4- Micro-examination: Cells Flashcards by The Deen

Urinary Sediment: Specimen preparation steps

• Centrifuge 10-15 ml of urine, 2000 rpm for 5 min.
• Pour off the supernatant fluid.
• Button mass remains at bottom of tube.
• Add one drop of sedi-stain.
• Place one drop of sediment on a slide and cover slip.
• Examine immediately.

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Normal amount of RBC _____ per high power field

0-3

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Describe RBCs

Round smooth cells

slightly red colour or yellowish

normal specific gravity of urine

disc shaped

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If specific gravity is more than 1.025 (hypertonic), what happens to RBCs

Lose their smooth texture

look like crenated (shrinked)

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If specific gravity less than 1.008 (hypotonic urine),
RBC appear as

“ghost” (partially lysed)

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More than 3 - 5 RBC per high power field is called

hematuria

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RBC in the slide may be confused with

oil droplets
or yeast cells.

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Oil droplets, however, exhibit a great variation in

size and are highly refractile

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Yeast cells usually are

ovoid

how budding and do not stain

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RBC vs Yeast

(picture)

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Exercise-induced hematuria is

self-limited,

benign condition.

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The results of Exercise-induced hematuria should be
negative after?

48 to 72 hours

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urinary tract diseases that causes hematuria

other urinary tract tumors
cystitis
urolithiasis
trauma
tuberculosis

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Pathology outside the urinary system that cause hematuria

liver failure
radiation disease
prostate diseases
diseases of uterus
overdoses of anticoagulants

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White Blood Cells Normal amount _____ per high power field

0-5

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More than 30 WBC per hpf indicated

pyuria

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WBCs size

Larger than RBCs but smaller than renal cells

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What type of WBCs is usually seen in urine

neutrophils
(Contain nuclei and granules/ Colourless)

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WBC vs RBC

(picture)

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WBC, RBC, Yeast presence indicate

UTI

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number of WBCs in an alkaline and hypotonic urine decreases by 50% within ___ hour after collection @ room temp

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Def: when WBCs expand in a dilute or hypotonic urine their granules are in Brownian motion

glitter cells

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Glitter cells were previously considered to be specific
for

pyelonephritis

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Increased WBC could be found in some physiological states:

dehydration
strenuous exercises

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Renal Diseases that raises WBCs

pyelonephritis kidney stones

Extra Renal Diseases that raises WBCs

inflammation of ureter, bladder, urethra urolithiasis prostatitis balanitis

How many tyoes of epithelial cells can be seen in urine

**3**

The three types of epithelial cells

Renal Transitional Squamous

Renal epithelial cells originate from

tubular portion of the nephrons and collecting ducts

Transitional cells originate from

the renal pelvis (caudate cells) upper 1/3 of the bladder and ureters (urothelial cells)

Squamous cells originate from

lower bladder urethra vagina

Epithelial Cells | (picture)

Describe Renal Tubular Epithelial Cells

few seen in urine Larger than leukocytes large round nucleus flat, cuboidal, or columnar shaped

Increased numbers of renal epithelial cells (15 cells per 10 hpfs) suggest tubular damage in

- pyelonephritis - acute tubular necrosis - acute trauma of kidney - kidney transplant rejection - neoplasms

Oval Fat Bodies are

renal tubular epithelial _{(with lipoproteins, cholesterol and triglycerides)} macrophage, or polymorphonuclear leukocytes (_{ingested lipids or degenerated)}

The presence of **lipid** accompanied by marked **proteinuria** is characteristic of

**nephrotic** syndrome

**Polarized** anisotropic fat droplets aka

Maltese crosses

Maltese crosses are composed of

**cholesterol**

Fat bodies consist of **triglycerides** or neutral fat will **not polarized** but will stain with:

Sudan III

detection of fat and oval fat bodies must be done through

**microscopic** examination

Lipiduria develops due to:

* Degeneration of tubules in **nephrotic syndrome** * Extensive superficial injuries with crushing of the subcutaneous fat * Fractures of the major long bones or pelvis

nephrotic syndrome is caused by

– chronic glomerulomephritis – diabetes mellitus – eclampsia – lipid nephrosis (minimal change disease) – toxic renal poisoning

Transitional epithelial cells are ____ times as large as white blood cells

2- 4

Transitional cells line the urinary tract are from

renal pelvis ureters and upper 1/3 of the bladder

Identify the type of cell: teardrop, pear-shaped cells, or may have tail-like projections with large nucleus located in the renal pelvis

caudate cells

Identify the type of cell: ``` ounded cells (look like hard boiled egg), occasionally may contain two nuclei located in the ureters and upper 1/3 of the bladder ```

urothelial cells

**Normal** amount of **Transitional** Epithelial Cells (TEC) **in the urine** of healthy persons is

**0 to few**

Increased amount of TEC could be found in

- urinary tract infection _{(upper or lower UTI)} - catheterisation of the ureter _{(ureteroscopy)} - transitional cell carcinoma _{(large clumps of the TEC)}

Squamous Epithelial Cells shapes:

* Large, flat, irregularly shaped cells * Flat scale-like shape, **(fried egg)**

describe the nucleus of Squamous Epithelial Cells

small central nucleus

Squamous Epithelial Cells Normal amount in urine?

up to 30 cells per field of vision

Large numbers of Squamous Epithelial Cells could represent:

- vaginitis - urethritis/ cystitis (low UTI) - testicular tumor - cystoscopy (diagnostic exam)

what's the bacterial count shoud be in normal urine?

**0** urine is normally **free** of bacteria

where does the bacterial contamination occur?

from bacteria present in the urethra or vagina, or from other external sources

Bacteria are reported according to

the number that is present | (few, moderate, many)

**bacteria** is easily recognized when the sediment is **viewed under**

**highpower magnification**

describe the shape of yeast

Smooth colorless ovoid cells with doubly refractile walls

yeasts replicate by

budding

yeast can be mistaken for

RBCs | (not insoluble in acid and alkali)

**most common yeast** to appear in the urine is

**Candida albicans**

Yeast may be **found in** patieths with | (**diseases**)

**UTI** **Diabetes** skin or vaginal contamination

describe the shape of Spermatozoa

Oval bodies with long, thin, delicate tails

Spermatozoa May be seen in urine of men after

epileptic convulsions or diseases of the genital organ

Spermatozoa May be seen in urine of women

after sex

Parasites can be found in urine due to

Vaginal or fecal contamination

Can chemical analysis detect parasites in urine?

how to detect parasites in urine?

Microscopic evaluation _{(WBCs may be present)}

the most frequently occurring parasite in the urine is

Trichomonas vaginalis

**Trichomonas vaginalis** is a **flagellate** organism that is about the same **size** as a

**large white cell**

In the **unstained** wet mount, Trichomonas vaginalis **should no**t be reported **unless**

it is **motile**

Trichomonas vaginalis more common in (**males/females**)?

more common in **females** _{may be found in males}

T. vaginalis is **frequently** accompanied by

**WBCs and epithelial cells**

Enterobius vermicularis aka

pinworm

what forms of Enterobius vermicularis (pinworm) are found in urine

**ova** and **female adult**

describe ova

one flat and one rounded side

# define the parasite: a **blood fluke** that inhabits the **veins** in the **wall** of the urinary **bladder**

**Schistosoma haematobium**

The adult Schistosoma haematobium deposits eggs in the capillaries of

mucosa

what can develop around the Schistosoma haematobium eggs?

Abscess

Schistosoma haematobium can be found in the urine accompanied by

RBCs and WBCs

what can be listed as Confusing Artifacts?

Fecal contamination Air bubbles Oil droplets

Air bubbles can assume a variety of shapes if

the **coverslip** **is moved or depressed**

Oil droplets in the urine are the result of contamination from

lubricants