ﻭﺯﺍﺭﺓ ﺍﻟﺻﺣﺔ ﺩﺍﺋﺭﺓ ﺻﺣﺔ ﻣﺣﺎﻓﻅﺔ ﺍﻷﻧﺑﺎﺭ ﻣﺩﻳﺭﻳﺔ ﻣﺳﺗﺷﻔﻰ ﺍﻟﻔﻠﻭﺟﺔ ﻟﻠﻧﺳﺎﺋﻳﺔ ﻭﺍﻷﻁﻔﺎﻝ ﺷﻌﺑﺔ ﺍﻟﻣﺧﺗﺑﺭﺍﺕ
ﻲ ﻣﻮﺟﺰ ﻓﻲ : ﺗﻘﺮﻳﺮ ﻋﻤﻠ ّ
ﺟﻣﻊ ﻭﺗﺭﺗﻳﺏ : ﺍﻟﺑﻛﺗﺭﻳﻭﻟﻭﺟﻲ ﺃﻗﺩﻡ /ﻋﺎﺷﻭﺭ ﺭﻳﺎﺽ ﻛﺎﻣﻝ ﺍﻟﻧﻌﻳﻣـﻲ E. mail : ashooralneami@yahoo.com
April
2005
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ﻭﺯﺍﺭﺓ ﺍﻟﺻﺣﺔ ﺩﺍﺋﺭﺓ ﺻﺣﺔ ﻣﺣﺎﻓﻅﺔ ﺍﻷﻧﺑﺎﺭ ﻣﺩﻳﺭﻳﺔ ﻣﺳﺗﺷﻔﻰ ﺍﻟﻔﻠﻭﺟﺔ ﻟﻠﻧﺳﺎﺋﻳﺔ ﻭﺍﻷﻁﻔﺎﻝ ﺷﻌﺑﺔ ﺍﻟﻣﺧﺗﺑﺭﺍﺕ ﻲ ﻣﻭﺟﺯ ﻓﻲ : ﺗﻘﺭﻳ ﺭ ﻋﻣﻠ ّ
ﺟﻣﻊ ﻭﺗﺭﺗﻳﺏ : ﺍﻟﺑﻛﺗﺭﻳﻭﻟﻭﺟﻲ ﺃﻗﺩﻡ /ﻋﺎﺷﻭﺭ ﺭﻳﺎﺽ ﻛﺎﻣﻝ ﺍﻟﻧﻌﻳﻣـﻲ E. Mail: ashooralneami@yahoo.com
April 2005
ﺍﻟﺗﺣﻠﻳــﻼﺕ ﺍﻟﻣﺭﺿﻳـــﺔ -:
ﺃﻭﻻً :ﺍﻟﺗﺣﻠﻳﻝ ﺍﻟﻌﺎﻡ ﻟﻺﺩﺭﺍﺭ ): General Urine Examination (G.U.E. ﻭﻳﺗﻡ ﺃﺧﺫ ﺍﻟﻌﻳﻧﺔ Sampleﻣ�ﻥ ﺍﻟﻣ�ﺭﻳﺽ ﺑﺄﻭﻋﻳ�ﺔ ﺃﻭ ﺃﻧﺎﺑﻳ�ﺏ Tubesﻧﻅﻳﻔ�ﺔ ﻭﺟﺎﻓ�ﺔ ،ﻭﻳﻔﺿّ�ﻝ ﺇﺗﻣ�ﺎﻡ ﺍﻟﺗﺣﻠﻳﻝ ﻣﺑﺎﺷﺭﺓ ﺧﻭﻓﺎ ﻣﻥ ﺗﻠﻑ ﺍﻟﻌﻳﻧﺔ ﺑﻌﺩ ﻓﺗﺭﺓ ﻗﺻﻳﺭﺓ .ﻳﺗﻡ ﺑﻌﺩ ﺫﻟﻙ ﻓﺣﺹ ﺍﻟﺗﺎﻟﻲ : .1ﺍﻟﻠﻭﻥ : Colourﻭﻳﻛﻭﻥ ﺃﺻﻔﺭ Yellowﻓﻲ ﺍﻟﺣﺎﻟﺔ ﺍﻟﻁﺑﻳﻌﻳﺔ ،ﻭﻳﻛﻭﻥ ﻓﺎﺗﺢ ﺍﻟﻠﻭﻥ ﺃﻭ ﻋﺩﻳﻡ ﺍﻟﻠ��ﻭﻥ Colourlessﻓ��ﻲ ﺣﺎﻟ��ﺔ ﺍﻟﺗﺧﻔﻳ��ﻑ ﻋﻧ��ﺩ ﺃﺧ��ﺫ ﻛﻣﻳ��ﺎﺕ ﻛﺑﻳ��ﺭﺓ ﻣ��ﻥ ﺍﻟﺳ��ﻭﺍﺋﻝ ،ﺃﻭ ﺍﻟﺑ��ﻭﻝ ﺍﻟﺳ��ﻛﺭﻱ .Glucosuriaﻭﻗ��ﺩ ﻳﻛ��ﻭﻥ ﺍﻟﻠ��ﻭﻥ ﺃﺻ��ﻔﺭ ﻣﺎﺋ��ﻝ ﺇﻟ��ﻰ ﺍﻷﺣﻣ��ﺭ Reddishﻓ��ﻲ ﺣﺎﻟ��ﺔ ﻭﺟﻭﺩ ﺁﺛﺎﺭ ﻟﻠﺩﻡ .hematinuriaﺃﻣﺎ ﻋﻧﺩﻣﺎ ﻳﻛﻭﻥ ﺍﻟﻠﻭﻥ ﺑﻧﻲ ﻣﺎﺋﻝ ﺇﻟﻰ ﺍﻷﺧﺿ�ﺭ Greenish ،Brownﻓﻬﺫﺍ ﺩﻟﻳﻝ ﻋﻠ�ﻰ ﻭﺟ�ﻭﺩ ﺃﻣ�ﻼﺡ ﻭﺃﺻ�ﺑﺎﻍ ﺍﻟﺻ�ﻔﺭﺍء Bile pigments and salts ﻣﺛﻝ .Bilirubin and Urobilinogenﻭﻓﻲ ﺑﻌﺽ ﺍﻷﺣﻳﺎﻥ ﻳﻛﻭﻥ ﺍﻟﻠﻭﻥ ﺑﺭﺗﻘﺎﻟﻲ ﺃﻭ ﺍﺣﻣﺭ ﻭﺭﺩﻱ Pink or Orangeﻋﻧﺩ ﺍﺧﺫ ﺑﻌﺽ ﺍﻟﻌﻘﺎﻗﻳﺭ ﺍﻟﻁﺑﻳﺔ ﻣﺛﻝ ﺍﻟﺭﻳﻔﺎﻣﺑﻳﺳﻳﻥ ﻭﺍﻟﻳﻭﺭﻳﺳﻳﺑﺕ. ﺃﺣﻳﺎﻧﺎ ﻳﻛﻭﻥ ﺍﻟﺑﻭﻝ ﺭﺍﺋﻕ ﻓﻲ ﺍﻟﺣﺎﻻﺕ ﺍﻟﻁﺑﻳﻌﻳﺔ ﺃﻭ ﻳﻛﻭﻥ ﻋﻛﺭ Turbidﻭﺫﻟﻙ ﻟﻭﺟﻭﺩ ﺍﻟﺗﻬﺎﺑﺎﺕ ﺑﻛﺗﻳﺭﻳﺔ ﺃﻭ ﻛﻣﻳﺔ ﻣﻥ ﺍﻟﺧﻼﻳﺎ ﺍﻟﻘﻳﺣﻳﺔ Pus cellsﺃﻭ ﻭﺟﻭﺩ ﺭﻭﺍﺳﺏ ﺭﻣﻠﻳﺔ .Crystals .2ﺍﻟﺗﻔﺎﻋﻠﻳﺔ : Reactionﺃﻭ ﻗﻳﻣ�ﺔ pH+ﻟ�ﻺﺩﺭﺍﺭ ﻭﻳ�ﺗﻡ ﺫﻟ�ﻙ ﻋ�ﻥ ﻁﺭﻳ�ﻕ ﻭﺭﻕ ﻋﺑ�ﺎﺩ ﺍﻟﺷ�ﻣﺱ Litmus paperﺃﻭ ﻏﻳﺭﻫﺎ ،ﺣﻳﺙ ﺃﻥ ﺍﻟﺣﺎﻟﺔ ﺍﻟﻁﺑﻳﻌﻳﺔ ﻳﻛﻭﻥ ﺣﺎﻣﺿﻳﺎ ً Acidicﻭﻳﺗﻐﻳ�ﺭ ﺗﺑﻌ�ﺎ ً ﻟﺗﻐﻳﺭ ﺍﻟﻁﻌﺎﻡ ﻭﺍﻹﺻﺎﺑﺎﺕ ﺍﻟﺟﺭﺛﻭﻣﻳﺔ ﺣﻳﺙ ﻗﺩ ﻳﻛﻭﻥ ﻗﺎﻋﺩﻱ .Alkaline .3ﺍﻟﺑﺭﻭﺗﻳﻧ��ﺎﺕ : Proteinsﻭﻫﻧ��ﺎ ﻳ��ﺗﻡ ﺍﻟﻛﺷ��ﻑ ﻋ��ﻥ ﺍﻷﻟﺑ��ﻭﻣﻳﻥ Albuminﺃﻭ ﻏﻳ��ﺭﻩ ﻣ��ﻥ ﺍﻟﺑﺭﻭﺗﻳﻧ���ﺎﺕ ،ﻭﻳ���ﺗﻡ ﺫﻟ���ﻙ ﺑﻌ���ﺩ ﺇﺟ���ﺭﺍء ﻋﻣﻠﻳ���ﺔ ﺍﻟﻁ���ﺭﺩ ﺍﻟﻣﺭﻛ���ﺯﻱ ﻟ���ﻺﺩﺭﺍﺭ ﺑﻭﺍﺳ���ﻁﺔ ﺟﻬ���ﺎﺯ ،Centrifugeﻳﺿ�ﺎﻑ ﻗﻁ�ﺭﺓ ﺃﻭ ﺍﻛﺛ�ﺭ ﻣ�ﻥ ﻣﺣﻠ�ﻭﻝ ﺣ�ﺎﻣﺽ 20% 5-Sulfo-Salicylic acidﻓﺈﺫﺍ ﺗﻛﻭﻧﺕ ﻋﻛ�ﺭﺓ ﺃﻭ ﺗﺿ�ﺑﺏ ﺑﺳ�ﻳﻁ ﻓﻬ�ﺫﺍ ﻳﻌﻧ�ﻲ ﻭﺟ�ﻭﺩ ﺍﺛ�ﺭ Traceﻟﻠﺑ�ﺭﻭﺗﻳﻥ ،ﺃﻣ�ﺎ ﺇﺫﺍ ﻏﻁﻰ ﺍﻟﺗﺿﺑﺏ ﺭﺑﻊ ﺣﺟﻡ ﺍﻹﺩﺭﺍﺭ ﺗﻘﺭﻳﺑﺎ ﻓﻳﻌﻁﻰ ) (+ﻓ�ﻲ ﻧﺗﻳﺟ�ﺔ ﺍﻟﻔﺣ�ﺹ ،ﻭﺇﺫﺍ ﻛﺎﻧ�ﺕ ﺍﻟﻌﻛ�ﺭﺓ ﺍﻟﻣﺗﻛﻭﻧﺔ ﺗﻐﻁﻲ ﻧﺻ�ﻑ ﺍﻟﺣﺟ�ﻡ ﺗﻘﺭﻳﺑ�ﺎ ﻓﻳﻌﻁ�ﻰ ) ،(++ﺃﻣ�ﺎ ﺇﺫﺍ ﻏﻁ�ﺕ ﻣﻌﻅ�ﻡ ﺍﻟﺣﺟ�ﻡ ﻭﺑﺻ�ﻭﺭﺓ ﻛﺛﻳﻔﺔ ﻓﻬﻧﺎ ﻳﻌﻁﻰ ) (+++ﻓﻲ ﻧﺗﻳﺟﺔ ﺍﻟﻔﺣﺹ .ﻓﻲ ﺣﺎﻟﺔ ﻋﺩﻡ ﻭﺟﻭﺩ ﺃﻱ ﻋﻛﺭﺓ ﻓﻳﻌﻁﻰ )ﻻﺷ�ﻲء .(Nil .4ﻓﺣﺹ ﺍﻟﺳﻛﺭ ﻓﻲ ﺍﻹﺩﺭﺍﺭ :Glucose in urineﻭﻳﻭﺟﺩ ﻋﺩﺓ ﻁ�ﺭﻕ ﻣﻧﻬ�ﺎ ﻁﺭﻳﻘ�ﺔ ﺍﻷﺷ�ﺭﻁﺔ Stripsﺣﻳﺙ ﻳﺗﻡ ﻏﻣﺭ ﺍﻟﺷﺭﻳﻁ ﻓﻲ ﺍﻹﺩﺭﺍﺭ ﻟﻠﺣﻅﺔ ﺛﻡ ﻳﺗﺭﻙ ﻓﺗﺭﺓ ﻗﺻ�ﻳﺭﺓ ﻻ ﺗﺗﺟ�ﺎﻭﺯ ﺩﻗﻳﻘ�ﺔ ﺛ�ﻡ 2
ﻳﻘﺎﺭﻥ ﺗﻐﻳﺭ ﺍﻷﻟﻭﺍﻥ ﻣ�ﻊ ﺍﻷﻟ�ﻭﺍﻥ ﺍﻟﻘﻳﺎﺳ�ﻳﺔ ﻋﻠ�ﻰ ﺍﻟﻌﻠﺑ�ﺔ .ﺃﻣ�ﺎ ﺍﻟﻁﺭﻳﻘ�ﺔ ﺍﻟﺛﺎﻧﻳ�ﺔ ﻫ�ﻲ ﻛﺎﺷ�ﻑ ﺑﻧ�ﺩﻛﺕ Benedict methodﻭﻓﻳﻬﺎ ﻳﺗﻡ ﻭﺿﻊ 1 mlﻣﻥ ﺍﻟﻛﺎﺷﻑ ﺍﻷﺯﺭﻕ ﺍﻟﻠ�ﻭﻥ ﻓ�ﻲ ﺃﻧﺑﻭﺑ�ﺔ ﻏﻠﻳ�ﺎﻥ ،Pyrexﺛﻡ ﻳﺿﺎﻑ ﻟﻬﺎ ﺛﻼﺙ ﻗﻁﺭﺍﺕ ﻣﻥ ﺍﻹﺩﺭﺍﺭ ،ﺑﻌﺩﻫﺎ ﺗﺳﺧﻥ ﻓ�ﻲ ﺣﻣ�ﺎﻡ ﻣ�ﺎﺋﻲ ﻟﻣ�ﺩﺓ ﺧﻣﺳ�ﺔ ﺩﻗﺎﺋﻕ ﺃﻭ ﻟﻬﺏ ﻣﺑﺎﺷﺭ ،ﻭﻳﻼﺣﻅ ﺗﻐﻳﺭ ﺍﻟﻠ�ﻭﻥ .ﺇﺫﺍ ﺑﻘ�ﻲ ﺍﻟﻠ�ﻭﻥ ﺍﺯﺭﻕ ﻓ�ﺫﻟﻙ ﻳﻌﻧ�ﻲ ﻻ ﻳﻭﺟ�ﺩ ﺳ�ﻛﺭ ﻓﻲ ﺍﻹﺩﺭﺍﺭ ﻭﺍﻟﻧﺗﻳﺟﺔ ﻁﺑﻳﻌﻳﺔ ، Normalﺃﻣﺎ ﺇﺫﺍ ﺗﻐﻳﺭ ﺍﻟﻠﻭﻥ ﺇﻟﻰ ﺍﻷﺧﺿﺭ ﻓﺎﺗﺢ ﻓﺗﻛﻭﻥ ﺍﻟﻧﺗﻳﺟ�ﺔ ﺍﺛ�ﺭ Traceﻭﺫﻟ�ﻙ ﺩﻻﻟ�ﺔ ﻋﻠ�ﻰ ﺍﺭﺗﻔ�ﺎﻉ ﻧﺳ�ﺑﺔ ﺍﻟﺳ�ﻛﺭ ﻓ�ﻲ ﺍﻟ�ﺩﻡ ﺇﻟ�ﻰ 200mg/100mlﺗﻘﺭﻳﺑ�ﺎً، ﻭﺗﻐﻳﺭ ﺍﻟﻠﻭﻥ ﺇﻟﻰ ﺍﻷﺧﺿﺭ ﻣﻊ ﻭﺟﻭﺩ ﺭﺍﺳ�ﺏ ﺍﺻ�ﻔﺭ ﺃﻱ ﻋﻛ�ﺭﺓ ﺍﻟﻣﺣﻠ�ﻭﻝ ﻓﺎﻟﻧﺗﻳﺟ�ﺔ ) ،(+ﺃﺧﺿ�ﺭ ﺩﺍﻛﻥ ) ، (++ﺑ ّﻧﻲ ) ، (+++ﻭ ﺃﺧﻳﺭﺍ ﺇﺫﺍ ﻛﺎﻥ ﺍﺣﻣﺭ ﻓﺎﻟﻧﺗﻳﺟﺔ ). (++++ .5ﺃﺻ�ﺑﺎﻍ ﺍﻟﺻ�ﻔﺭﺍء :Bile pigmentﺃﻭ ﻓﺣ�ﺹ ﺍﻟﻳﺭﻗ�ﺎﻥ ﻭﻫﻧ�ﺎ ﻳ�ﺗﻡ ﺇﺿ�ﺎﻓﺔ ﻗﻁ�ﺭﺓ ﺃﻭ ﻗﻁ�ﺭﺗﻳﻥ ﺑﺻﻭﺭﺓ ﻣﺎﺋﻠﺔ ﻋﻠﻰ ﺟﺩﺍﺭ ﺃﻧﺑﻭﺑﺔ ﺍﻹﺩﺭﺍﺭ ﻣﻥ ﺍﻟﻣﺣﻠﻭﻝ ﺍﻟﻳ�ﻭﺩﻱ ﺍﻟﻣﺳ�ﻣﻰ ،Lugol’s solution ﻓﺈﺫﺍ ﺗﻛﻭﻧﺕ ﺣﻠﻘﺔ ﺧﺿﺭﺍء ﺍﻟﻠﻭﻥ ﻋﻠﻰ ﺳﻁﺢ ﺍﻹﺩﺭﺍﺭ ﺩﻻﻟﺔ ﻋﻠﻰ ﻭﺟ�ﻭﺩ Bilirubinﺍﻟ�ﺫﻱ ﻳﺅﻛ�ﺩ ﺍﻹﺻﺎﺑﺔ ﻭﺍﻟﻧﺗﻳﺟﺔ ﻣﻭﺟﺑﺔ ).(+ve .6ﻓﺣ��ﺹ :Urobilinogenﻳﻭﺿ��ﻊ 1 mlﻣ��ﻥ ﺍﻹﺩﺭﺍﺭ ﻓ��ﻲ ﺃﻧﺑﻭﺑ��ﺔ ﺍﺧﺗﺑ��ﺎﺭ ﺛ��ﻡ ﻳﺿ��ﺎﻑ ﻟﻬ��ﺎ ﻗﻁﺭﺗﻳﻥ ﻣﻥ ﻛﺎﺷﻑ Earlechﻭﺗﺭﺝ ﺍﻷﻧﺑﻭﺑﺔ ﺟﻳﺩﺍ ﻭﺗﺗﺭﻙ ﻣﺩﺓ ﺧﻣﺳﺔ ﺩﻗ�ﺎﺋﻕ ،ﻓ�ﺈﺫﺍ ﺗﻛ�ﻭﻥ ﻟ�ﻭﻥ ﺍﺣﻣﺭ ﻗﺎﻥ ﺩﻻﻟﺔ ﻋﻠﻰ ﻭﺟﻭﺩ ﻛﻣﻳﺔ ﻋﺎﻟﻳﺔ ﻣﻧﻪ ﻭﺗﻛﻭﻥ ﺍﻟﻧﺗﻳﺟﺔ ﻣﻭﺟﺑﺔ ) ،(+veﺃﻣ�ﺎ ﺇﺫﺍ ﻛ�ﺎﻥ ﺍﻟﻠ�ﻭﻥ ﺍﺣﻣﺭ ﻭﺭﺩﻱ ﺧﻔﻳﻑ ﺃﻭ ﺍﺳﻣﺭ ﺩﻻﻟﺔ ﻋﻠﻰ ﺍﻟﻧﺗﻳﺟﺔ ﻁﺑﻳﻌﻳﺔ. .7ﺍﻟﻔﺣ�ﺹ ﺍﻟﻣﺟﻬ�ﺭﻱ : Microscopic Examinationﻭﻳ�ﺗﻡ ﺑﻌ�ﺩ ﺇﺟ�ﺭﺍء ﺍﻟﻁ�ﺭﺩ ﺍﻟﻣﺭﻛ�ﺯﻱ ﻟﻠﻌﻳﻧﺔ ﻭﺑﻌﺩ ﺇﺟﺭﺍء ﺍﻟﻔﺣﻭﺻﺎﺕ ﺍﻟﺳﺎﺑﻘﺔ ،ﺣﻳﺙ ﻳﺗﻡ ﺳﻛﺏ ﺍﻟﺭﺍﺋﻕ Supernatantﻭﺍﺧﺫ ﺍﻟﺭﺍﺳ�ﺏ precipitateﺍﻟﺫﻱ ﻫﻭ ﺁﺧﺭ ﻗﻁﺭﺓ ﻣﻥ ﺍﻷﻧﺑﻭﺑﺔ ،ﺛﻡ ﺗﻭﺿﻊ ﻋﻠﻰ ﺷﺭﻳﺣﺔ ﺯﺟﺎﺟﻳﺔ slideﻧﻅﻳﻔﺔ ﻭﺟﺎﻓ�ﺔ ،ﺛ�ﻡ ﺗﻐﻁ�ﻰ ﺑﺎﻟﻐﻁ�ﺎء ﺍﻟﺯﺟ�ﺎﺟﻲ .Cover slideﺗﻭﺿ�ﻊ ﺍﻟﺷ�ﺭﻳﺣﺔ ﺗﺣ�ﺕ ﺍﻟﻣﺟﻬ�ﺭ ﻋﻠ�ﻰ ﺍﻟﻌﺩﺳﺔ 10xﻷﺧﺫ ﻧﻅﺭﺓ ﺳﺭﻳﻌﺔ ﻟﻣﻌﻅﻡ ﺍﻟﻌﻳﻧ�ﺔ ﻟﻣﻼﺣﻅ�ﺔ ﺑﻌ�ﺽ ﺍﻷﺟﺳ�ﺎﻡ ﺃﻭ ﺍﻟﺗﺟﻣﻌ�ﺎﺕ ﺍﻟﻘﻠﻳﻠ�ﺔ ﺍﻟﺗﻲ ﻗﺩ ﻻ ﺗﻼﺣﻅ ﺃﺣﻳﺎﻧﺎ ﻋﻠﻰ ﺍﻟﻘﻭﺓ ﺍﻟﻛﺑﺭﻯ ،H.P.F.ﺑﻌﺩ ﺫﻟﻙ ﺗﺣﻭﻝ ﺍﻟﻌﺩﺳ�ﺔ ﺇﻟ�ﻰ ﺍﻟﻘ�ﻭﺓ ﺍﻟﻛﺑ�ﺭﻯ ،40xﻭﻳﺗﻡ ﻣﻼﺣﻅﺔ: ♦ ﺍﻟﻛﺭﻳﺎﺕ ﺍﻟﺩﻡ ﺍﻟﺣﻣﺭﺍء :R.B.Csﺇﻥ ﺍﻟﺑﻭﻝ ﺍﻟﻁﺑﻳﻌﻲ ﻻ ﻳﺣﺗ�ﻭﻱ ﻋﻠﻳﻬ�ﺎ ﺃﻱ ﺇﻥ ﺍﻟﻧﺗﻳﺟ�ﺔ ،Nil ﻭﺍﻥ ﻭﺟ��ﺩﺕ ﻓﻬ��ﻲ ﺃﻗ��ﺭﺍﺹ ﺻ��ﻔﺭﺍء ﺻ��ﻐﻳﺭﺓ ﺣﻭﺍﻓﻬ��ﺎ ﺃﻗ��ﺗﻡ ﻣ��ﻥ ﻣﺭﻛﺯﻫ��ﺎ ﻭﺑﻌﺿ��ﻬﺎ ﺫﺍﺕ ﺣ��ﻭﺍﻑ ﻣﻔﺻﺻﺔ ﻭﺷﺎﺋﻛﺔ .ﻳﺛﺑﺕ ﻋﺩﺩﻫﺎ ﻛﻣﻌﺩﻝ ﻓﻲ ﺍﻟﺗﻘﺭﻳﺭ ﻣﺛﻼ (0-3) in H.P.F.ﺃﻱ ﻓﻲ ﺣﻘﻝ ﺍﻟﻘ�ﻭﺓ ﺍﻟﻛﺑﺭﻯ ) ،(40xﺃﻭ ،(20-24) in H.P.F.ﺃﺣﻳﺎﻧﺎ ﺗﻛﻭﻥ ﻛﺑﻳﺭﺓ ﺍﻟﻌﺩﺩ ﻻ ﻳﻣﻛﻥ ﺇﺣﺻﺎﺋﻬﺎ ﻓﺗﻛﺗﺏ ﺍﻟﻧﺗﻳﺟﺔ ﻣﻣﺗﻠﺊ ﺍﻟﺣﻘﻝ .Full field ♦ ﺍﻟﺧﻼﻳﺎ ﺍﻟﻘﻳﺣﻳﺔ :Pus cellsﻭﻫ�ﻲ ﻛﺭﻳ�ﺎﺕ ﺍﻟ�ﺩﻡ ﺍﻟﺑﻳﺿ�ﺎء ﺍﻟﻣﻧﺗﻛﺳ�ﺔ ﺑﻔﻌ�ﻝ ﺍﻻﻟﺗﻬﺎﺑ�ﺎﺕ ،ﻭﻫ�ﻲ ﺧﻼﻳﺎ ﺻﻐﻳﺭﺓ ﻣﺣﺑﺑﺔ ﺟﺩﺍ ،ﻳﺑﻠﻎ ﻣﻌﺩﻝ ﻗﻁﺭﻫﺎ) (7μﻧﻭﺍﺗﻬﺎ ﺗﻛﺳﺭ ﺍﻟﺿﻭء ﻭﻏﺎﻟﺑ�ﺎ ﻳﻭﺟ�ﺩ ﺍﻟﺑ�ﺭﻭﺗﻳﻥ ﻣﺭﺍﻓﻘﺎ ﻣﻌﻬﺎ ﻓﻲ ﺍﻟﺑﻭﻝ. ♦ ﺍﻟﺧﻼﻳﺎ ﺍﻟﻁﻼﺋﻳﺔ :Epithelial cellsﻭﻫﻲ ﺍﻟﺧﻼﻳﺎ ﺍﻟﻣﺑﻁﻧﺔ ﻟﻠﻣﺛﺎﻧﺔ ﻭﺍﻟﻣﺟﺎﺭﻱ ﺍﻟﺑﻭﻟﻳ�ﺔ ،ﻓ�ﺈﺫﺍ ﻛﺎﻧﺕ ﻗﻠﻳﻠﺔ ﺍﻟﻌﺩﺩ ﻓﻳﻛﺗﺏ ﻓ�ﻲ ﺍﻟﻧﺗﻳﺟ�ﺔ ،Fewﺃﻣ�ﺎ ﺇﺫﺍ ﻛﺎﻧ�ﺕ ﺗﻐﻁ�ﻲ ﺭﺑ�ﻊ ﺍﻟﺣﻘ�ﻝ ﺍﻟﻣﺟﻬ�ﺭﻱ ﺗﻘﺭﻳﺑ�ﺎ
3
ﻓﺎﻟﻧﺗﻳﺟﺔ ) ،(+ﺃﻣﺎ ﺇﺫﺍ ﻏﻁﺕ ﻧﺻﻑ ﺍﻟﺣﻘﻝ ﻓﻳﻛﺗﺏ ) (++ﻭﻫﻛﺫﺍ ﺇﺫﺍ ﻛﺎﻥ ﺍﻛﺛﺭ ).(+++ ♦ ﺍﻷﺟﺳ��ﺎﻡ ﺍﻟﺑﻠﻭﺭﻳ��ﺔ )ﺍﻟﺭﻣ��ﻝ( : Crystalsﻭﻫ��ﻲ ﺃﺟﺳ��ﺎﻡ ﺷ��ﺑﻪ ﺷ��ﻔﺎﻓﺔ ﻋﺎﻛﺳ��ﺔ ﻟﻠﺿ��ﻭء ﻭﺑﻌﺿ��ﻬﺎ ﺫﺍﺕ ﻟﻣﻌﺎﻥ ،ﻭﺗﻘﺳﻡ ﺣﺳﺏ ﺩﺭﺟﺔ ﺣﺎﻣﺿﻳﺔ ﺍﻹﺩﺭﺍﺭ -: pH+ .1ﺃﻟﺣﺎ ﻣﺿﻲ : Acidicﻭﺗﺷﻣﻝ ﺍﻷﻧﻭﺍﻉ ﺍﻟﺗﺎﻟﻳﺔ-: ) (aﺍﻟﻳﻭﺭﺍﺕ ﻋﺩﻳﻣﺔ ﺍﻟﺷﻛﻝ . Amorphous urate ) (bﺣﺎﻣﺽ ﺍﻟﻳﻭﺭﻳﻙ . Uric acid ) (cﺍﻭﻛﺯﺍﻻﺕ ﺍﻟﻛﺎﻟﺳﻳﻭﻡ . Calcium oxalate
.2ﺍﻟﻘﺎﻋﺩﻱ : Alkalineﺃﺣﻳﺎﻧﺎ ً ﺍﻟﻣﺗﻌﺎﺩﻝ ﻭﺗﺷﻣﻝ ﺍﻷﻧﻭﺍﻉ ﺍﻟﺗﺎﻟﻳﺔ-: ) (aﺍﻟﻔﻭﺳﻔﺎﺕ ﻋﺩﻳﻣﺔ ﺍﻟﺷﻛﻝ . Amorphous phosphate ) (bﻛﺭﺑﻭﻧﺎﺕ ﺍﻟﻛﺎﻟﺳﻳﻭﻡ . Calcium carbonate ) (cﻓﻭﺳﻔﺎﺕ ﺍﻟﻛﺎﻟﺳﻳﻭﻡ . Calcium phosphate ) (dﺍﻟﻔﻭﺳﻔﺎﺕ ﺍﻟﺛﻼﺛﻳﺔ . Triple phosphate ) (eﻳﻭﺭﺍﺕ ﺍﻷﻣﻭﻧﻳﻭﻡ . Ammonium urate ) (fﻳﻭﺭﺍﺕ ﺍﻟﺻﻭﺩﻳﻭﻡ . Sodium urate
♦ ﺍﻷﺟﺳﺎﻡ ﺍﻷﺳﻁﻭﺍﻧﻳﺔ : Castsﻭﻏﺎﻟﺑﺎ ً ﻣﺎ ﺗﻅﻬﺭ ﻣﺭﺍﻓﻘﺔ ﻻﻟﺗﻬﺎﺑﺎﺕ ﺍﻟﻛﻠﻰ ،ﻭﺗﺷﻣﻝ 4
.1ﺍﻟﺷﻔﺎﻓﺔ : Hyaline Castsﻭﻏﺎﻟﺑﺎ ً ﻣﺎ ﺗﻅﻬﺭ ﻓﺎﺭﻏﺔ. .2ﺍﻟﺣﺑﻳﺑﻳﺔ : Granular Castsﻭﺗﻛﻭﻥ ﻣﻣﺗﻠﺋﺔ ﺑﺧﻼﻳﺎ ﻁﻼﺋﻳﺔ .Epithelial cells .3ﺍﻟﺩﻣﻭﻳﺔ : R.B.Cs. Castsﻭﺗﻛﻭﻥ ﻣﻣﺗﻠﺋﺔ ﺑﺧﻼﻳﺎ ﺍﻟﺩﻡ ﺍﻟﺣﻣﺭﺍء. .4ﺍﻟﻘﻳﺣﻳﺔ : Pus Castsﻭﺗﻛﻭﻥ ﻣﻣﺗﻠﺋﺔ ﺑﺧﻼﻳﺎ ﺍﻟﺩﻡ ﺍﻟﺑﻳﺿﺎء ﺍﻟﻣﻧﺗﻛﺳﺔ. ♦ .1 .2 .3 .4
ﺃﺷﻳﺎء ﺃﺧﺭﻯ : Othersﻭﺗﺷﻣﻝ-: ﺍﻟﺑﻛﺗﻳﺭﻳ�ﺎ : Bacteriaﻭﺗﻼﺣ�ﻅ ﺃﺣﻳﺎﻧ�ﺎ ً ﻣﺭﺍﻓﻘ�ﺔ ﻟﻼﻟﺗﻬﺎﺑ�ﺎﺕ ﻣ�ﻊ ﺍﻟﺧﻼﻳ�ﺎ ﺍﻟﻘﻳﺣﻳ�ﺔ ، Pus cells ﻭﺗﻅﻬﺭ ﺃﺣﻳﺎﻧﺎ ً ﻋﻧﺩ ﺍﻟﺗﻠﻭﺙ ﺍﻟﺧﺎﺭﺟﻲ Contaminationﻭﻫﻧﺎ ﻻ ﺗﺫﻛﺭ ﻓﻲ ﺍﻟﺗﻘﺭﻳﺭ. ﺍﻟﺧﻣ��ﺎﺋﺭ : Moniliaﻭﻳﻼﺣ��ﻅ ﻓﻳﻬ��ﺎ ﻁ��ﻭﺭ ﺍﻟﺗﺑ��ﺭﻋﻡ ،ﻭﻏﺎﻟﺑ��ﺎ ً ﻣ��ﺎ ﺗﻅﻬ��ﺭ ﻓ��ﻲ ﺍﻟﺑ��ﻭﻝ ﺍﻟﺳ��ﻛﺭﻱ . Glucose in urine ﻁﻔﻳﻠﻲ ﺍﻟﻣﺷﻌﺭﺍﺕ ﺍﻟﻣﻬﺑﻠﻳ�ﺔ : Trichomonas vaginalisﻭﺗﻼﺣ�ﻅ ﻓ�ﻲ ﻁﻭﺭﻫ�ﺎ ﺍﻟﺧﺿ�ﺭﻱ Trophozoitﻭﺗﺗﺣﺭﻙ ﺑﺄﺳﻭﺍﻁﻬﺎ ﺣﺭﻛﺔ ﺩﻭﺭﺍﻧﻳﺔ. ﺑﻳﻭﺽ ﺍﻟﺑﻠﻬﺎﺭﺯﻳﺎ : Schistosoma haematobium eggsﻭﻓﻲ ﻫﺫﻩ ﺍﻟﺣﺎﻟ�ﺔ ﻳﻛ�ﻭﻥ ﺍﻟﺑ�ﻭﻝ ﺩﻣﻭﻳﺎ ً ﺑﻛﺛﺎﻓﺔ ﻣﻊ ﻭﺟﻭﺩ ﺃﻋﺭﺍﺽ ﺍﻟﺑﻠﻬﺎﺭﺯﻳﺎ ﻋﻠﻰ ﺍﻟﻣﺭﻳﺽ.
ﺛﺎﻧﻳﺎ ً :ﻓﺣﺹ ﺍﻟﺑﺭﺍﺯ ﺍﻟﻌﺎﻡ : General Stool Examinationﻭﻳﺗﻡ ﻓﺣﺹ ﺍﻟﺗﺎﻟﻲ -: ♦ ﺍﻟﻛﺛﺎﻓﺔ ﺃﻭ ﺍﻟﻘﻭﺍﻡ : Consistencyﻭﻳﻛﻭﻥ ﺃﻣﺎ ﻟﻳّﻥ Softﺃﻭ ﺷﺑﻪ ﺻﻠﺏ ، Semisolidﺃﻭ ﺻ��ﻠﺏ ، Solidﻭﺃﺣﻳﺎﻧ��ﺎ ً ﻳﻛ��ﻭﻥ ﺳ��ﺎﺋﻝ ﻣﻔﻛ��ﻙ Looseﺣﻳ��ﺙ ﻳﺣﺗ��ﻭﻱ ﻋﻠ��ﻰ ﻣ��ﻭﺍﺩ ﻣﺧﺎﻁﻳ��ﺔ . Mucus ّ ♦ ﺍﻟﻠ��ﻭﻥ : Colourﻭﻳﻛ��ﻭﻥ ﺑﻧ��ﻲ Brownﻓ��ﻲ ﺍﻟﺣ��ﺎﻻﺕ ﺍﻟﻁﺑﻳﻌﻳ��ﺔ ،ﺃﻭ ﺩﻣ��ﻭﻱ Bloodyﻓ��ﻲ ﺣﺎﻟ��ﺔ ﺍﻟﺯﺣ��ﺎﺭ ﺍﻷﻣﻳﺑ��ﻲ )ﺍﻟ��ﺩﺯﻧﺗﺭﻱ( ، E.histolyticaﻭﻗ��ﺩ ﻳﻛ��ﻭﻥ ﻣﺻ��ﻔﺭﺍً Yellowishﺃﻭ ﻣﺧﺿﺭﺍً Greenishﻓﻲ ﺣﺎﻻﺕ ﺇﺳﻬﺎﻝ ﺍﻷﻁﻔﺎﻝ ﺍﻟﺭﺿﻊ ﺑﺳﺑﺏ ﺣﺩﻭﺙ ﺍﻟﺣﺳّﺎﺳ�ﻳﺔ ﻓ�ﻲ ﺃﻣﻌ�ﺎﺋﻬﻡ ﻭﻳﻌﺭﻑ ﺫﻟﻙ ﻋﻧﺩ ﻗﻳﺎﺱ ﺩﺭﺟﺔ pH+ﻟﻠﺑﺭﺍﺯ ،ﺣﻳﺙ ﻳﻛﻭﻥ ﺣﺎﻣﺿﻳﺎ ً ﺃﻣّ�ﺎ ﻓ�ﻲ ﺍﻟﺣ�ﺎﻻﺕ ﺍﻟﻁﺑﻳﻌﻳ�ﺔ ﻳﻛﻭﻥ ﻗﺎﻋﺩﻳﺎ ً ﺇﻟﻰ ﻣﺗﻌﺎﺩﻝ ،ﻭﻳﺭﺍﻓﻕ ﺣﺎﻟﺔ ﺍﻹﺳﻬﺎﻝ ﻭﺟﻭﺩ ﻗﻁﻳﺭﺍﺕ ﺯﻳﺗﻳ�ﺔ Oil dropletsﻓ�ﻲ ﺍﻟﺣﻘﻝ ﺍﻟﻣﺟﻬﺭﻱ .ﻳﻛﻭﻥ ﻟﻭﻥ ﺍﻟﺑﺭﺍﺯ ﺃﺳﻭﺩ Blackﻋﻧﺩ ﻭﺟﻭﺩ ﺍﻟﺩﻡ ﺍﻟﻣﺗﺣﻠ�ﻝ ﻭﻏﺎﻟﺑ�ﺎ ً ﻻ ﻳﻅﻬ�ﺭ ﻓ��ﻲ ﺍﻟﻔﺣ��ﺹ ﺍﻟﻣﺟﻬ��ﺭﻱ ﻭﺇﻧﻣ��ﺎ ﻳﻔﺣ��ﺹ ﻋ��ﻥ ﻁﺭﻳ��ﻕ ﺍﻻﺧﺗﺑ��ﺎﺭ Occult blood testﻟﻠﺑ��ﺭﺍﺯ ﻭﺗﻛﻭﻥ ﺍﻟﻧﺗﻳﺟﺔ ﻣﻭﺟﺑﺔ ) ، (+veﻭﻳﺣ�ﺩﺙ ﺫﻟ�ﻙ ﻓ�ﻲ ﺣ�ﺎﻻﺕ ﻗﺭﺣ�ﺔ ﺍﻟﻣﻌ�ﺩﺓ ﻭﺍﻷﻣﻌ�ﺎء ﺍﻟﻧ�ـﺯﻓﻳّﺗﻳﻥ، ﻭﻛﺫﻟﻙ ﻳﻛﻭﻥ ﺍﻟﻠﻭﻥ ﺍﺳﻭﺩ ﻋﻧﺩ ﺗﻧﺎﻭﻝ ﻋﻘﺎﻗﻳﺭ ﻭ ﺃﻏﺫﻳﺔ ﺗﺣﺗﻭﻱ ﻣﺭﻛﺑﺎﺕ ﺍﻟﺣﺩﻳﺩ. 5
♦ ﻛﺭﻳ��ﺎﺕ ﺍﻟ��ﺩﻡ ﺍﻟﺣﻣ��ﺭﺍء : R.B.Cs.ﺇﻥ ﺍﻟﺑ��ﺭﺍﺯ ﺍﻟﻁﺑﻳﻌ��ﻲ ﻻ ﻳﺣﺗ��ﻭﻱ ﻋﻠﻳﻬ��ﺎ ،ﻭﺍﻥ ﻭﺟ��ﺩﺕ ﻳﺛ ّﺑ��ﺕ ﻋﺩﺩﻫﺎ ﻓﻲ ﺍﻟﺗﻘﺭﻳﺭ. ♦ ﺍﻟﺧﻼﻳﺎ ﺍﻟﻘﻳﺣﻳﺔ : Pus cellsﺇﻥ ﺍﻟﺑﺭﺍﺯ ﺍﻟﻁﺑﻳﻌﻲ ﻻ ﻳﺣﺗﻭﻱ ﻋﻠﻳﻬ�ﺎ ،ﻭﺍﻥ ﻭﺟ�ﺩﺕ ﻳﺛﺑّ�ﺕ ﻋ�ﺩﺩﻫﺎ ﻓﻲ ﺍﻟﺗﻘﺭﻳﺭ. ♦
ﺍﻟﺑﻳ��ﻭﺽ : Ovaﻭﻫ��ﻲ ﺑﻳ��ﻭﺽ ﺍﻟﺩﻳ��ﺩﺍﻥ ﺍﻟﺗ��ﻲ ﺗﺻ��ﻳﺏ ﺍﻟﺟﻬ��ﺎﺯ ﺍﻟﻬﺿﻣﻲ ﻟﻺﻧﺳﺎﻥ ،ﻭﻳﺑﻠﻎ ﻣﻌﺩﻝ ﻗﻁﺭﻫﺎ ) (20μﺃﻱ ﺃﻛﺑ�ﺭ ﻣ�ﻥ ﺍﻟﻛﺭﻳﺎﺕ ﺍﻟﺩﻡ ﺍﻟﺣﻣﺭﺍء ،ﻭﺗﺷﻣﻝ ﺍﻷﻧﻭﺍﻉ ﺍﻟﺗﺎﻟﻳﺔ-:
♦ ﺍﻟﻣﺗﻛ ّﻳﺳ��ﺎﺕ : Cystsﻭﻫ��ﻲ ﺍﻟﻁ��ﻭﺭ ﺍﻟﻣﺗﻛ��ﻳّﺱ ﻟﻠﻁﻔﻳﻠﻳ��ﺎﺕ ﻭﺣﻳ��ﺩﺓ ﺍﻟﺧﻠﻳّ��ﺔ Unicellular ، parasitesﻭﻳﺗﺭﺍﻭﺡ ﻣﻌ ّﺩﻝ ﻗﻁﺭﻫﺎ ﺑﻳﻥ ) ،(10μ-20μﻭﻫ�ﺫﺍ ﺍﻟﻁ�ﻭﺭ ﻏﻳ�ﺭ ﻣﺗﺣ�ﺭﻙ ،ﻭﺗﺷ�ﻣﻝ ﺍﻷﻧﻭﺍﻉ ﺍﻟﺗﺎﻟﻳﺔ-:
6
♦ ﺍﻷﺟﺳ�ﺎﻡ ﺍﻟﺧﺿ�ﺭ ّﻳﺔ : Trophozoitesﻭﻫ�ﻲ ﺍﻟﻁ�ﻭﺭ ﺍﻟﺣﻳ�ﻭﻱ ﻟﻠﻁﻔﻳﻠﻳ�ﺎﺕ ﻭﺣﻳ�ﺩﺓ ﺍﻟﺧﻠﻳّ�ﺔ، ﻭﻳﻛﻭﻥ ﺣﺟﻣﻬﺎ ﺃﻛﺑﺭ ﻣﻥ ﺍﻟﻁﻭﺭ ﺍﻟﻣﺗﻛﻳّﺱ ،ﻭﻫﻲ ﺗﺗﺣﺭﻙ ﺑﻌﺩﺓ ﻁﺭﻕ ﻣﻧﻬﺎ ﺣﺭﻛﺔ ﺃﻣﻳﺑﻳﺔ ﻭﺑﻌﺿﻬﺎ ﺑﻭﺍﺳﻁﺔ ﺍﻷﺳﻭﺍﻁ Flagellaﺃﻭ ﺍﻷﻫﺩﺍﺏ ،Ciliaﻭﺗﺷﻣﻝ ﺍﻷﻧﻭﺍﻉ ﺍﻟﺗﺎﻟﻳﺔ-:
♦ ﺍﻷﺷﻳﺎء ﺍﻷﺧﺭﻯ :Othersﻣﺛﻝ ﺍﻟﻘﻁﻳﺭﺍﺕ ﺍﻟﺯﻳﺗﻳ�ﺔ Oil dropletsﺍﻟﺗ�ﻲ ﺗﻅﻬ�ﺭ ﻓ�ﻲ ﺣ�ﺎﻻﺕ ﺇﺳﻬﺎﻝ ﺍﻷﻁﻔﺎﻝ ﺍﻟﺭﺿّﻊ ،ﻭﺗﻅﻬﺭ ﻓﻲ ﺍﻟﺣﻘﻝ ﺍﻟﻣﺟﻬﺭﻱ ﺑﺄﻗﻁﺎﺭ ﻣﺧﺗﻠﻔﺔ ﺫﺍﺕ ﻟﻭﻥ ﺍﺻﻔﺭ ﺑﺎﻫﺕ ﻟ�ﻪ ﺑﺭﻳﻕ .ﻛﻣﺎ ﻗﺩ ﻳﻼﺣﻅ ﻁﻌﺎﻡ ﻏﻳﺭ ﻣﻬﺿﻭﻡ ،Indigestive foodﺃﻭ ﺧﻣﺎﺋﺭ .Monilia
ﺛﺎﻟﺛﺎ ً :ﻓﺣﺹ ﺍﻟﺩﻡ : Hematological Testﻭﺗﺷﻣﻝ -: ♦ ﺻﻭﺭﺓ ﺍﻟﺩﻡ ﺍﻟﻛﺎﻣﻠﺔ ) Complete Blood Picture (C.B.P.ﻭﻫﻲ ﺍﻟﻔﺣﻭﺻﺎﺕ: .1ﻓﺣﺹ ﻧﺳﺑﺔ ﺍﻟﻬﻳﻣﻭﻏﻠ�ﻭﺑﻳﻥ : Hb%ﻭﺗﻭﺟ�ﺩ ﻋ�ﺩﺓ ﻁ�ﺭﻕ ﻣ�ﻥ ﺃﺳ�ﻬﻠﻬﺎ ﺍﺳ�ﺗﺧﺩﺍﻡ ﺟﻬ�ﺎﺯ Sahliﻭﻳﻌﺗﻣﺩ ﻋﻣﻠﻪ ﻋﻠﻰ ﺍﻟﺗﻁﺎﺑﻕ ﺍﻟﻠﻭﻧﻲ ،ﻁﺭﻳﻘﺔ ﺍﻟﻌﻣﻝ -: (aﻳﻭﺿﻊ ﻓﻲ ﺃﻧﺑﻭﺑ�ﺔ ﺍﻟﺟﻬ�ﺎﺯ ﻣﻘ�ﺩﺍﺭ 20%ﻣ�ﻥ ﻣﺣﻠ�ﻭﻝ ﺣ�ﺎﻣﺽ ﺍﻟﻬﺎﻳ�ﺩﺭﻭﻛﻠﻭﺭﻳﻙ HCl ) (0.1Nﺍﻟﻣﺧﻔﻑ. (bﻳﺅﺧﺫ ﻣﻥ ﺩﻡ ﺇﺻﺑﻊ ﺍﻟﻳﺩ ﺃﻭ ﻛﻌﺏ ﺍﻟﻘ�ﺩﻡ ﻟﻠﻁﻔ�ﻝ ﺍﻟﺭﺿ�ﻳﻊ ﻣﻘ�ﺩﺍﺭ 20μlﺑﻭﺍﺳ�ﻁﺔ ﺍﻟﻣﺎﺻّ�ﺔ ﺍﻟﺷﻌﺭﻳﺔ ﺍﻟﺧﺎﺻّﺔ. ً (cﺗﺿﺎﻑ ﻛﻣﻳﺔ ﺍﻟﺩﻡ ﺇﻟﻰ ﺍﻟﻣﺣﻠﻭﻝ ﻓﻲ ﺍﻷﻧﺑﻭﺑﺔ ﻭﺗﺭﺝ ﺑﻠﻁﻑ ﺟﻳﺩﺍ ﻟﻳﺗﻡ ﺍﻟﺗﻔﺎﻋﻝ. (dﻳﺗﺭﻙ ﺍﻟﻣﺣﻠﻭﻝ ﻟﻣﺩﺓ ﺩﻗﻳﻘﺗ�ﻳﻥ ،ﺛ�ﻡ ﻳﺿ�ﺎﻑ ﺑﺎﻟﺗ�ﺩﺭﻳﺞ ﻗﻁ�ﺭﺍﺕ ﻣ�ﻥ ﺍﻟﻣ�ﺎء ﺍﻟﻣﻘﻁ�ﺭ D.W. ﻭﺗﺟ�ﺎﻧﺱ ﺟﻳ�ﺩﺍً ﺑﻭﺍﺳ�ﻁﺔ ﻋ�ﻭﺩ ﺧﺷ�ﺑﻲ Stickﺃﻭ ﺯﺟ�ﺎﺟﻲ ،Glass rodﺇﻟ�ﻰ ﺃﻥ ﻳﺗﻁ�ﺎﺑﻕ ﻟﻭﻥ ﺍﻟﻣﺣﻠﻭﻝ ﻣﻊ ﻋﻣﻭﺩﻱ ﺟﻬﺎﺯ )ﺳﺎﻟﻲ(. (eﺍﻟﻣﻘﺩﺍﺭ ﺍﻟﻁﺑﻳﻌﻲ : Normal values Male: (85 – 110)% = (12.6 – 16) gm / 100 ml Female: (80 – 95)% = (12.0 – 14) gm / 100 ml
.2ﺣﺟﻡ ﺍﻟﺧﻼﻳﺎ ﺍﻟﻣﺭﺻﻭﺹ )-: Packet Cell volume (P.C.V. (aﻳﺅﺧﺫ ﻣﻘ�ﺩﺍﺭ ﻣ�ﻥ ﺩﻡ ﺍﻹﺻ�ﺑﻊ ﺑﻭﺍﺳ�ﻁﺔ ﺃﻧﺑﻭﺑ�ﺔ ﺷ�ﻌﺭﻳﺔ Capillary tubesﺗﺣﺗ�ﻭﻱ ﻣ�ﺎﻧﻊ ﻟﻠﺗﺧﺛﺭ ﻣﺛﻝ ﺍﻟﻬﻳﺑﺎﺭﻳﻥ ) Heparinﺣﻣﺭﺍء ﺍﻟﻠﻭﻥ(. (bﺗﻐﻠﻕ ﺇﺣﺩﻯ ﻧﻬﺎﻳﺗﻲ ﺍﻷﻧﺑﻭﺑﺔ ﺍﻟﺷﻌﺭﻳﺔ ﺑﻭﺍﺳﻁﺔ ﺍﻟﻁﻳﻥ ﺍﻻﺻﻁﻧﺎﻋﻲ. (cﻳﻌﻣﻝ ﻁﺭﺩ ﻣﺭﻛﺯﻱ ﻟﻣﺩﺓ ﺧﻣﺳﺔ ﺩﻗﺎﺋﻕ ﺑﺟﻬﺎﺯ .Microcentrifuge
7
(dﺗﺣﺳﺏ ﺍﻟﻧﺗﻳﺟﺔ ﺑﻭﺍﺳﻁﺔ ﺍﻟﻣﺳﻁﺭﺓ ﺍﻟﺧﺎﺻﺔ ﺑﻬﺫﺍ ﺍﻟﻔﺣﺹ.
(eﺍﻟﻧﺳﺑﺔ ﺍﻟﻁﺑﻳﻌﻳﺔ ﻋﻧﺩ ﺍﻟﺑﺎﻟﻐﻳﻥ: Male: (40 – 50) % Female: (37 – 44) %
.3ﻋﺩﺩ ﺍﻟﻛﺭﻳﺎﺕ ﺍﻟﺩﻡ ﺍﻟﺑﻳﺿﺎء -:W.B.Cs. count (aﻳﻭﺿ�ﻊ ﻣﻘ�ﺩﺍﺭ 0.4 mlﻣ�ﻥ ﻣﺣﻠ�ﻭﻝ (2% Glacial acetic acid + Crystal ) violetﺍﻟ��ﺫﻱ ﻳﻌﻣ��ﻝ ﻋﻠ��ﻰ ﺗﻛﺳ��ﻳﺭ ﺍﻟﻛﺭﻳ��ﺎﺕ ﺍﻟﺣﻣ��ﺭﺍء R.B.Cs.ﻭﺍﻟﺻ��ﺑﻐﺔ ﺍﻟﺑﻧﻔﺳ��ﺟﻳﺔ ﻟﺗﻠﻭﻳﻥW.B.Cs. (bﻳﺅﺧ�ﺫ 20μlﻣ�ﻥ ﺩﻡ ﺇﺻ�ﺑﻊ ﺍﻟﻳ��ﺩ ﺑﻭﺍﺳ�ﻁﺔ ﺍﻟﻣﺎﺻ�ﺔ ﺍﻟﺷ�ﻌﺭﻳﺔ ﻭﺗﻣ��ﺯﺝ ﻣ�ﻊ ﺍﻟﻣﺣﻠ�ﻭﻝ ﻟﻣ��ﺩﺓ ﺩﻗﻳﻘﺗﻳﻥ. (cﺗﺅﺧﺫ ﻗﻁﺭﺓ ﻣﻥ ﺍﻟﻣﺣﻠﻭﻝ ﻭﺗﻭﺿﻊ ﻋﻠﻰ ﺍﻟﺷﺭﻳﺣﺔ ﺍﻟﺯﺟﺎﺟﻳﺔ .Chamber Slide
(d
ﺗﺗﺭﻙ ﺍﻟﺷﺭﻳﺣﺔ ﻣﺩﺓ ﺩﻗﻳﻘﺔ ﻟﻛﻲ ﺗﺳﺗﻘﺭ ﺍﻟﻛﺭﻳﺎﺕ ﺟﻳﺩﺍً ،ﺛﻡ ﺗﻘﺭﺃ ﻣﺟﻬﺭﻳﺎ ً ﻋﻠﻰ ﺍﻟﻘﻭﺓ )(10X
. 8
(e (f
ﺗﺣﺳﺏ ﺍﻟﻛﺭﻳﺎﺕ ﺍﻟﺑﻳﺿﺎء ﻓﻲ ﺍﻟﻣﺭﺑﻌﺎﺕ ﺍﻟﻛﺑﻳﺭﺓ ﺍﻷﺭﺑﻌﺔ )ﻛ�ﻝ ﻣﺭﺑ�ﻊ ﻛﺑﻳ�ﺭ ﻳﺣﺗ�ﻭﻱ )(16 ﻣﺭﺑﻊ ﺻﻐﻳﺭ( ﻣﻊ ﺇﻫﻣﺎﻝ ﻋﺩﺩ ﺍﻟﻛﺭﻳﺎﺕ ﺍﻟﻭﺍﻗﻌﺔ ﻋﻠﻰ ﺣﺎﻓﺔ ﺃﻭ ﺧﺎﺭﺝ ﺍﻟﻣﺭﺑﻌﺎﺕ ﺍﻟﻛﺑﻳﺭﺓ. ﻳﻁﺑﻕ ﺍﻟﻘﺎﻧﻭﻥ ﺍﻟﺗﺎﻟﻲ: ّ ﺍﻟﻣﺟﻣﻭﻉ ﺍﻟﻛ ﻠ ﻲ ﻟﻠﺧﻼﻳﺎ X 200ــــــــــــــــــــــــــــــــــــــــــــــــــــ = W.B.Cs. 4
X 50ﺍﻟﻣﺟﻣﻭﻉ ﺍﻟﻛﻠّﻲ ﻟﻠﺧﻼﻳﺎ = W.B.Cs. (gﺍﻟﻣﻘﺩﺍﺭ ﺍﻟﻁﺑﻳﻌﻲ ﻟﻠﺑﺎﻟﻎ : (4000 – 11000 ) cell / mm3 ﺃﻣﺎ ﺣﺩﻳﺛﻲ ﺍﻟﻭﻻﺩﺓ ﻓﻳﺻﻝ ﺍﻟﻌﺩﺩ ﺇﻟﻰ( 26000 ) cell / mm3 :
or
.4ﻣﻌ���ﺩﻝ ﺗﺭﺳ���ﻳﺏ ﺍﻟﺧﻼﻳ���ﺎ ﺍﻟﺣﻣ���ﺭﺍء )-: (E.S.R. (aﻳﻭﺿ�ﻊ ﻣﻘ�ﺩﺍﺭ 0.4 mlﻣ�ﻥ ﻣﺣﻠ�ﻭﻝ Sodium citrateﻭﻫ�ﻭ ﻣ�ﺎﻧﻊ ﻟﻠﺗﺧﺛ�ﺭ ﻓ�ﻲ ﺃﻧﺑﻭﺑ�ﺔ ﺍﺧﺗﺑﺎﺭ Test tubeﻧﻅﻳﻔﺔ ﻭﺟﺎﻓﺔ. (bﻳﺅﺧﺫ 1.6 mlﻣﻥ ﺩﻡ ﺍﻟﻭﺭﻳﺩ ،ﻟﺫﻟﻙ ﻳﺻﺑﺢ ﺍﻟﻣﺟﻣﻭﻉ ﺍﻟﻛﻠﻲ ﻟﻠﻣﺣﻠﻭﻝ .2 ml (cﻳﺧﻠﻁ ﺟﻳﺩﺍً ﺑﻠﻁﻑ ،ﺛﻡ ﻳﺳﺣﺏ ﺑﻭﺍﺳﻁﺔ ﺍﻟﻣﺎﺻّﺔ ﺍﻟﺧﺎﺻّﺔ ﺑﺎﻟﻔﺣﺹ ،ﺛ ّﻡ ﺗﺛﺑّ�ﺕ ﺍﻟﻣﺎﺻّ�ﺔ ﺑﺷ�ﻛﻝ ﻋﻣﻭﺩﻱ ﻋﻠﻰ ﺍﻟﺭّ ﻙ ﺍﻟﺧﺎﺹ ﺑﺎﻟﻔﺣﺹ ﻟﻣ ّﺩﺓ ﺳﺎﻋﺔ ﻛﺎﻣﻠﺔ. (dﺗﻘﺎﺱ ﻛﻣﻳﺔ ﺍﻟﺩﻡ ﺍﻟﻧﺎﺯﻟﺔ ﻣﻥ ﺍﻟﺣﺩ ﺍﻟﻌﻠﻭﻱ 0 mmﺇﻟﻰ ﺣﺩ ﺍﻟﺩﻡ ،ﺃﻱ ﻛﻣﻳﺔ ﺍﻟﺑﻼﺯﻣﺎ. (eﺍﻟﻣﻘﺩﺍﺭ ﺍﻟﻁﺑﻳﻌﻲ : Normal values Male: (3 – 14) mm / 1 hr Female: (14 – 18) mm / 1 hr
Erythrocyte Sedimentation Range
.5ﻓﺻﻳﻠﺔ ﺍﻟﺩﻡ -: Blood group and Rh factor (aﺗﺅﺧﺫ ﺛﻼﺙ ﻗﻁﺭﺍﺕ ﻣﻥ ﺍﻟﺩﻡ ﻭﺗﻭﺿﻊ ﻋﻠﻰ ﺷ�ﺭﻳﺣﺔ ﺯﺟﺎﺟﻳّ�ﺔ ﺃﻭ ﻋﻠ�ﻰ ﻗﻁﻌ�ﺔ ﻣ�ﻥ )ﺍﻟﻔﺭﻓ�ﻭﺭﻱ( ﻧﻅﻳﻔﺔ ﻭﺟﺎﻓﺔ. (bﻳﺿﺎﻑ ﻗﻁﺭﺓ ﻟﻛ ّﻝ ﻗﻁﺭﺓ ﺩﻡ ﻋﻠﻰ ﺍﻟﺗﻭﺍﻟﻲ ﺍﻟﻣﺣﺎﻟﻳﻝ ﺍﻟﺗﺎﻟﻳﺔ .a anti A, anti B, anti D (cﺗﻣﺯﺝ ﺟﻳﺩﺍً ﺑﻭﺍﺳﻁﺔ ﺃﻋﻭﺍﺩ ﺧﺷﺑﻳﺔ ، Wood stickﺛ ّﻡ ﺗﺣﺭﻙ ﺍﻟﺷﺭﻳﺣﺔ ﺣﺭﻛﺔ ﺗﻣﻭّ ﺟﻳﺔ ﺧﻔﻳﻔﺔ ﻟﻌﺩﺓ ﻟﺣﻅﺎﺕ ﻟﻛﻲ ﻳﺗﻡ ﺍﻟﺗﻔﺎﻋﻝ ،ﻓﺈﺫﺍ ﺣﺩﺛﺕ ﺗﻛﺗﻼﺕ ﺻﻐﻳﺭﺓ ﻛﻣﺎ ﻓﻲ anti Dﺃﻭ ﻛﺑﻳﺭﺓ ﻛﻣ�ﺎ ﻓ�ﻲ ﺍﻟﺑﻘﻳﺔ ،ﻓﻳﺩﻝ ﺫﻟﻙ ﻋﻠﻰ ﺍﻟﻧﺗﻳﺟﺔ ﺍﻟﻣﻭﺟﺑﺔ ) (+veﺃﻣﺎ ﺇﺫﺍ ﺑﻘﻲ ﺍﻟﺩﻡ ﻣﺗﺟﺎﻧﺳﺎ ً ﻻ ﻳﺣﺗﻭﻱ ﺃﻱ ﺗﻛ�ﺗﻼﺕ ﻓﻬﺫﺍ ﻳﻌﻧﻲ ﺃﻥّ ﺍﻟﻧﺗﻳﺟﺔ ﺳﺎﻟﺑﺔ).(-ve
9
ﻭﺗﻘﺭﺃ ﺍﻟﻔﺻﻳﻠﺔ ﺣﺳﺏ ﺍﻟﺟﺩﻭﻝ ﺍﻟﺗﺎﻟﻲ: )Anti D (Rh
Anti B
-ve +ve -ve +ve -ve +ve -ve +ve
-ve -ve +ve +ve +ve +ve -ve -ve
.6 (a (b (c (d
(e
(f
Anti A 2B
1B
+ve +ve -ve -ve +ve +ve -ve -ve
ﺍﻟﻔﺻﻳﻠﺔ 3B
A -ve A +ve B -ve B +ve AB -ve AB +ve O -ve O +ve 0B
ﺗﻁﺎﺑﻕ ﺍﻟﺩﻡ -: Cross match ﺗﻁﺎﺑﻕ ﻓﺻﻳﻠﺗﺎ ﺍﻟﺩﻡ ﻟﻠﻣﺭﻳﺽ ﻭﻟﻠﻣﺗﺑﺭﻉ ﺑﺎﻟﺩﻡ .Donor ﻳﺅﺧﺫ ﺩﻡ ﺍﻟﻣﺭﻳﺽ ﻭﻳﻔﺻﻝ ﺑﺎﻟﻁﺭﺩ ﺍﻟﻣﺭﻛﺯﻱ ﺍﻟﻣﺻﻝ ﺃﻭ ﺍﻟﺑﻼﺯﻣﺎ ﻋﻥ ﺍﻟﺩﻡ. ﻳﺅﺧﺫ ﻣﻥ ﻗﻁﺭﺓ ﺇﻟﻰ ﺛﻼﺙ ﻗﻁﺭﺍﺕ ﻣﻥ ﺍﻟﺩﻡ ﻣﺑﺎﺷﺭﺓ ﻣﻥ ﺍﻟﻣﺗﺑﺭﻉ ﻗﺑﻝ ﺃﻥ ﻳﺗﺧﺛﺭ ،ﻭﺗﻭﺿﻊ ﻓ��ﻲ ﺃﻧﺑﻭﺑ��ﺔ ﺍﺧﺗﺑ��ﺎﺭ ﻧﻅﻳﻔ��ﺔ ﻭﺟﺎﻓ��ﺔ ،ﻭﻳﺿ��ﺎﻑ ﻟﻬ��ﺎ ﻣﺑﺎﺷ��ﺭﺓ ﻛﻣﻳ��ﺔ ﻣ��ﻥ ﺍﻟﻣﺣﻠ��ﻭﻝ ﺍﻟﻣﻠﺣ��ﻲ Normal Salineﺃﻟﻲ ﺛﻼﺙ ﺃﺭﺑﺎﻉ ﺍﻷﻧﺑﻭﺑﺔ ،ﻟﻳﺗﻡ ﻏﺳﻝ ﺍﻟﻛﺭﻳﺎﺕ ﺍﻟﺣﻣﺭﺍء. ﻳﻌﻣﻝ ﻟﻠﻣﺣﻠﻭﻝ ﻁﺭﺩ ﻣﺭﻛﺯﻱ ،ﺛ ّﻡ ﻳﺳﻛﺏ ﺍﻟﺭﺍﺋﻕ ،ﻭﻳﺅﺧﺫ ﺍﻟﺭﺍﺳﺏ ﻓﻘﻁ ﻭﻳﺿﺎﻑ ﻟﻪ N. S. ﻣﺭﺓ ﺃﺧﺭﻯ ﻭﻳﻣﺯﺝ ﺟﻳﺩﺍً ،ﻭﻳﻌﻣﻝ ﻁﺭﺩ ﻣﺭﻛﺯﻱ ﻣﺭّ ﺓ ﺃﺧ�ﺭﻯ ،ﻭﺗﻛ�ﺭﺭ ﻫ�ﺫﻩ ﺍﻟﻌﻣﻠﻳّ�ﺔ ﻟﻌ� ّﺩﺓ ﻣ��ﺭّ ﺍﺕ ﻟﺿ��ﻣﺎﻥ ﻏﺳ��ﻝ ﺍﻟﻛﺭﻳ��ﺎﺕ ﺍﻟﺣﻣ��ﺭﺍء ﺟﻳ��ﺩﺍً ﻭﻋ��ﺩﻡ ﺑﻘ��ﺎء ﺃﻱ ﻛﻣﻳ��ﺔ ﻣ��ﻥ ﺍﻟﻣﺻ��ﻝ )ﺍﻟ��ﺫﻱ ﻳﺣﺗﻭﻱ ﻋﻠﻰ Antibodiesﺍﻟﺫﻱ ﻳﺅﺛﺭ ﻋﻠﻰ ﺍﻟﻔﺣﺹ(. ﻳﺅﺧ��ﺫ ﻗﻁ��ﺭﺓ ﺇﻟ��ﻰ ﺛ��ﻼﺙ ﻗﻁ��ﺭﺍﺕ ﻣ��ﻥ ﻣﺻ��ﻝ ﺍﻟﻣ��ﺭﻳﺽ ،ﻭﺗﻭﺿ��ﻊ ﻋﻠ��ﻰ ﺷ��ﺭﻳﺣﺔ ﺯﺟﺎﺟﻳ��ﺔ ﻧﻅﻳﻔﺔ ﻭﺟﺎﻓﺔ ،ﻳﺿﺎﻑ ﻟﻬﺎ ﻧﻔﺱ ﺍﻟﻛﻣﻳﺔ ﻣﻥ ﻣﻌﻠّﻕ ﺩﻡ ﺍﻟﻣﺗﺑﺭّ ﻉ ﻣﻊ N. S.ﺍﻟ�ﺫﻱ ﺗ� ّﻡ ﻏﺳ�ﻠﻪ ﻋ ّﺩﺓ ﻣﺭّ ﺍﺕ ،ﻳﻣﺯﺝ ﺍﻟﻣﺻﻝ ﻣ�ﻊ ﺍﻟﻣﻌﻠّ�ﻕ ﺟﻳ�ﺩﺍً ،ﻭﺗﺗ�ﺭﻙ ﺍﻟﺷ�ﺭﻳﺣﺔ ﻓﺗ�ﺭﺓ ﺩﻗﻳﻘ�ﺔ ﺃﻭ ﺍﻛﺛ�ﺭ ﻓ�ﻲ ﺩﺭﺟﺔ ﺣﺭﺍﺭﺓ ﺍﻟﻐﺭﻓﺔ ﺃﻭ ﻓﻲ ﺩﺭﺟﺔ ﺣﺭﺍﺭﺓ .370C ﻳﺗﻡ ﻓﺣﺹ ﺍﻟﺷﺭﻳﺣﺔ ﻣﺟﻬﺭﻳﺎ ً ﻋﻠﻰ ﺍﻟﻘﻭﺓ ﺍﻟﺻﻐﺭﻯ ) ،(10xﻓﺈﺫﺍ ﻛﺎﻧﺕ ﺍﻟﻛﺭﻳﺎﺕ ﻣﺗﻛ ّﺗﻠﺔ ﻓﻲ ﻣﺟ�ﺎﻣﻳﻊ ﻓﻬ�ﺫﺍ ﻳﻌﻧ�ﻲ ﻋ�ﺩﻡ ﺗﻁ�ﺎﺑﻕ ﻓﺻ�ﻳﻠﺗﻲ ﺍﻟ�ﺩﻡ ﺃﻱ ،Cross match : Unfitﺃﻣ�ﺎ ﺇﺫﺍ ﻛﺎﻧﺕ ﺍﻟﻛﺭﻳﺎﺕ ﺍﻟﺣﻣﺭﺍء ﻣﻧﺗﺷﺭﺓ ﻭﻣﻧﻔﺻﻠﺔ ﻛ ّﻝ ﻛﺭّ ﻳﺔ ﻋﻠﻰ ﺣﺩﺓ ﻓﻬﺫﺍ ﻳﻌﻧﻲ ﺗﻁﺎﺑﻕ ﻓﺻﻳﻠﺗﻲ ﺍﻟﺩﻡ ﻟﻠﻣﺭﻳﺽ ﻭﺍﻟﻣﺗﺑﺭﻉ ،ﻭﺗﻛﻭﻥ ﺍﻟﻧﺗﻳﺟﺔ . Cross match : Fit
10