[Urinalysis] Sperm

                                          Image by Cooldesign, from FreeDigitalPhotos.net

When we take a look at urine under the microscope, there are things we tend to look for. Most of them seem pretty clear cut on why they are reportable - they are signs of infection or conditions that the doctors can then treat. Bacteria, and WBC are both obvious signs of urinary tract infections; yeast signal a yeast infection. White cells casts can predict pyelonephritis, and red cell casts glomerulonephritis.

 But what about sperm?

Shouldn't sperm be something we see in every male midstream sample?

Nope.

Spermatozoa are only normal if the sample isn't midstream, AND the patient has had sexual activity within five hours of collection. As collection protocol for urinalysis is midstream, we should not expect to see sperm in sample.

Sperm is seen in midstream urine when the bladder sphincter fails to produce the usual tightening before ejaculation. The sperm then travel into the bladder instead of out of the body, and are excreted during urination. This condition is called retrograde ejaculation, and can be due to nerve damage, diabetes, medication side effect, post bladder/prostate surgery, or weak muscle condition. This is one of the more common causes of male infertility, and can be treated.

Another reason sperm may be seen in male patients' urine is prostatitis. When the prostate is swollen with fluid, it can block off the paths that sperm would normally travel, causing a redirect. This can be due to prostate cancer, recent surgery, bacterial infection of the prostate or urinary system, or arousal without ejaculation. Sometimes this is also seen when methods to avoid mess are used in sexual expression; the interference (or application of Hughes Method) to prevent ejaculation can cause backflow into the bladder. Unless other symptoms are present, treatment is generally unnecessary.

Reporting sperm in male urine can be a real clue to infertility patients

.What about females and children though? You should never see sperm in a child's urine. If you do, you must report it; that child could be sexually abused. I would advise confirming with a second sample if you can, to ensure there are no mistakes. Know that you cannot be sued for bringing this to your hospitals' attention so they can follow up; this is part of your duty to report as a technologist. In one case, the parents attempted to sue, but failed. Seeing sperm in an adult female's sample is a non-clinical finding.

[Hot Topic] CBS Blood Donation Policy, Update

Last year, the big news was Canadian Blood Service's attitude change towards accepting blood donations from gay men. Previously completely banned, gay men can now donate blood if they have had no same sex sexual activity for the past five years.

This is a huge step for Canadian Blood Services.

Last year, they had still not quite ironed out how this change would echo through the rest of their policies.

For instance, what about women who had had sex, even once, with a man who had had a male sexual experience? Up until last May, they were also still excluded from giving blood. Even last May, when I called and spoke with a CBS associated nurse, they were still excluding those women from giving blood, as they "just didn't know" how things would play out.

I called back this year and clarified. Now the question for women has been changed from

"Are you a woman, who has had, even once, had sex with a man, who has had sex with a man?" 

to,

"Are you a woman, who has had sex with a man, who has had sex with a man, in the last five years?"

I.e. if the same sex sexual experience took place greater than five years ago, then you can donate.

This is particularly applicable for bisexual men and women, or partner's of those who "experimented" in college. Previously, if they were aware of their partner's past, they would have been permanently deferred. Now, if it has been more than five years since the MSM encounter, women are eligible to donate again.

As always, if you have questions about your eligibility to donate blood in BC, call the donor line at 1888- 2DONATE, and ask for the nurseline. They will be able to help address concerns about whether you are a good fit for a donor.

CBS continues to collect data to see if it can relax it's deferral policies in the manner any further.

It will likely be at least ten years of data collection though before we see any more change. One step at a time though is all we can do.

Hopefully, the screening process will continue to move more towards an actual sexual-risk based policy based on number/frequency of sexual partners rather than the sexual orientation of the donor.

[Acronym of the Day]: DAP

Acronyms are certainly part any workplace's jargon; the lab is no different in that respect.

One of the more important ones to know about is DAP.

What is DAP, and what does it do? The Diagnostic Accreditation Program, according to the DAP website:

"sets accreditation standards for best practices that are evidence based, outcome focused and aligned to the principles of continuous quality improvement. The accreditation standards are comprehensive and address medical, technical, and management aspects of service delivery."


Since 1971, each facility in British Columbia that performs laboratory testing must be DAP reviewed, public or private.

What this boils down to is every four years, an outside team of your profession/stakeholders comes in and goes over your work with a fine toothed comb to ensure you are meeting standards in patient care, quality, and safety. It sets an external standard of trust in the system, and encourages vigilance in maintaining current methods, up to date safety procedures, and overall evidence based best practice.

DAP also produces a line of external quality control samples, or blind controls, to ensure your results are accurate. They are released quarterly, and laboratories that do not meet standards are held accountable.

The DAP is headed by some of the top minds in each discipline in the province; there are representatives from the management, educational and the vocational views on each board. They in turn supervise DAP teams, each formed depending on the facility and disciplines necessary in review.

If you have a chance to participate in a DAP review of another facility, take it; it's a great way to learn from the ground up.

New in Serum Osmolality: Zander's Formula

Serum Osmolality and OGAP... two of the formulae chemistry techs can do in their sleep. We all know the standard textbook Worthley et al equations;

Serum Osmolality (all in mmol/L):

2 Sodium + Urea + Glucose + 1.2 Blood Alcohol

Osmolar Gap  

Measured Osmolality - Calculated Osmolality

To make it easier for doctors or nurses without a lab handy, many websites/apps are even set up to do the math, with the reference ranges and criticals on the side. We've used the same formula for more than twenty-five years.

Last year, 2013, Zander's Formula was released as a "better, more useful calculation" for osmolality.

Zander's Osmolality (all in mmol/L): 

(Sodium + Urea + Glucose + Potassium + Bicarbonate + Lactate +6.5)x0.985

How is it better? Not only does it show a much better correlation between calculated and measured, it also has the closest 95% limits of agreement, when compared to 36 other possible formulae, (including the Worthley.) 

This new formula also only uses analytes commonly found on a blood gas analyzer panel. This will enable, in the future, a calculated osmolar gap to be added on automatically to trauma panels, giving the clinician one more piece of the puzzle in differentiating metabolic acidosis.

This is important because with such improved accuracy of OGAP, we would reduce the necessity for follow up methanol or ethylene glycol testing on many of our trauma patients who present with elevated gaps due to renal failure/shock/lactic acidosis, thus speeding diagnosis. (Remember though, the measured osmolality MUST be done by freezing point method if looking for any types of alcohol, as vapour pressure methods don't detect volatile solutes such as ethanol/methanol)

That said, Zander's is built to be used broadly; it doesn't include ethanol contribution as a matter of course; you would have to add the 1.2(ALC) yourself, to rule out/confirm any gap being due to ethanol rather than methanol, mannitol, or any of the other usual suspects. Depending on your population and preferred use, it could do with some tweaking.