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604 PART 8 ■ Fundamentals of Hematological Analysis
Microscopic Exam ination determine whether the sperm cells are able to penetrate the
Several microscopic procedures may be valuable in the assess- cervical mucus.
ment o seminal f uid. Tese procedures, in CLSI ormat, are In medicolegal cases, identi cation and security are para-
provided on this book’s companion Web site at thepoint.lww. mount, and the procedural protocol is determined by local
com/ urgeon6e. Enumeration o the number o sperm and jurisdiction. In cases o alleged rape or suspected sexual
examination o the morphological characteristics o the cells assault, vaginal smears may be submitted or evaluation o
are routinely per ormed procedures. Other microscopic pro- the presence o sperm. Sperm can be detected in the vagina
cedures include motility, viability, and agglutination studies. or 24 to 72 hours a er intercourse. However, the absence o
Agglutination may indicate sperm-agglutinating antibodies sperm does not mean that intercourse has not taken place.
or prostatitis. A signi cant increase in abnormal movements Procedures or the identi cation o semen stains on cloth-
o sperm, notably immobilizing-type motion, is highly sugges- ing may also be requested. T ese procedures can include
tive o the presence o sperm-immobilizing antibodies in the screening or A, B, or H blood group substances, the labile
f uid. Viability and mobility studies should also be correlated. enzyme marker peptidase A, and phosphoglucomutase
Morphological characteristics, the commonly encountered in combination with ABO typing. Other procedures can
variant orms, are presented in able 29.14. Increases in the include examination or f uorescence under ultraviolet light,
number o tapered spermatozoa and immature orms are re- acid phosphatase test, and enzyme-linked immunosorbent
quently characteristic o patients with a varicocele and those assay or p30 male-speci c semen glycoprotein o prostatic
who have been under extreme stress. Increases in both o these origin or an immunological precipitin test to identi y semen
variants are re erred to as a nonspeci c stress pattern. Other o human origin on clothing.
variants have no direct correlation with speci c disorders.
Sperm viability requires a very simple two-step staining Other Microscopic Features
procedure using eosin y as the stain and nigrosin as a coun- When sperm are being examined or morphological charac-
terstain. Using these stains, sperm that do not take up the teristics, the presence o other cellular elements (e.g., eryth-
stain are alive; dead sperm cells appear as pink cells because rocytes, leukocytes, or bacteria) in the specimen should
they do not take up the eosin stain. Additionally, a peroxi- be observed. Debris (e.g., precipitated stain) should not be
dase stain, or example, Leucostain, can be used to identi y mistaken or bacteria. All specimens should be observed or
peroxidase-positive leukocytes. richomonas parasites, particularly donor semen.
Semen pH should be between 7.2 and 7.8, ructose at 150 echnical Notes: I bacteria are observed, a sterile portion
to 600 mg/dL, and there should be ewer than 2,000 white o the specimen should be cultured. However, the probability
blood cells per mL. A pH o 8.0 or higher may indicate an o a positive nding is low. Semen or arti cial insemination
in ection, whereas a pH less than 7.0 suggests contamination should be tested or in ectious diseases (e.g., Neisseria gonor-
with urine or an obstruction in the ejaculatory ducts. rhoeae). I a man is being evaluated or in ertility, the speci-
Agglutination o sperm occurs when sperm stick together men should be cultured or Mycoplasma.
in a speci c and consistent manner (head to head, tail to
tail, etc.) suggesting an immunologic cause to in ertility. Synovial Fluid
Clumping o sperm in a nonspeci c manner may be due to Synovial (joint) f uid is a transparent, viscous f uid secreted
bacterial in ection or tissue contamination.
by the synovial membrane. T is f uid is ound in joint cavi-
ties, bursae, and tendon sheaths (Fig. 29.9). Its unction is to
Additional Laboratory Procedures
lubricate the joint space and transport nutrients to the artic-
Other techniques or the examination o semen may be ular cartilage. Impaired unction o synovial f uid with age or
requested in various situations. In cases o in ertility, cervical disease may play a role in the development o degenerative
mucus and sperm compatibility tests may be warranted to joint disease (osteoarthritis). A variety o disorders produce
changes in the number and types o cells and the chemical
composition o the f uid. Analysis o synovial f uid plays a
Sperm Morphology (Variant
TABLE 29.14 major role in the diagnosis o joint diseases.
Forms)
Type % Normal Limits Anatomy and Physiology of Joints
Immature sperm cells (spermatids) <15 Diarthrodial joints are lined at their margins by a syno-
vial membrane (synovium), with synovial cells lining this
Tapered heads <15
space. T e lining cells synthesize protein and are phago-
Poorly formed heads <15 cytic. Mechanical, chemical, immunological, or bacterio-
Double heads <5 logical damage may alter the permeability o the membrane
Large heads <5 and capillaries to produce varying degrees o inf ammatory
response. In addition, inf ammatory joint f uids contain lytic
Small heads <5
enzymes that produce depolymerization o hyaluronic acid,
Double or broken tails <5 which greatly impairs the lubricating ability o the f uid.
