GROUP 3

MODUL
CLINICAL INTERPRETATION OF LABORATORY TESTS
 CASE 1

A 30-year-old-woman is seen by her physician. She has

a temperature of 380C and complains of nausea,
headache, and flank (below the ribs and above the ileac
crest) tenderness and pain. When asked, she states
that urination is sometimes painful, that she must
urinate more frequently than usual, and that she has a
sensation of urgency. A random, midstream “clean
catch” urine specimen is collected for a routine UA and
culture.
Physical Exam Chemical Exam Microscopic Exam

Color: yellow Glu: neg RBCs: 0 to 2

Clarity: cloudy Bili: neg WBCs: 25 to 50
Odor: NA Ket: neg Casts: 0 to 2
Sp Grav: 1.010 granular
Blood: trace 2 to 5 WBC
pH: 6.5 Bacteria: mod
Pro: 30 Epith: few SEs
Urob: norm Crystals: few
Nitr: pos CaOx
LE: pos
QUESTION :
1. Circle any abnormal or discrepant urinalysis
findings
2. What is the probable diagnosis?
3. State two physiologic mechanism that can lead this
condition
 Answer
Physical Exam Chemical Exam Microscopic Exam
Color: yellow Glu: neg RBCs: 0 to 2
Clarity: cloudy Bili: neg WBCs: 25 to 50
Odor: NA Ket: neg Casts: 0 to 2 granular
Sp Grav: 1.010 2 to 5 WBC
Blood: trace Bacteria: mod
pH: 6.5 Epith: few SEs
Pro: 30 Crystals: few CaOx
Urob: norm
Nitr: pos
LE: pos
2. Diagnosis yang mungkin adalah Infeksi Saluran Kemih.
3. Dua mekanisme fisiologis yang memicu kondisi ini yaitu :
a. Keadaan fisiologis yang sering ditemukan yaitu proteinuria.
Sementara pada keadaan demam tinggi, gagal jantung, latihan
fisik yang kuat ditemukan proteinuria bukan karena kebocoran
plasma tetapi karena banyak protein dan eritrosit yang pecah
di dalam urin.
b. Konsumsi vitamin bisa meningkatkan glukosa dalam darah.
 Reference
Hardjono, H. 2006. Interpretasi Hasil Tes
Laboratorium Diagnostik. Cet 4: Makassar
Windarwati. 2015. Lecture Interpretasi Urinalisis
 CASE 2

A 58-year-old male is seen in the emergency room

complaining of intermittent severe pain that radiates
from his right side to his abdomen and groin area (renal
colic). He has frequent need to urinate with little or no
urine output. Other complaints include a “cold” that he
has been self-treating with over the counter
medications and vitamin supplements for more than a
week.
Physical Exam Chemical Exam Microscopic Exam
Color : Pink Glu : neg RBCs : 10 to 25
Clarity : Slt Bili : neg WBCs : 5 to 10
cloudy Ket : >1.030 Casts : 0 to 2 hyaline
Odor : NA Sp Grav : neg Epith : few TEs
Blood : neg Bacteria: few
pH : 5.5 Crystals: many CaOx
Pro : trace
Urob : norm
Nitr : pos
LE : neg
QUESTION:
1. Circle any abnormal or discrepant urinalysis findings.
2. For each discrepancy noted, list a test the laboratories
should perform to confirm or deny the cause of the test
discrepancy.
3. Based on the information provided, which of the following is
the most probable cause of the patient’s condition?
4. State at least three factors that could lead to the
development of the patient’s condition.
 Answer
1.
Physical Exam Chemical Exam Microscopic Exam
Color : Pink Glu : neg RBCs : 10 to 25
Clarity : Bili : neg WBCs : 5 to 10
Slt cloudy Ket : >1.030 Casts : 0 to 2 hyaline
Odor : NA Sp Grav : neg Epith : few TEs
Blood : neg Bacteria: few
pH : 5.5 Crystals: many CaOx
Pro : trace
Urob : norm
Nitr : pos
LE : neg
2. Berdasar deskripsi tersebut, pemeriksaan
laboratorium yang perlu dilakukan yaitu :
a. Pemeriksaan kimia meliputi glukosa darah dan tes
faal hati
b. Pemeriksaan mikroskop meliputi tes faal ginjal, tes
faal hati, biakan dan spesimen baru
3. Dari informasi tersebut, yang paling kemungkinan
menyebabkan kondisi pasien itu karena nefrolithiasis
(batu ginjal)
4. Berikut 3 faktor yang memicu perkembangan pasien :
- Asupan air yang kurang dan tinggi kalsium
- Diet tinggi purin, oksalat, kalsium
- Sering pada orang yang pekerjaannya lebih banyak
duduk atau kurang aktivitas
 Reference
• Hardjono, H. 2006. Interpretasi Hasil Tes
Laboratorium Diagnosis. Makassar
• Sudoyo, dkk. 2009. Buku Ajar Ilmu Penyakit
Dalam. Interna Publishing. Jakarta
 CASE 3

An obese 58-year-old women is seen by her physician.

She complains of perineal itching and soreness. On
pelvic examination, a white vaginal discharge is noted.
A sample of the discharge is collected for culture. A
midstream “clean catch” urine specimen is also
collected for culture and routine urinalysis.
Physical Exam Chemical Exam Microscopic Exam
Color : Yellow Glu : 500 RBCs : 0 to 2
Clarity : cloudy Bili : neg WBCs : 10 to 25 ;
Odor : NA Ket : neg clumps
Sp Grav : Casts : 0 to 2 hyaline
1.015 Epith : many SEs
Blood : neg Bacteria : neg
pH : 5.0 Yeast : mod
Pro : neg Crystals : few
Urob : norm urates
Nitr : neg
LE : pos
QUESTION:
1. Circle any abnormal or discrepant urinalysis findings.
2. What is the most likely cause of the patient’s vaginitis?
3. Which two microscopic findings suggest that the urine
tested is not from a mid stream “clean catch” specimen?
4. Is the patient showing signs of renal damage or
dysfunction?
A. Yes
B. No
5. Explain the physiologic mechanism most likely responsible
for the presence of glucose in the patient’s urine
6. Select the diagnosis that best accounts for the glucosuria
observed in this specimen.
A. Normal ; the glucose renal threshold was exceeded
B. Insulin-dependent diabetes mellitus
C. Non-insulin-dependent diabetes mellitus
D. Glucose intolerance
 Answer
1.
Physical Exam Chemical Exam Microscopic Exam
Color : Yellow Glu : 500 RBCs : 0 to 2
Clarity: cloudy Bili : neg WBCs : 10 to 25 ;
Odor : NA Ket : neg clumps
Sp Grav : Casts : 0 to 2 hyaline
1.015 Epith : many SEs
Blood : neg Bacteria : neg
pH : 5.0 Yeast : mod
Pro : neg Crystals : few
Urob : norm urates
Nitr : neg
LE : pos
2. Yeast
3. Kejernihan dan Leukosit
4. Tidak, karena hasil pemeriksaan tidak
memperlihatkan adanya darah (hematuria),
protein (proteinuria)
5. Mengonsumsi vit C Bisa meningkatkan
glukosa dalam urin
6. Normal ; the glucose renal threshold was exceeded
 Reference
Boon, Na, et al. 2009. Principle A Practice of
Medicine Ed 20. Elsevier. Uk
Hardjono. 2006. Interpretasi Hasil Tes
Laboratorium Diagnostik. Makassar
 CASE 4

Yuliana presented to her physician with pains in her

lower back following an automobile accident. The
physician suspected renal trauma and ordered a
complete urinalysis. The results from the dipstick were
negative for blood. The technologist saw microscopic
fields similar to the field shown below.
QUESTION:
1. What may be a cause for the discrepancy in the
results?
2. How would you describe the morphology of the red
blood cells seen above?
3. Would you expect the specific gravity of this sample
to be high or low?
1. Yang menyebabkan ketidaksesuaian hasil adalah
pemeriksaan dipstik darah negatif yang
menandakan negatif palsu. Hal ini bisa diakibatkan
berat jenis meningkat, penggunaan formaldehid,
pemeriksaan yang tertunda.
2. Gambaran morfologi eritrosit di kasus yaitu ada
perlekatan eritrosit dengan benda lain yang
mengindikasikan terjadinya hematuria dan hal ini
dipengaruhi oleh pemeriksaan tertunda atau berat
jenis meningkat.
3. Berat jenis yang diharapkan dari kasus ini adalah
tinggi karena urin mengandung hematuria.
Sedangkan jika rendah biasanya pada pasien usia
lanjut dikarenakan kemampuan penekanan urin
berkurang.
 Reference
• Harry, et al. 2001. Basic Examination of Urine
• John, K J.2015. Comprehensive Clinical
Nephrology
• Kemenkes RI. 2011. Pedoman Interpretasi
Data Klinik. Kemenkes RI. Jakarta
CASE 5
The medical technologist
performing urinalysis on this
sample went on her lunch
break and did not refrigerate
this sample to preserve it. It
was left at room temperature
for three hours before being
examined microscopically.
QUESTION :
1. Is the bacteria seen most likely a result of an
infection or contamination? Why?
2. What dipstick results would you expect to be
abnormal?
 Answer
1. Kontaminasi, karena dalam kasus ini urin dibiarkan
dalam suhu ruangan selama 3 jam yang
memungkinkan terjadinya kontaminasi bakteri atau
mikroorganisme lainnya. Infeksi bisa ditentukan
apabila urin dalam kondisi tidak terkontaminasi, segar,
dan diambil secara midstream
2. Hasil dipstick yang abnormal adalah darah, nitrit,
glukosa, bilirubin, keton, dan leukosit
 Reference:
• Johnson et al. 2005. Comprehensive Clinical
Morfology. Elevier. Uk
• Hardjono. 2006. Interpretasi Hasil Tes
Laboratorium Diagnostik. Makassar
 CASE 6

A B

Beni, an eight year old boy, was admitted to the

hospital with symptoms of weakness, anorexia, and
oliguria. He recently had a streptococcal throat
infection. His urinalysis revealed :
Physical Appearance Reagent Strip Results
Color- red/amber pH- 6
Clarity- cloudy specific gravity- 1.025
protein- >2000
mg/dL (SSA 4+)
Blood- Large
Nitrite- negative
Leukocytes- negative
Glucose- negative
Ketones- negative
Bilirubin- negative
Urobilinogen- normal
QUESTION:
Which image above is representative of the microscopic
examination of this patient? Why?

Answer
Gambar A
Terdapat Electrolyte cast yang menunjukkan
kalau pasien menderita kerusakan pada
ginjal tepatnya glomerulus dalam fungsi
filtrasi sehingga dapat ditemukan eritrosit
dalam urin. Penumpukan eritrosit ini
membentuk cast. Ex: glomerulonephritis
akut
 Reference
Bonita M. 2003. Nurses Manual of Laboratory
and Diagnostic Test. Philadelphia: Naves
Company
 CASE 7

A B
Scenario :
Toni presents to his doctor with
swelling in his knees and
ankles. He was diagnosed with
gouty arthritis.
C
QUESTION:
Which of the crystals above support the diagnosis?

Answer :
Gambar A : kristal bikarbonat
Gambar B : kristal asam urat
Gambar C : kristal triple fosfat
 Dari gambar tesebut yang mendukung diagnosis dari
skenario adalah gambar B (kristal asam urat) karena
dengan menemukan kristal asam urat tofi merupakan
diagnosis spesifik gout. Akan tetapi tidak semua pasien
memiliki tofi sehingga tes diagnostik ini kurang spesifik.
Dibawah bisa dipakai untuk menegakkan diagnosis :
- Riwayat inflamasi klasik artritis monoartikuler khusus
di sendi
- Diikuti stadium interkritik
- Resolusi sinovitis yang cepat
- Hiperurisemia
 Reference
Tehorusory, E. 2009. Arthritis Gout : Buku Ajar
Ilmu Penyakit Dalam. Jakarta: Interna
Publishing.
 CASE 8

A B
QUESTION : Which formed element above is
associated with the most serious pathological
condition?
 Answer
Gambar A: Silinder eritrosit
Gambar B: Silinder Hyalin
Yang paling berhubungan dengan kondisi
patologis serius adalah silinder eritrosit
(gambar A)
 Reference
Hardjono. 2006. Interpretasi Hasil Tes
Laboratorium Diagnostik. Makassar