrin and iron in hemoglobin synthesis. seen in lead poisoning
(2) Howell-Jolly's body (chromatin body): mature erythrocyte or immature erythrocyte cytoplasm contains one or more dark purple round bodies with a diameter of 1-2 μm, which are nuclear fragmentation , the residue after dissolution. Seen after splenectomy, asplenia, splenic atrophy, hyposplenic function, erythroleukemia, and certain anemias (such as megaloblastic anemia).
(3) Carbo ring: In the cytoplasm of pleochroic and basic stippling erythrocytes, a purplish-red thin coil-like structure appears in the form of a ring and a figure-eight, which is the remnant of the nuclear membrane and the remnant of the spindle body (under the electron microscope, it can be seen Spindle-forming capillary staining abnormalities), lipoprotein denaturation. Found in leukemia, giant cell anemia, proliferative anemia, lead poisoning, after splenectomy.
(4) Parasites: Pathogens such as Plasmodium, microfilaria, and Dulishmania can be seen in the cytoplasm of red blood cells.
- Nucleated red blood cells: immature red blood cells
Task 5 Reticulum Count
Immature RBCs between late immature and mature erythrocytes. Cytoplasm contains varying amounts of basophils
After living body staining, basophilic substances condense into granules, and the granules can be linked into threads to form a network.
Original red early young middle red young red late young red net weaving red RBC
2. Grading:
Type I silk ball type: only found in normal human bone marrow
Type II reticulum: abundant in bone marrow
Type III broken network type: a small amount exists in peripheral blood
Type IV point granular type: mainly present in peripheral blood
New methylene blue N solution: recommended by who
②Brilliant tar blue solution:
【Reference value】 Adult: 0.008～0.02 or (25～75)×109/L Newborn: 0.02～0.06
Out of score = ×100%
4. Clinical significance
(1) Elevation of Ret: indicates strong bone marrow hematopoietic function, such as hemolytic anemia
Decrease in Ret: Indicates that the hematopoietic function of the bone marrow is weakened.
Common aplastic anemia: Ret<0.005 absolute value<15×109/L, which is one of the diagnostic criteria.
Task 7 Determination of erythrocyte sedimentation rate
3. Factors affecting ESR
Changes in plasma or RBC itself will cause changes in erythrocyte sedimentation rate.
1. Plasma factors:
ESR is accelerated in patients with hyperlipidemia with increased fibrinogen globulin
Albumin Glycoprotein Lecithin ESR slowed down
2. Red blood cell factors:
More red blood cells, slower ESR Less red blood cells, faster ESR
Spherical erythrocyte sedimentation rate slows down, aggregated erythrocyte sedimentation rate speeds up
3 technical factors
ESR tube: large inner diameter, long tube, inclined ESR speed up
Unclean ESR slows down
Anticoagulant: high concentration, slow erythrocyte sedimentation rate
(4) Reference value
Male: 0~15mm/h
Female: 0~20mm/h
(5) Methodological evaluation
(6) Clinical significance:
It has a certain reference value for the identification and dynamic observation of diseases
1. Physiological acceleration:
① Women are faster than men ② Pregnancy > 3 months ③ > 50 years old ④ Women's menstrual period
2. Pathological acceleration:
① Tissue injury, necrosis and major surgery: Differentiate between myocardial infarction and angina pectoris.
② Malignant tumors: Differentiation between benign and malignant tumors.
③ All kinds of inflammation: acute bacterial infection, active rheumatism, active tuberculosis, etc.
④ Hyperglobulinemia: MM, SLE, liver cirrhosis, chronic nephritis, etc.
⑤ Hypercholesterolemia: atherosclerosis, diabetes, etc.
3.ESR slow down:
Polycythemia vera, abnormal RBC morphology, hypofibrinogenemia, etc.
Item 3 Test urine
type
1. Morning urine: Dynamic observation of urinary system diseases and early pregnancy test. Can be used to assess the concentrating capacity of the kidneys
2. Random urine: suitable for outpatients and emergency patients.
3 Chronological urine ① 3-hour urine: 6:00 to 9:00, measure urine formed components, such as white blood cell excretion rate, 1-hour urine excretion rate check ② Postprandial urine: urine after lunch to 14:00, suitable for urine sugar and urine protein , urobilinogen, etc. ③ 12h urine: urine type component count. ④ 24h urine: used for quantification of chemical components. Such as electrolytes, creatinine, etc. ⑤Special test urine: Three cups of urine are mostly used for preliminary determination of male reproductive system diseases.
- Sterile urine: take the middle urine
preservative
| formaldehyde |
It has a good fixation effect on the shape and structure of formed elements such as urinary casts and cells |
| Toluene |
Used for qualitative or quantitative inspection of chemical components such as urine sugar and urine protein |
| Thymol |
It can not only inhibit bacteria, but also better preserve the type components in urine, and is used for urine concentration combined with bacillus inspection |
| Concentrated hydrochloric acid |
For 17-keto, 17-hydroxysteroids, catecholamines in urine |
| Glacial acetic acid |
5-HT, aldosterone |
odor
① Fresh urine has an ammonia smell, which is mostly caused by chronic cystitis and chronic urinary retention. ② When diabetic ketoacidosis occurs, the urine may smell like rotten apples. ③ The urine of patients with phenylketonuria may have a special "mouse droppings"-like odor. ④ In case of intestinal fistula in the urinary system, there may be fecal odor in the urine
urine output
Polyuria: Refers to the urine output of adults exceeding 2500ml in 24 hours
Pathological polyuria: a. Endocrine diseases: diabetes insipidus, diabetes, etc.
b. Renal diseases: chronic nephritis, renal insufficiency, chronic pyelonephritis, etc.
c. Mental factors: hysteria, etc.
d. Drugs: mannitol, sorbitol, etc.
Oliguria: <400ml / 24h, or <17ml / h
Pathological oliguria: ① Prerenal oliguria: dehydration, massive blood loss, shock, etc. caused by various reasons
②renal oliguria: acute glomerulonephritis, chronic renal failure.
③Postrenal oliguria: unilateral or bilateral upper urinary tract obstruction disease.
④ Pseudooliguria: Prostatic hypertrophy
Anuria: <100ml / 24h
urine color
①Hematuria: When the urine contains a certain amount of red blood cells, it is called hematuria.
Color: light red cloudy, lightly washed meat or fresh blood
Cause: urinary system bleeding. Such as renal tuberculosis, renal tumors, stones and bleeding disorders
Gross hematuria: > 1ml blood/L urine → light red may appear.
Microscopic hematuria: no obvious changes in the appearance of the urine, and in centrifugal sedimentation microscopy, >3 RBC/HPF → microscopic hematuria.
②Hemoglobinuria: Hemoglobin in acidic urine can be oxidized to methaemoglobin and turns brown. The content is mostly brown-black soy sauce-like appearance.
③ Bilirubinuria: dark yellow, obstructive jaundice and hepatocellular jaundice → foamy and yellow after shock. When taking furazolidone, riboflavin, bezoar drugs, etc., the urine can be dark yellow.
④ Chyluria: Appearance: It is milky white in varying degrees. In severe cases, it looks like milk, sometimes containing blood.
Reasons: mostly caused by filariasis, a few can be caused by tumor, abdominal trauma or surgery.
⑤ Pyuria: Appearance: Contains a large number of white blood cells→yellow-white turbidity or pus-containing filamentous suspension→microscopic examination shows a large number of pus cells
Reason: Seen in urinary system infection, prostatitis, seminal vesiculitis, etc.
⑥Salt crystal urine: Appearance: white or light pink granular turbidity
urine osmolarity
①Urine osmolality: 600~1000mmol/kg H2O (equivalent to urine specific gravity 1.015~1.025). The maximum range is 40~1400mmol/kg H2O. ②Urine osmolarity/plasma osmolarity (3.0~4.7): 1.0.
urine pH
Under normal dietary conditions: ①Morning urine pH 5.5~6.5, average 6.0; ②Random urine pH 4.5~8.0.
Urine cytology examination
red blood cells
Gross hematuria: blood content ≥ 1ml Microscopic hematuria: ≥ 3/HPF
Clinical significance:
1. Physiological hematuria: transient microscopic hematuria may occur in strenuous exercise, rapid march, cold water bath, prolonged standing, or heavy physical labor
2. Pathological hematuria:
①Diseases of the urinary system itself: inflammation, tumor, tuberculosis, calculus, etc.
②Diseases in other systems of the body: mainly seen in bleeding disorders caused by various causes:
③Diseases of organs near the urinary system: such as prostatitis, seminal vesiculitis, etc.
leukocyte
Normal adult: 1 to 2 WBC/HPF can be seen occasionally; if more than 5 WBCs are increased, it is called microscopic pyuria .
Pus cells: destroyed or dead neutrophils with fuzzy structure, the pulp is full of coarse particles,
The nucleus is not clear, and it is easy to gather into groups.
Reference value: Mix one drop of urine: White blood cells: 0~3/HP Urinary sediment after centrifugation: White blood cells: 0~5/HP
Clinical significance:
A. Urinary system inflammation: increased white blood cells in urine.
B. Female vaginitis, cervicitis, adnexitis: leukocytosis, a large number of squamous epithelial cells.
C. Rejection reaction after kidney transplantation: a large number of LC, mononuclear C.
D. Active stage of pyelonephritis, acute attack stage of chronic pyelonephritis: Visible flashing cells: Under the condition of hypotonicity, the inner particles of neutrophils exhibit Brownian molecular motion, and flashing phenomenon appears due to light refraction.
E. Mononucleosis in urine: drug-induced acute interstitial nephritis
Urinary cast examination
1. Conditions for tube formation:
A. Presence of proteinuria.
B. Kidney tubules have the ability to concentrate and acidify urine.
C. Slow urine flow.
D. There are nephrons for alternate use.
Common cast types:
| Transparent cast |
Acute and chronic nephritis , kidney disease , long-term fever , occasionally after strenuous exercise . |
| granular cast |
Acute and chronic nephritis , nephropathy , seen in renal parenchymal lesions, suggesting stasis in nephrons |
| waxy cast |
Severe glomerulonephritis , end-stage chronic nephritis, renal amyloidosis |
| fat cast |
Lipid nephropathy, chronic glomerular |
| Renal epithelial cell casts |
Nephropathy, toxin reaction, long-term high fever , heavy metal poisoning and renal amyloidosis |
| RBC casts |
Kidney inflammation with bleeding. |
| WBC casts |
Acute pyelonephritis , interstitial nephritis |
urine bile pigment test
Bilirubin, urobilinogen, and urobilin: commonly known as the “three gallbladders” in urine, the average adult produces 250-350mg per day
Urobilinogen test: Ehrilich aldehyde reaction
Proteinuria (proteinuria): When the protein in the urine exceeds 150mg/24h (or exceeds 100mg/L), the protein qualitative test is positive
There may be trace amounts of glucose in the urine of healthy people, generally <2.8mmol/24h, which is negative by ordinary methods. When the blood sugar concentration exceeds 8.88mmol/L (1.6g/L), glucose will start to appear in the urine
Urine Analyzer Test Parameters:
1. PH 2. Glucose (GLU) 3. Protein (PRO) 4. Occult blood (BLD) 5. Urine ketone body (KET) 6. Urine bilirubin (BIL) 7. Urobilinogen (URO) 8. Nitrite ( NIT) 9. White blood cells 10. Specific urine density 11. Vitamin C
item four
Unusual stool color and possible causes
| color |
food or drug cause |
病理原因 |
| 绿色 |
食用大量绿色蔬菜 |
乳儿肠炎因胆绿素来不及转变为粪胆素而呈绿色 |
| 灰白色 |
钡餐造影服用硫酸钡，食入脂肪过量 |
胆道梗阻、胰腺及肝细胞病变，阻塞性黄疸 |
| 鲜红色 |
服用西红柿和西瓜 |
肠道下段出血，如痔疮、肛裂、直肠癌等 |
| 黑色 |
食用铁剂、动物血、肝脏、活性炭及某些中药 |
上消化道出血 |
| 果酱色 |
食用大量咖啡、可可、巧克力等 |
阿米巴痢疾、肠套叠 |
粪便异常性状及临床意义
| 粘液便 |
小肠炎症时，增多的粘液均匀混合于粪便中；大肠炎症时，粪便已经逐渐形成而附着于粪便表面。 |
| 脓血便 |
其中细菌性痢疾以脓及粘液为主，脓中带血 |
| 鲜血便 |
见于结肠癌、直肠息肉、肛裂及痔疮等 |
| 柏油样便 |
见于上消化道出血 |
| 米泔样便 |
呈乳白色淘米水样，内含粘液片块，多见于霍乱、副霍乱 |
| 胨状便 |
过敏性肠炎及慢性菌痢。病人常于腹部绞痛后排出粘胨状、膜状或纽带状粪便 |
| 稀汁样便 |
各种感染性或非感染性腹泻，尤其是急性胃肠炎 |
| 绿豆汤样便 |
见于沙门氏菌感染 |
| 蛋青样便 |
白色念珠菌性肠道感染 |
| 白陶土样便 |
胆管阻塞，阻塞性黄疸 |
| 乳凝块状便 |
（蛋花样便）婴儿消化不良 |
细胞
| 细胞 |
正常 |
临床意义 |
| 白细胞 |
不见或偶见 |
肠道炎症，数量与炎症轻重程度及部位相关 |
| 红细胞 |
不含红细胞 |
细菌性痢疾，阿米巴痢疾，上消化道出血 |
| 大吞噬细胞 |
无 |
诊断急性细菌性痢疾依据 |
| 上皮细胞 |
很难发现 |
坏死性肠炎、霍乱、副霍乱、伪膜性肠炎 |
| 肿瘤细胞 |
无 |
肿瘤 |
寄生虫检查标本
阿米巴滋养体：立即检查，标本保温
蛲虫卵：透明薄膜拭子/棉拭子，晚12时或清
晨排便前自肛门周围皱襞处拭取，立即镜检。
检查寄生虫虫体及虫卵计数，采集24小时粪便
食物残渣
1．淀粉颗粒2．脂肪3．肌肉纤维4．结缔组织5．植物纤维及细胞
p 正常粪便球菌(G+)和杆菌(G-)比例大致为1∶10
项目五 脑脊液检验
ô正常成人CSF总量约为120～180ml，人体每日更换3 ～5次。 pH在7.31-7.34
标本采集
腰椎穿刺，小脑延髓池穿刺， 侧脑室穿刺
第一管：作细菌培养
第二管：作化学分析和免疫学检查
第三管：细胞计数
颜色
| 无色 |
正常，也可见于病毒性脑炎、轻型结核性脑膜炎、脊髓灰质炎、神经梅毒 |
| 红色 |
陈旧性出血：蛛网膜下腔或脑室出血；新鲜出血：穿刺损伤出血 |
| 黄色 |
出血、黄疸、淤滞、梗阻陈旧性蛛网膜下隙出血或脑出血，由于红细胞释放出血红蛋白 |
| 白色 |
脑脊液白细胞增多常见于脑膜炎奈瑟氏菌、肺炎链球菌、溶血性链球菌引起的化脓性脑膜炎 |
| 绿色 |
见于铜绿假单胞菌性、急性肺炎双球菌性脑膜炎 |
| 褐色或黑色 |
多见于脑膜黑色素肉瘤或黑色素瘤等 |
中枢神经系统疾病脑脊液改变表格
| 疾病 |
外观 |
蛋白质定性 |
葡萄糖 |
氯化物 |
细胞 |
细胞分类 |
细菌 |
| 化脑 |
浑浊,脓性,凝块 |
显著增加 |
↓↓↓ |
↓ |
显著增加 |
中性粒细胞为主 |
致病菌 |
| 结脑 |
毛玻璃样浑浊薄膜 |
中度增加 |
↓↓ |
↓↓ |
中度增加 |
早期中性粒，后期淋巴细胞 |
结核菌 |
| 病脑 |
透明或微浑 |
轻度增加 |
正常 |
正常 |
轻度增加 |
淋巴细胞为主 |
无 |
脑脊液白细胞达（10～50）×10^6/L为轻度增高，（50～100）×10^6/L为中度增高，大于200×10^6/L为显著增高。
化学检查
1.蛋白质 定性检查（quality）：有Pandy试验、硫酸铵试验和 Leevinson试验。
参考值：0.2～0.4g/L(腰椎穿刺)； 0.1～0.25g/L(小脑延髓池穿刺)0.05～0.15g/L(侧脑室穿刺)
[临床意义] 蛋白质含量增高常见于： 提示血脑屏障受到破坏，CSF循环梗阻，血性CSF。
①中枢神经系统炎症； ②神经根病变；
③椎管内梗阻； ④出血；
⑤其他：如早产儿CSF
2.葡萄糖测定：
与血浆葡萄糖测定法相同，CSF中葡萄糖含量仅为血糖的3/5
参考值：2.5～4.4mmol/L (腰椎穿刺)
临床意义：
CSF中葡萄糖含量与下列因素有关:
FCSF中葡萄糖酵解程度；血糖浓度。
CSF中葡萄糖减低主要见于：化脑、结脑、霉菌性脑膜炎；脑肿瘤；神经性梅毒； 低血糖等 。
3.氯化物测定：
参考值：成人120～130mmol/L；儿童111～123mmol/L(腰椎穿刺)
临床意义：
CSF中氯化物含量与血氯浓度、pH值、血脑屏障和
CSF蛋白含量有关。
F减低：细菌性脑膜炎和霉菌性脑膜炎、结脑；
F不减低：病毒性脑炎、脑肿瘤等
F增高：尿毒症、脱水等。
项目六 浆膜腔积液检验
人体的浆膜腔：指胸腔、腹腔、心包腔等。
第1管细菌学；第2管化学和免疫学；第3管细胞学，第4管观察凝固现象。
常规及细胞学检查宜用EDTA-K2抗凝，化学检查肝素抗凝。
注意：送检和检测必须及时；如不能检查应该加无水乙醇放置于冰箱保存
| 漏出液 |
渗出液 |
|
| 病因 |
非炎症 |
炎症 |
| 外观 |
淡黄 |
不定 |
| 透明度 |
透明 |
多浑浊 |
| 比密 |
<1.015 |
>1.018 |
| 凝固 |
不凝 |
凝固 |
| 粘蛋白 |
阴性 |
阳性 |
| pH |
> 7.4 |
<6.8 |
| 蛋白定量 |
<25 g/l |
>30 g/l |
| 葡萄糖 |
>3.3mmol/l |
可变， 常<3.3mmol/l |
| 细胞总数 |
<100×106/l |
常>500×106/l |
| 白细胞分类 |
淋巴和间皮细胞为主 |
急性炎症：粒c；慢性炎症：淋巴c |
| 癌细胞 |
无 |
可能有 |
| 细菌 |
无 |
可找到病原菌 |
| 常见疾病 |
充血性心衰、肝硬化、肾炎等 |
感染、肿瘤、急性胰腺炎等 |
项目7精液和前列腺
精液 精子约5% 精浆约95%
精浆成分：精囊液：凝固酶、果糖，前列腺液：酸性磷酸酶、纤溶酶，精浆附睾尿道旁腺润滑，尿道球腺
精液检查的目的
F 1 评价男性的生育功能
F 2 辅助男性生殖系统疾病的诊断
F 3男性绝育后效果观察
F 4人工受精的优质精子的筛选
F 5法医学鉴定
6婚前检查
1．外观：
① 正常呈灰白色，不透明，厚稠胶冻状，放置一段时间，自行液化呈半透明乳白色。
② 血精：多呈鲜红、酱油色或黑色见于：生殖系结核、肿瘤、结石、炎症。
③ 脓性精液：多呈黄色，棕色。见于：前列腺炎或精囊炎。
2. 量：用小量筒或刻度吸管测定全部精液量
⑴正常： 2～5ml (一次) 。
⑵异常：<1.5ml或>8ml
精液减少：禁欲5～7天，精液量仍＜1.5ml见于精囊腺和前列腺病变。
3. 凝固及液化：
正常：30-60分钟 自行液化
异常：超过60分钟不液化见于前列腺炎
4. 粘稠度：粘稠度检查应在精液完全液化后进行
正常：拉丝长度应不超过2cm，呈水样，形成不连续小滴。
异常：粘稠度下降：先天性无精囊腺及精子浓度太低或无精子症，粘稠度增加：多与附属性腺功能异常有关，如前列腺炎、附睾炎
5. 酸碱度：7.2～8.0
精子活动率>70%
精子存活率≥75%
a：快速前向运动 ，精子活动力良好
b：慢或呆滞的前向 ，精子活动力较好
c：非前向，在原地打转或抖动，精子活动力不良
d：不动 ，死精子
a级精子≥25% ，a级和b级总和≥50%
6. 精子形态：
（1）正常形态：似蝌蚪状，分头、体、尾头部正面呈卵圆形，侧面呈扁平梨形，主要结构为细胞核和核前的顶体体部轮廓直而规则，与头纵轴成一直线尾部细长，外观规则而不卷曲（2）异常精子形态：
①头部异常：大头、小头、双头、锥形头、梨形头、无定形头等。
②体部异常：体部肿胀变粗或变细或不规则、弯曲中段等。
③尾部异常：无尾、短尾、双尾、卷尾、断尾等。
正常精液中异常精子≤20%. >40%会影响精液质量 >50%会导致不育
前 列 腺 液 检 验P246prostatic fluid examination
一、成分：
ü 无机离子（如钾、钠、钙、锌等）
ü 酶类（如纤溶酶、酸性磷酸酶、乳酸脱氢酶等）
ü 免疫物质（如免疫球蛋白、补体及前列腺特异抗原）
ü 有形成分（淀粉样颗粒、少量上皮细胞和白细胞） 二、主要功能：
① 维持精液适当的pH；
② 参与精子能量代谢；
③ 抑制细菌生长；
④ 含有蛋白水解酶和纤溶酶，促使精液液化。
三、检验目的：
① 前列腺炎、前列腺脓肿、前列腺结核和前列腺癌的辅助诊断和疗效观察。
② 性传播疾病的诊断。
五、理学检查：
1. 量：一次可采集数滴至2ml
↑：前列腺慢性充血、过度兴奋
↓：前列腺炎
2. 颜色和透明度：
乳白色、稀薄、有光泽、不透明的液体
黄色、混浊、脓性粘稠：前列腺炎
红色：结核、肿瘤、结石、炎症
3. 酸碱度 ：6.3~6.5
六、显微镜检查：
1. Direct smear examination
(1) Lecithin bodies:
Shape: round or oval, varying in size, strong refraction.
Normal: Evenly distributed over the entire field of view.
Prostatitis - reduced and unevenly distributed
(2) Prostatic granulosa cells:
Larger, containing more phosphatidylcholine bodies
p Normal: no more than 1/HPF,
An increase in such cells can be seen in the prostatic fluid of the elderly.
p Prostatitis: increased to several 10 times with a large number of pus cells.
(3) Amyloid bodies: Amyloid bodies may exist and increase with age, generally without clinical significance.
(4) cells:
①Red blood cells: normal: < 5/HPF
Abnormal: Inflammation, tuberculosis, calculus and tumor
② White blood cells: normal: white blood cells are often <10/HPF, often scattered.
Abnormal: piles of pus cells can be seen in prostatitis, such as >10-15/HPF
(5) Sperm:
(6) Trichomonas: Trichomonas prostatitis
Item 8 Vaginal discharge
| color |
clinical disease |
| white thin paste odorless |
normal |
| Purulent vaginal discharge with yellow or yellow-green odor |
More common in purulent infection, endometritis |
| bean curd residue-like leucorrhea |
candidal vaginitis, fungal vaginitis |
| bloody leucorrhea |
Be wary of malignant tumors |
| yellow foamy purulent leucorrhea |
Trichomonal vaginitis, |
| yellow watery leucorrhea |
Due to tissue degeneration and necrosis at the lesion site, it is more common in: fibroids, cervical cancer, etc. |
| creamy leucorrhea |
Seen in Gardnerella vaginalis infection |
( 1) Vaginal cleanliness:
Add 1 drop of normal saline smear to vaginal secretions and check with HPF.
| cleanliness |
bacilli/epithelial cells |
cocci |
leukocyte |
clinical significance |
| Ⅰ |
++++ |
— |
0~5 |
normal |
| Ⅱ |
++ |
- |
5~15 |
normal |
| Ⅲ |
- |
++ |
15~30 |
suggest inflammation |
| Ⅳ |
— |
++++ |
>30 |
severe vaginitis |
(2) Trichomonas vaginalis:
ÿ The pathogenic anaerobic protozoa that parasitizes the vagina is pear-shaped, 2 to 3 times the size of white blood cells, with 4 pro-flagella at the front and 1 post-flagella at the back. The optimum pH for growth is 5.5-6.0
- Gardnerella vaginalis: clue cells
(4) Neisseria gonorrhoeae: & commonly known as Neisseria gonorrhoeae, Gram-negative diplococci, kidney-shaped or oval, with oppositely arranged pairs of concave surfaces.
(5) Fungi: & Oval spores, often budding or multiple connected into chains, branches or hyphae.