Urinalysis with Reflexed Culture and Microscopic Exam
Label Mnemonic: UAR, UARM and URCXR
Epic Lab Code: LAB8379
(see Comments for further details)
Downtime Form: A-1a General Laboratory Requisition
Hematology and Microbiology
Hematology: 6240 RCP
Microbiology: BT 6004
Hematology: 356-3527
Microbiology: 356-2591
Specimen(s):
Specimen Instructions:
[1] Transport to the microbiology laboratory immediately. Samples in Gray Top C&S tubes may be stored at room temperature. Refrigerate urine samples not in Gray Top tubes. Specimens should be delivered to the lab as soon as possible and may be rejected if not received within 24 hours of collection.

[2] Gray top C&S tubes are not acceptable for urinalysis and urine chemistries because the preservative interferes with testing. This includes Epic LAB1160, LAB1164 and other urine tests that are incompatible with tube preservatives.
Collection Medium:
or or
Yellow top round bottom tube (no additive) UA - C&S Collection Kit Sterile Container
Minimum:
URINALYSIS:
Collect in Random Urine Yellow Top, round bottom tube (no additive).

URINE CULTURE:
[1] UA - C&S Collection kit is preferred and is available from Hospital Stores (#91900 for clean catch urines and #91901 for Foley catheters). Transfer urine to a Gray Top C&S urine container -- tubes must be filled to 3 mL to prevent inhibition of bacterial growth.

[2] If unable to fill the Gray Top C&S tube, send any volume in the sterile container from the C&S kit or in a sterile specimen container (Hospital Stores #37777).
Rejection Criteria:
Sample will be unacceptable for future add-on requests for Drugs of Abuse or pregnancy screen testing.
Delivery Instructions:
Deliver to laboratory immediately after collection.
Testing Schedule:
24 hrs/day, 7 days a week, including holidays.
Turn Around Time:
1 hour (upon receipt in laboratory) for urinalysis

Urine culture (if performed) turnaround time dependent on bacterial growth, typically 24-48 hours.
Reference Range:
Specific gravity: 1.001-1.029; pH: 5.0-9.0, Dipstick negative for protein, blood, bilirubin, urobilinogen, ketones, glucose, leukocyte esterase and nitrite.
Comments:
Order:
LAB8148 for Urinalysis with Reflex Culture
LAB8149 for Microscopic Exam
LAB8116 for Urine Culture Reflex

NOTE:
[1] Culture cannot be performed as an add-on test to urinalysis. Send separate samples for urinalysis (Random Urine Yellow Top, conical bottom tube (no additive)) and culture (as above).

[2] See "Microbiology Specimen Collection and Transport" and individual test descriptions in the Pathology Lab Handbook (links above).

[3] STAT Microbiology requests are not accepted for this specimen type.

UIHC's reflex culture algorithm is designed to cancel cultures if nitrite and leukocyte esterase are negative and the microscopic WBC count is less than 3 WBC per high-power field. Combinations of test outcomes and whether they generate a reflex urine culture are summarized below.

Nitrite/Leukocyte Esterase/Microscopic WBC
-/-/less than 3 --> reflexively cancel culture
+/-/less than 3 --> reflex to culture
ANY/+/ANY --> reflex to culture
ANY/ANY/>=3 --> reflex to culture
Methodology:
Reflectance Spectrophotometry
CPT Code:
81003