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Urinalysis reflex microscopic in Children?

  • 1.  Urinalysis reflex microscopic in Children?

    Posted 02-24-2024 17:17

    Hey,

    I am a lead tech at a Children's Hospital.  I am wondering if there are articles about testing Urinalysis dipstick, using the protein, blood, nitrite, and leukocyte esterase (any results that are not negative) to reflex the microscopic Urinalysis portion?

    Is there an age cutoff where the reflex should/ should not make a difference. 

    We currently test all samples for macroscopic (dipstick, pH, specific gravity,  color, clarity) and microscopic (automated with reflex to manual).

    Thanks everyone in advance for your help. 



    ------------------------------
    Mark Kohlhepp Med Lab Scientist, Evening Lead
    PENNSYLVANIA

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  • 2.  RE: Urinalysis reflex microscopic in Children?

    Posted 02-25-2024 02:37
      |   view attached
    Hello  Mark Kohlhepp,
    I remember when I was in Clinical Laboratory we had a refreshment training then it was a discussion on the dipstick Vs Microscopic. Then; the study paper attached was our reference. And I hope it will help you with your question. 

    Giorgis Yeabyo (ASCP,HTL,CPHQ,PhD(c))
    ABiTi Consultancy Services (ACS)
    Addis Ababa, Ethiopia
    Cell: +251935352425






  • 3.  RE: Urinalysis reflex microscopic in Children?

    Posted 02-25-2024 10:13

    Hello, 

    Send this question to the CAP.  They may be able to cite an article. 

    Most labs do not perform the microscopic until one of the macroscopic parameters is positive. 



    ------------------------------
    Don Tran Supervisor/Lead Med Lab Scientist/MedTechnologist
    Stanton CA
    (714)791-5819
    ------------------------------



  • 4.  RE: Urinalysis reflex microscopic in Children?

    Posted 10 days ago


    Tana Flies





  • 5.  RE: Urinalysis reflex microscopic in Children?

    Posted 9 days ago

    Hi Mark,

    We went through this several years ago.  We were looking for ways to reduce unnecessary urine cultures and setup an order called Urine Culture Screen that replaced the Urine Culture order and used the Nitrites and Leukocyte esterase to reflex a culture. However, if a couple questions were answered Yes (Pregnant or Urological Procedure) or if the patient was less than 18 years, a culture automatically reflexed and microscopic never got tested. 

    As far as microscopics are concerned, we perform them for all Complete Urinalysis orders.

    Hope that helps to think about what you all want to do  

    Thank you,



    ------------------------------
    Jonathan Perry, MLS(ASCP)
    President
    ASCP West Virginia Chapter
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  • 6.  RE: Urinalysis reflex microscopic in Children?

    Posted 8 days ago

    Your  current setup is the best for the patient and the most cost saving protocol without cutting corners. 



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    Josie Corros Supervisor/Lead Med Lab Scientist/MedTechnologist
    Henderson NV
    (702)556-7111
    ------------------------------



  • 7.  RE: Urinalysis reflex microscopic in Children?

    Posted 8 days ago

    Hello,

    Sorry for the delayed response. Here are our criteria for reflexing to culture and specimen volume guideline chart when lab receives less than preferred volume.

     

     

     

    Sandra Jameson, MBA MLS (ASCP) QLS
    Manager Clinical Pathology

    She/Her/Hers

    Children's 
    NEBRASKA
    8200 Dodge Street • Omaha, NE 68114-4113
    402.955.5523 • 402.955.5546 FAX

    sjameson@ChildrensNebraska.org


    ChildrensNebraska.org

     

     

     






  • 8.  RE: Urinalysis reflex microscopic in Children?

    Posted 6 days ago

    My experience is to check the microscopic on all urines.  I had one patient, everything negative on the dip, pale in color and clear.  The doctor persisted on the microscopic.  Respectfully, I complied.  There was a 4+ bacteria.  Going the extra mile for mankind is worth it.



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    Alice Macqueen Perry Technician (MLT, Histologic, Phlebotomy)
    Raleigh NC
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  • 9.  RE: Urinalysis reflex microscopic in Children?

    Posted 5 days ago

    We reflex to micro for all UA unless it is performed as a POC then it is upon provider request.



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    Katherine Garman Supervisor/Lead Med Lab Scientist/MedTechnologist
    Portis KS
    (785)346-6418
    ------------------------------



  • 10.  RE: Urinalysis reflex microscopic in Children?

    Posted 5 days ago
    This is such a great discussion. It has also come to our attention in the Laboratory that even if the dip stick chemistry results for Blood are (Negative) if the Ascorbic acid is greater than >20 it interferes and suppress the red blood cells on Microscopic results. We have started to scan red blood cells under manual microscope. Interesting topic. 





  • 11.  RE: Urinalysis reflex microscopic in Children?

    Posted 5 days ago
    Hello Gifti Kenea,
    You brought up a very interesting discussion case. I remember that our instructor at the internship asked us this question. 
    How can we determine if there is bleeding from the urinary tract or if a drop of blood was accidentally added to the urine sample after it was collected and placed in the container?

    Giorgis Yeabyo (ASCP, HTL)
    ABiTi Consultancy Services (ACS)
    Addis Ababa, Ethiopia





  • 12.  RE: Urinalysis reflex microscopic in Children?

    Posted 4 days ago

    First of all urine samples are collected aseptically. Accidental addition of blood should never happen. If so recollect. If there's bleeding at the urinary tract, doctors  should be able to identify the cause from the rest of the result. 



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    Josie Corros Supervisor/Lead Med Lab Scientist/MedTechnologist
    Henderson NV
    (702)556-7111
    ------------------------------



  • 13.  RE: Urinalysis reflex microscopic in Children?

    Posted 2 days ago

    I suppose this would be more dependent as to where the sample was collected.  Home, ED, acute or collected in the lab.  I would think if blood was accidently dropped in the urine I would suspect it might possibly be visible macroscopically.  Our laboratory has a specific section for urine testing that is not close to blood specimens so it should not occur at the testing phase.  Unless, the performing tech does not display good PPE usage and is possibly careless.  Your question is very good and there are so many variables to answer it.   



    ------------------------------
    Katherine Garman Supervisor/Lead Med Lab Scientist/MedTechnologist
    Portis KS
    (785)346-6418
    ------------------------------



  • 14.  RE: Urinalysis reflex microscopic in Children?

    Posted 5 days ago
    I agree that doing urine microscopic as part of the Urinalysis test is good practice.  Parasites like Giardia, budding yeast, etc. cannot be detected on dipstick. 


    Michele V Inigo, MLS(ASCP)
    Core Lab Supervisor
    Costa Mesa, CA





  • 15.  RE: Urinalysis reflex microscopic in Children?

    Posted 5 days ago

    I agree, Sometimes Microscopy of UA does help for those minor girls, who suspect for some abuse. And Once I have found sperms in a 10 yr old girl who came to ED. Usually in UA we do not report sperms specially for Women. But for minor girls it is very crucial. So I agree to go for some extra miles by looking UA under microscope for stuffs like budding yeast, Cast,Crystal's, or sperms. Nowadays IRIS auto microscopic has done our jobs pretty easy. But it's still worth looking actually under the scope. 



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    Gopi Mehta
    Savannah GA
    912-401-7965
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  • 16.  RE: Urinalysis reflex microscopic in Children?

    Posted 4 days ago
    4+ bacteria will not give you a clear urine ever.
    Sent from my iPhone





  • 17.  RE: Urinalysis reflex microscopic in Children?

    Posted 4 days ago

    Never say never.  You weren't there, you didn't see it.  Don't be judgmental.  How long have you actually done urines?  I have done it 47 years.  I think I have enough experience.  



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    A M Perry MT
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  • 18.  RE: Urinalysis reflex microscopic in Children?

    Posted 4 days ago
    Yes






  • 19.  RE: Urinalysis reflex microscopic in Children?

    Posted 4 days ago

    Hello Alice, I believe you did the right thing in your circumstance. The clinician saw the patient and knew why he or she insisted on the microscopic evaluation of the urine. Your agreement was patient-centered. Regarding urine reflex to microscopy in children, after 30 years on the bench, my opinion is to stick to the standard practice of reflexing any positive dipstix in children just as we would in adults to microscopy. I have not seen any article or research indicating the need to reflex all children's urine dipstix to microscopy irrespective of the urine chemical analysis outcome. Without using the standard criteria, it could amount to waste of resources in a busy laboratory with high volume of urinalysis in their patient population.

    Leke

    Defense Health Agency

     

    Sent from Mail for Windows