2. The Johns Hopkins Hospital May 2010 Iris Microscopic Training Module

3. Introduction of Presenters Kathleen Lewis The Johns Hopkins Hospital Hematology Division Lead MT (ASCP) CM Elsbeth Markie The Johns Hopkins Hospital Hematology Division MT (ASCP) CM

4. Why have a refresher lecture?  Review of Standard Operating Procedure.  Enhance the efficiency and workflow in the UA area.  Reflection of observed data.  Update competency protocol.

5. Course Objectives  Correlating UA Chemistry results with the Microscopic Analysis  Identifying key elements in a UA sample  Microscopic Confirmations

6. Urine Work Flow What should be the procedure for analysis of a UA sample once it is received in the UA area?  Prioritize your UA samples.  Check color & clarity (clearest to cloudy).  Uncap your samples.  Place on the AX-4280. Note: Turbid samples can be run on the AX-4280 ONLY! You must dilute samples for the IQ200.  If sample is turbid, then remove the sample to dilute before analysis on the IQ200.  Complete analysis and wand the specimen to confirm verification. **** No further testing can be performed (by Chemistry, etc) once the specimen has been analyzed on the iQ200.****

7. Correlating the Data AX-4280 & IQ200 What do you expect to see microscopically with the following positive chemistry dipstick results: Protein pH Blood Nitrite Leukocytes Note: Take a minute to analyze the following dipstick results.

8. Dipstick Results #1

9. Dipstick Results #1 – Expected Microscopic Findings RBC - Yes WBC - Yes Bacteria - Yes Casts – Possibly Crystals – Possibly

10. Dipstick Results #2

11. Dipstick Results #2 – Expected Microscopic Findings Casts – Very Likely Crystals – Possibly

12. Correlating the Data AX-4280 & IQ200 What do you expect to see with the following positive chemistry dipstick results: Protein - casts, rbc, mucus, NSE’s pH - crystals Blood – rbc (exception = hemolysis) Nitrite – bacteria Leukocytes - wbc

13. Microscopic Analysis Name that particle!

14. Microscopic Analysis Particle Recognition NOTE: Image size during microscopic analysis includes the entire box (square) that the image is displayed in.

15. Microscopic Analysis Particle Recognition

22. Common Errors During Microscopic Analysis Bacteria misIDs Amorphous Budding yeast Sperm Mucous UNCL misses NSEs Casts (cellular) Budding and hyphenated yeast Bacteria Trichomonas Crystals RBC misIDs Calcium Oxalate Other crystals Artifacts WBC misIDs Trichomonas Artifacts

23. Common Errors During Microscopic Analysis

24. Are these particle truly rbcs?

25. Common Errors During Microscopic Analysis

30. Microscopic Analysis – Good Examples

38. Microscopic Confirmation Confirm the following by manual microscopy: Yeast Sperm Cellular casts Trichomonas Any questionable particles

39. Plan of Action – UA Bench  Annual Competency – Updates  Mandatory review of this lecture by new hires and students

40. Questions/Comments/Concerns

41. Copyright All rights reserved. No part of this presentation may be reproduced in any form or by any electronic or mechanical means, including information storage and retrieval systems, without permission in writing from the publisher, except by a reviewer who may quote brief passages in a review. This is a EM & KL Production 2009.

42. CEU Contact Hours JHH Pathology Dept UA Training Module 2010 Hematology Division