ADH-LENZ DIAGNOSTIC LABORATORY

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TABLE OF CONTENTS

INTRODUCTION TO MEDICAL PARASITOLOGY ....................................................... 2

Infections Acquired through the Gastrointestinal Tract ...................................... 2
Stool / Fecal Analysis ........................................................................................ 3
COLLECTING FECAL SPECIMENS............................................................................. 3
STORAGE AND HANDLING ........................................................................................ 4
Specimen Processing ....................................................................................... 5
Fecal Occult Blood............................................................................................. 21
QUALITY ASSURANCE / QUALITY CONTROL .......................................................... 23
REPETITION OF THE TEST......................................................................................... 23
RECORDING / ENCODING OF RESULT .................................................................... 23
WHO STANDARD REPORTING FOR FECALYSIS .................................................... 23
RELEASING ................................................................................................................. 24
CLEANLINESS AND ORDERLINESS WITHIN THE SECTION .................................. 24

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INTRODUCTION TO MEDICAL PARASITOLOGY

PARASITLOGY is the study of parasites and as such does not include bacterial, fungal or viral
parasites. Human parasites are separated into intestinal and blood borne parasites. For a
parasite to be defined as intestinal it must have an intestinal life cycle stage, though it may have
life-cycle stages in the heart, circulation, lung, tissue, other animals or the environment.

Parasites found in the intestines can be categorized into two groups: Protozoa and Helminths.

Protozoa are single called organisms. There are classes of protozoa commonly found in
concentrated faecal samples. They are differentiated by the method of motility. Protozoa
include Entamoeba, Giardia, Trichomonas, Crytosporidium, Isospora, Pnueocystis and
Balantidium. There are two diagnostic life cycle stages commonly seen in parasite, the cyst and
the adult trophozoite stage. The trophozoite stage is analysed directly on a slide without
concentration. Cysts require concentration. The key diagnostic factor is that protozoan cysts
are typically 5-30 microns in diameter, and such are smaller than most Helminth eggs. Due to
the size they are particularly difficult to see under the microscope is the sample clarity is bad.

The medically important helminthes are nematodes (roundworm), cestodes (tapeworms) and
trematodes (flukes). Genera include: Fasciola, Schistosoma, Ascaris, Hookworm, Trichuris,
Taenia, and Enterobius. The normal stage for examination is the egg stage, although larvae
may develop in some organisms (strogyloides). The diameter of the eggs ranges from 30-150
microns.

The other major groupings of parasites are known as blood-borne parasites where they are
transmitted through an arthropod vector. By far the most important arthropod for transmitting
parasitic infections is the mosquitoes. Mosquitoes are known to carry malaria and filarial
nematodes. Different types of biting flies transmit African trypanosomiasis, leishmaniasis and
several kinds of filariasis.

Most protozoan and helminthic infections that are transmitted by arthropods can readily be
diagnosed, on clinical grounds alone, but are usually identified by fairly simple te4chniques
designed to present the presence of the causative parasite by microscopy. Sophisticated
techniques are also being employed including highly sensitive and specific simple monoclonal
antibody tests, DNA probes and PCR primers.

Infections Acquired through the Gastrointestinal Tract

Many of the infections of the gastrointestinal tract (GI) are caused by parasites that are
cosmopolitan in distribution. Protozoa can be directly infectious for man when they are passed
in the feces into the environment, but helminthes require a period of maturation whilst in the soil,
where they become infectious. Others such as Taenia saginata require the involvement of an
intermediate host during their life cycle.

Infections of GI tract account for a high proportion of deaths in infants where the standards of
hygiene and nutrition are low.

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Fecal-oral transmission of the pathogens is the most common mode of GI infections, where
water, food and hands become contaminated with fecal material which then comes in contact
with the mouth.

A number of GO infections can reach epidemic proportions, protozoal pathogen Crytospiridium

parvum, has been known cause the severe water-borne epidemic, even in 1 st world countries
such as the United States and the UK. Other infections such as amoebiasis or enterobiasis can
be more localized, infecting the household or institutions.

Some of the rarer protozoal infections such as the microsporidia are only now being understood
as they are appearing as contaminant infections in people with depressed immune
responsiveness e.g. AIDS.

STOOL / FECAL ANALYSIS (FECALYSIS)

A stool analysis is a series of tests done on a stool (feces) sample to help diagnose certain
affecting the digestive tract. These conditions can include infection such as from parasites,
viruses and bacteria, poor nutrient absorption or cancer.

Collection of Satisfactory Fecal Specimens, Storage and Handling in the Laboratory

I. Collecting Fecal Specimen

A. Criteria for Satisfactory Specimens

1. Size - entire passage, if possible, or at least 20 to 30 grams or about 1 to 2
tablespoonfuls.

2. Contaminants of interfering substances

a. Urine – destroys protozoan trophozoites
b. Water - destroys protozoan trophozoites
c. Dirt – interferes with examinations may introduce free-living organisms that
might be confused with parasites.
d. Compounds
i. Oily laxatives – interfere with examination; oil may cause inaccurate
or ineffective performance of techniques
ii. Bismuth – crystals in feces which interfere with examinations
iii. Barium – abrasive action, which may destroy organisms; interfere with
examinations
iv. Kaolin compounds – abrasive action may affect appearance of
organisms. Wait 7 to 10 days after these compounds have been given
before collecting specimens for parasitologic examinations
v. Antibiotics – cause decrease in numbers of protozoa in intestinal tract.
Wait 1 to 2 weeks after termination of therapy before collecting
specimens.

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3. Time of collection – unpreserved specimens should reach the laboratory within 1

hour after passage; time and date of passage should be recorded on all unpreserved
specimens.

B. Preservatives (Ratio of 1 part of feces to 3 parts of preservatives)

1. Formalin – 5 or 10%. Preserves eggs, larvae, and cysts for wet mount examinations
2. PVA – fixatives (Polyvinyl alcohol-fixatives). Preserves trophozoites and cysts for
subsequent permanent staining.
3. MIF (Merthiolate-iodine-formaldehyde) preserves all stages for wet mount
preparation
4. PAF (phenol-alcohol-formaldehyde) Preserves all stages for wet mount examinations
a. Permanent stains cannot be made from feces preserved in MIF or PAF
solutions; therefore, a portion of the specimen should also be preserved in
PVA-fixative.

C. Number of Normally Passed Specimens to Collect

Because of irregular passages of diagnostic stages, more than 1 specimen may be
necessary to establish a diagnosis, especially in cases of suspected protozoan infections.

II. Storage and Handling

A. Macroscopic Examination
1. Color
2. Consistency: Formed, semi-formed, soft, mucoid, diarrheic, watery (degree of moisture
affects distribution of protozoan stage)
3. Abnormalities Excessive mucus, blood or worms. Visible evidence of interfering
substances such as barium or water

B. Storage
1. Soft or diarrheic specimens can be stored for short periods as follows:
a. In incubator for no longer than ½ to 1 hour – if specimen is very fresh and if
received immediately after passage.
b. At room temperature up to 4 hours

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c. In refrigerator for over 4 hours, but no longer than 24 hours.

2. Formed specimens may be left at room temperature for several hours or in the
refrigerator for several days.
3. Ideally, specimens should be examined as soon as passed or within an hour after
passage.

EVALUATION OF TECHNIQUES FOR EXAMINING FECAL

SPECIMENS AND ESTABLISHMENT OF A LABORATORY ROUTINE
Methods of Examining Feces

Specimen Processing

Stool specimens can be examined fresh or preserved

Examination of fresh specimens permits the observation of motile trophozoites, but this must be
carried out without delay. Liquid (diarrheic) specimens, which are more likely to contain
trophozoites, should be examined within 30 minutes of passage (not within 30 minutes of arrival
in the laboratory), and soft specimens, which may contain both trophozoites and cysts, should
be examined within one hour of passage. If delays cannot be avoided, the specimen should be
preserved to avoid disintegration of the trophozoites. Formed specimens less likely to contain
trophozoites can be kept up to one day, with overnight refrigeration if needed, prior to
examination.

A. DIRECT WET MOUNTS (ALL DIAGNOSTIC STAGES)

1. Use 3x2 inch slides and 22mm sq., #1 thickness cover slips
2. Density important. Fine print should be distinct through layer of suspension. Does not
use too much dilute. Saline and iodine mounts are routinely prepared.
3. Examine saline mount systematically and completely with low power (10 x objectives).
Use high, dry and oil immersion magnifications for more detailed observation.
4. Solution:
a. Saline – all diagnostic stages
b. Iodine – cyst. Use approximately 1% iodine solutions such as Dobell’s, D’Antoni’s
or a 1:5 dilution of Lugol’s

Wet Mount Preparation

Before preparing a wet mount slide, the microscope should be calibrated. The objective and
oculars used for the calibration procedure should be used for all measurements on the
microscope. The calibration factors should always be posted on the side of the microscope.

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Protozoan trophozoites, cysts, oocysts, and Helminth eggs and larvae may be seen and
identified using a wet mount identification technique. To prepare a wet mount, obtain a
microscope slide and the stool specimen. Take a small amount of the specimen and place it on
a microscope slide. If the stool specimen is still somewhat solid, add a drop or two of saline to
the specimen and mix. Ideally, two smears can be prepared can be prepared on one slide, of
which one can be stained with iodine. Thickness of the wet mount should be as the image below
illustrates.

I desire the coverslip(s) can be sealed. A preparation of petroleum jelly and paraffin in a 1:1
ration can be applied with a cotton tip swab as illustrated. It must be heated to approximately
7˚C to both mix and use. Sealing the coverslip keeps organisms from moving when using oil
immersion objectives and prevents the preparation form drying out. To seal, secure the four
corners by placing a drop of hot sealant to anchor the coverslip. Spread a thin layer aroung the
edges. Other suitable sealing preparations can be used if desired.

Systematically scan the entire coverslip area using the 10x objective as illustrated. If something
suspicious is seen, a higher magnification may be necessary.

CAUTION: Bringing high power objectives too near the edges of the slide will result in the
sealant smearing the objective and interfering with the optics.

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B. KATO THICH SMEAR TECHNIQUE (Cellophane Thick Smear)

Materials:
Cellophane cut into 1”x1” squares are soaked in glycerine-malachite green solution for
24 hours before use.

The formula for the glycerine malachite green solution is as follows:

Distilled water ............................................. 500 ml
Glycerine ..................................................... 500 ml
3% malachite green solution in water ........... 5 ml
The cellophane thus treated turns green and protects the eyes from the strong light
during microscopic examination. Glycerine in the mixture provides a clearer
differentiation of the egg.

Procedure:
1. Place approximately 50 to 60 mg of stool (the size of 2 mongo beans) at the center
of a glass slide and cover with a square piece of penetrated cellophane.
2. With the aid of a rubber stopper (about ¾ inch in diameter), press the cellophane
gently in order to spread the stool specimen evenly, taking care that the specimen
does not spread beyond the cellophane cover. The cellophane thus serves as a
cover slip.
3. Leave the prepared slide at room temperature for 10 to 20 minutes. During this time,
the microscopic field becomes clear due to the action of glycerine on the stool
constituents.
4. The slide should be examined after 10 to 20 minutes or within one hour after
preparation. Allowing the slides to stand for a long period of time will cause drying
and shells of hookworm ova will become too transparent and will be difficult to see.

Advantages:
 Time saving, simple and economical
 Adapted to mass examination
 Satisfactory for all common type of helminthes eggs.

Disadvantages:
 Unsuitable for diarrheic stools.
 In some stools (especially infants) fermentation gas is troublesome.
 Cannot be used to diagnose protozoan cyst and trophozoites.

Note: Green cellophane is often used and the malachite green omitted for the
preparation if the glycerine solution

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Suggestions for differentiating Trophozoites if Entamoeba histolytica and Entamoeba

coli and for differentiation Amoeba and Artifacts.

Entamoeba histolytica and Entamoeba coli trophozoites

When typical, “textbook” Entamoeba trophozoites are found in fecal preparations, species
differentiation is not usually a problem. Trophozoites (with appropriate nuclear morphology)
containing red blood cells are readily identified as E.histolytica; those with coarse cytoplasm,
ingested bacteria, and irregular nuclei are usually called E. coli. However, morphology may
be atypical and characteristics of E.histolytica and E.coli may overlap. It is there organisms
which cause the diagnostic problems.

Differentiation of these species is frequently difficult and requires careful study of several
organisms. Both cytpoplasmic and nuclear characteristics must be considered.
a. Typical E.histolytica trophozoites have even, uniform peripheral chromatin in the
nucleus and a small, distinct central karyosome. The cytoplasm is finely granular
and delicate in appearance. However, the following variations may occur:
i. The karyosome may be eccentric. In trophozoites form chronic or
asymptomatic infection, eccentric karyosome may be present in one-third
of the organisms. It is usually small and discrete, however, regardless of
position.
ii. The peripheral chromatin occasionally appears uneven, especially in
permanent stains, although rarely as in E.coli. In old specimen (those left
standing at room temperature for several hours), the cytoplasm of
E.histolytica may become vacuolated, resembling that of E.coli. Bacteria
are sometimes ingested also.

b. Typical E.coli trophozoites have uneven, irregular peripheral chromatin in the

nucleus and an eccentric karyosome. The karyosome is small in comparison with
that if E.nana or I.butschlii, but is slightly larger than the karyosome of
e.histolytica. The cytoplasm is usually coarse, frequently vacuolated and may
contain ingested bacteria, yeast, or mold. Like E.histolytica, morphologic
variations can occur, particularly in the nucleus. The karyosome may be central
or at least, appear so, and the peripheral nuclear chromatin may be more or less
regular. In other words, the nucleus resembles that of E.histolyica.

c. Therefore, since these variations can and do occur, the microscopist should not
rely in a single feature for species identification. Rather, a combination of
characteristics should be used and species determination be based on a
composite picture form several organism.

In preparation where most of the trophozoites are more or less typical

E.histolytica, if a few with eccentric karyosome or uneven peripheral chromatin
are found, the microscopist should be very cautious in identifying these. There is
a good chance of that they are atypical E.histolytica and not E.coli. The same
caution should be exercised in cases where most of the organisms are
characteristically E.coli and an occasional one resembles E.histolytica. Usually,
however, even if the nucleus of E.histolytica is atypical, the cytoplasm is fine
granular. Conversely, when the E.coli nucleus resembles that of E.histolytica,

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the cytoplasm is usually typically coarse and rough. Although this suggests that
the cytpoplasmic morphology may be more reliable than nuclear morphology, we

can’t really say this; nevertheless, close observation of the cytoplasm may help in
speciation. However, the cytoplasm of E.histolytica can resemble that of E.coli
especially in old specimens; so again, caution should prevail. Nevertheless, it is
rare to find an E.histolytica trophozoite, or an E.coli trophozoite, with both
atypical nuclear and cytpoplasmic appearance; usually it is one or the other.
E.coli tends to stain heavier and darker that E.histolytica but variations occur
from smear to smear and with the degree of staining. In general, however, E.coli
is coarser in appearance than E.histolytica and this may aid in identification.

d. Because of the overlapping characteristics, it is impossible to set up clearly

defined criteria for speciation, nut it is well to remember that a given organism
may be tentatively identified by the company it keeps.

Amoeba and Artifacts

Artifacts such as pus cells, macrophages, epithelial cells, yeasts, molds and other plant cells are
often confused with amoebae cysts and trophozoites, especially in permanent stains.

One of the most common confusions is pus cells and cysts. The nuclei of the wbc appear as
“ringed” structures similar to those of Entamoeba species. They usually stain very distinctly and
“stand-out” as the microscopist scans the smear. The cytoplasm of the pus cells, however, is
quite different from that of the cysts. It is frequently fragmented and appears pale and “washed-
out”.

Often the whole structure seems to consist mostly of nuclei. Furthermore, the cell membrane is
indistinct. The amoeba cyst is usually more distinctive in appearance with a well-defined cell
membrane.

Macrophages and epithelia cells are sometimes confused with trophozoites. The key to
differentiation here is the nucleus. In general, the nuclei of macrophages and epithelial cells are
larger in comparison to the overall size of the cell that in the amoeba and they may differ
somewhat in appearance for amoebae nuclei.

Plant cells often have thicker cell walls than amoeba and careful observation may reveal
differences in internal structures between these two.

The microscopist should be cautious in identifying objects as amoeba unless the morphologic
features are sufficiently distinctive to be sure they for the criteria for a protozoan. When
something “looks like an amoeba”, but somehow doesn’t “quite fit”, it is probably an artefact. At
least, a definitive diagnosis should not be made unless more characteristics organisms are
found. Perhaps it would be wise to follow the advice “when in doubt, leave it out.”

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COMPARISON OF FECAL EXAMINATION TECHNIQUES

TECHNIQUE ADVANTAGES DISADVANTAGES

Direct Smear  Quick to prepare.  Can miss parasite if
 No distortion of parasites if concentration is too low or if too
isotonic saline is used as much debris or fat is present.
diluents.  Sand seeds or other fecal debris
 Only way to see live trophozoites can make apposition of coverslip
(isotonic saline must be used as into slide difficult
the diluents)  May take a long time to examine.
 Useful for examining feces of
small birds and reptiles (where
trematodes eggs are common).
Saturated  Procedure floats the most  Procedure will not float
Sucrose or Salt common Helminth ova and trematodes ova and some
coccidian oocyst. tapeworm (psuedophyllidian)
 Solutions are expensive ova.
 There is little debris to obscure  Time consuming if centrifugation
the view of the parasite no performed
 Unsuitable for fatty stool
samples.
Zinc Sulfate  Recommended procedure for  Procedure will not float some
Flotation most fecal exams trematodes ova, and some
 Procedure floats most Helminth tapeworm (psuedophyllidian)
eggs. ova.
 Best method for protozoan cysts,  Unsuitable for fatty stool
especially Giardia samples.
 There is little debris to obscure  ZnSO4 is expensive and
view of parasites. hydrometer should be used to
make up the solution.
Ethyl Acetate  Procedure recovers ALL types of  It is more difficult to perform than
Sedimentation Helminth ova, larvae and most other techniques
protozoan cysts.  Ethyl acetate is flammable and
 It is the best technique for expensive
formalin fixed samples and for  There is more debris in
stools with high fat content. preparation preps than in
flotation preps – therefore it will
take longer to read.

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DIRECT MICROSCOPY vs. CONCENTRATION TECHNIQUE

TECHNIQUE ADVANTAGES DISADVANTAGES

Direct Useful for the observation of motile May not detect ova, cysts and
Microscopy protozoan trophozoites and the larvae which are present in scant
examination of cellular exudates numbers.
Concentration Maximises the numbers of Destroys stages and distorts
Techniques organisms detected which may be cellular exudates.
too scanty to be seen by direct
microscopy alone.

MACROSCOPIC CONSISTENCY

CONSISTENCY CODE NSS IODINE KATO-THICK

Formed F Yes No Yes
Semi-formed SF Yes No Yes
Soft S Yes No Yes
Mucoid Muc Yes Yes No
Diarrheic D Yes Yes No
Watery W Yes Yes No

MACROSCOPIC STOOL CHARACTERISTICS

COLOR / APPEARANCE POSSIBLE CAUSE

Black Upper gastrointestinal bleeding
Iron therapy
Charcoal
Red Lower gastrointestinal bleeding
Beets and food coloring
Rifampicin
Pale Yellow, white, gray Bile-duct obstruction
Barium sulphate
Green Biliverdin / oral antibiotics
Green vegetables
Bulky / frothy Bile-duct obstruction
Pancreatic obstruction
Ribbon-like Intestinal constriction
Mucus / blood-streaked Colitis
mucus Dysentery
Malignancy
Constipation

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Normal Values
 The stool appears brown, soft and well-formed consistency.
 The stool does not contain blood, mucus, pus, bacteria, viruses, fungi or parasite.
 The stool is shaped like a tube.
 The pH of the stool is about 6.
 The stool contains less than 2mg / gram of sugar called reducing factors.

Abnormal Values
 High levels of fat in the stool may be caused by disease such as pancreatitis, sprue
(celiac disease), cystic fibrosis or other disorders that affect the absorption of fats.
 The presence of undigested meat fibers in the stool may be caused by pancreatitis.
 A pH greater than 6.8 may be caused by poor absorption of carbohydrate or fat and
problems with the mount of bile in the digestive tract. Stool with pH less than 5.3 may
indicate poor absorption of sugars.
 Blood in the stool may be caused by bleeding in the digestive tract.
 White blood cells in the stool may caused by bacterial diarrhea. A specific organism may
be identified.
 Rotaviruses are common cause of diarrhea in young children. If diarrhea is present,
testing may be done to look for rotaviruses in the stool.
 High levels of reducing factors in the stool may indicate a problem digesting some
sugars such as sucrose and lactose.
 Low levels of reducing factors may be caused by sprue (celiac disease, cystic fibrosis or
malnutrition). Medicine such as colchicines (for gout) or birth control pills may also cause
low levels.

Safety
Medical Technologist working with stool specimens face potential risk including ingestion of
eggs or cysts, skin penetration by infective larvae and infection by non-parasitic agents found in
stool and biologic fluids. These risks can be minimized by adopting universal precaution as well
as standard microbiological laboratory practices, such as:
 Wear protective safety glasses, gloves and laboratory coat when processing specimens.
 Use biological safety cabinets as needed.
 Do not eat, drink, smoke, apply cosmetics or manipulate contact lens in working areas.
 Decontaminate work surface at least once a day and after any spill of potentially
infectious materials.
 If you have cuts or abrasions on the skin of your hands, cover them with adhesive
dressing.
 If you use any sharp instruments, dispose them in a “sharps” container for
decontamination.
 Remove gloves and wash your hands after completing any task involving the handling of
fecal material.

Note:
These precautions should be taken even stool specimens that have been fixed in preservatives
because they may still be infectious. For example, fixation in formalin takes days or weeks to kill
some parasitic cysts or oocyst that are protected by a thick shell. Eggs of Ascaris lumbricoides
may continue to develop and are infectious even when preserved in formalin.

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FECAL OCCULT BLOOD TEST

Discussion

The occult blood test is a rapid, convenient and virtually odourless qualitative method for
detecting faecal occult blood. Occult is a word meaning “hidden”. Blood can be present in a
stool sample, but due to the digestive process, will not retain its bright red color. The occult
blood tests detect excess blood loss which may have significance when related to certain
diseases such as colorectal cancer. A positive test usually indicates blood in excess of normal
and should be followed up medically. A negative test usually indicates that no blood, in excess
of normal, is apparent in the fecal specimen tested. The accuracy of the test depends upon the
status of the patient at the time specimen is taken and may be affected by interfering
substances.

The occult blood is recommended for use as a diagnostic aid during routine physical
examination, when hospital patients are first admitted, to monitor for bleeding in patients
recuperating from surgery and other conditions and in screening programs for colorectal cancer.
It is not a test for colorectal cancer or any other specific disease. It is used as a qualitative aid
to the diagnosis of various gastrointestinal conditions which manifest themselves by the
presence of fecal occult blood,

Principle of the Test

The test consist of a special guaiac impregnates paper. A smear from a stool sample is applied
to one side of the paper, the paper is turned over and a special developer is added. The
developer will react with haemoglobin released form lysed red blood cells resulting in the
formation of blue color if blood is present. The test reaction is based on the oxidation of guaia
by hydrogen peroxide to a blue-colored compound. Haemoglobin, if present in the fecal
specimen, acts as a pseudo-peroxidase material. It catalyzes the oxidation of alpha guaiaconic
(active component of guaiac paper by hydrogen peroxide – active component of the developer)
to form a highly conjugated blue quinine compound. Appearance of any blue color on the
specimen area of the slide is an indication of the presence of occult blood.

Patient Preparation

If possible, the patient should be placed on the meat-free low-peroxidase diet to reduce the
possibility of false positive indications. The special diet should be started two days before
testing and continued through the testing period. Such a diet may help reduce the number of
false positive results. It also provides roughage that may help uncover silent lesions which may
bleed intermittently and may increase the rate of true positive reactions. The recommended diet
will also increase the likelihood of soft stool greater ease in obtaining fecal samples by wiping.

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Suggested Diet

Avoid
 Red or rare meat, and the following raw vegetables and fruits: broccoli, turnips,
horseradish, cauliflower, red radish, parsnips and cantaloupe
 Vitamin in excess of 250mg per day.
 Aspirin and anti-inflammatory drugs which may cause gastrointestinal irritation for 7 days
prior to and during the test period.
 No iron supplements

Try to Eat
 Cooked vegetables and fruits, especially lettuce, spinach and corn
 Prunes, grapes, plums, and apples, well-cooked fowl and canned tuna fish
 Peanuts, popcorn and bran cereals.

If any of the above dietary restrictions and recommendations are known to cause discomfort,
patients should be instructed to inform their physician. The patient should always consult the
physician before discontinuing or interrupting any prescription medication.

Specimen Collection

The specimen required is a small stool sample which should be applied as a very thin smear
onto both windows of the slide. Slides may be developed immediately after the specimen
application or may be stored and developed up to 8 days after specimen application. Once they
have been prepared with a specimen, keep the slides away from heat and light. The work area
should be kept clear and free of blood to avoid accidental contact of blood with the slides.

Patients experiencing hemorrhoidal bleeding, menstrual period, or bleeding from the nose,
gums etc. should delay testing for at least 48 hours form the time that all such bleeding has
stopped. To increase the chances of detecting intermittent gastrointestinal bleeding, it is
recommended that stool samples be collected from three consecutive bowel movements and
that two smears are made from different areas of each bowel movement, especially from
darkened or discoloured areas of the feces. Excessive GI bleeding may result in black, tarry
stools.

Procedure
1. Write the patient information for the front flap of the slide onto your report form.
2. Turn the slide over and open the flap to expose the test area.
3. Collect small specimen on applicator stick. Apply thin smear in box 1. Re use applicator
stick to obtain another sample from different part of the stool. Apply thin smear in box 2.
4. To develop the smears place 2 drops of hemascreen developer over each smear. Wait
30 seconds and read results within 2 minutes.

Interpretation of Result

Blue Color: POSITIVE No Change: NEGATIVE

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ADH-LENZ DIAGNOSTIC LABORATORY
Revision Number: 2nd Edition
Date Revised: February 2017
Date Printed:

QUALITY ASSURANCE / QUALITY CONTROL

Quality Assurance (QA)

Refers to the overall process of guaranteeing quality patient care. Essentially, QA is the continual
monitoring of the entire test process from the test ordering and specimen collection through
reporting and interpreting results.

Quality Control (QC)

Refers to the materials, procedure and techniques that monitor the accuracy, precision and
reliability of the laboratory test. It is performed to ensure that acceptable standard are being met
during the process of patient testing.
ANALYTICAL ERRORS
1. Random Errors
These are brought babout by accidentally and indeterminate errors with no trends or means of
predicting it.
2. Systematic Errors
Determinate errors which occur regularly and are measurable when recognized.

REPETITION OF THE TEST

Repetition of analysis on the same sample should be performed in case the requesting physician has
doubts on the results reported.

Repeat collection whenever the sample is contaminated and or the specimen is not properly collected
depending in the request.

RECORDING / ENCODING OF RESULTS

 The result should be encoded on the specific test result form
 All laboratory request should be recorded on the general logbook for further evaluation and
record keeping in the laboratory
 Patients’ result of each examination must be recorded in the designated logbook with complete
name, case number, age and gender.

WHO STANDARD OF REPORTING

Occasional 1 – 2 ova or cyst / smear

Few 3 – 5 ova or cyst / smear

Moderate 6 – 12 ova or cyst / smear

Many > 12 ova or cyst / smear

Negative “No ova of intestinal parasite found”

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ADH-LENZ DIAGNOSTIC LABORATORY
Revision Number: 2nd Edition
Date Revised: February 2017
Date Printed:

RELEASING
 Results are properly checked before releasing to the different wards.
 All the results should be signed by the laboratory staff who performed the test together with the
pathologist.

CLEANILINESS AND ORDERLINESS WITHIN THE SECTION

 Always see to it that all things and materials are back in their proper places and order.
 All reagents must be kept in their proper places when not in use
 Observe cleanliness before leaving the area.

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