4- Micro-examination: Cells Flashcards
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.
Normal amount of RBC _____ per high power field
0-3
Describe RBCs
Round smooth cells
slightly red colour or yellowish
normal specific gravity of urine
disc shaped
If specific gravity is more than 1.025 (hypertonic), what happens to RBCs
Lose their smooth texture
look like crenated (shrinked)
If specific gravity less than 1.008 (hypotonic urine),
RBC appear as
“ghost” (partially lysed)
More than 3 - 5 RBC per high power field is called
hematuria
RBC in the slide may be confused with
oil droplets
or yeast cells.
Oil droplets, however, exhibit a great variation in
size and are highly refractile
Yeast cells usually are
ovoid
how budding and do not stain
RBC vs Yeast
(picture)
Exercise-induced hematuria is
self-limited,
benign condition.
The results of Exercise-induced hematuria should be
negative after?
48 to 72 hours
urinary tract diseases that causes hematuria
- other urinary tract tumors
- cystitis
- urolithiasis
- trauma
- tuberculosis
Pathology outside the urinary system that cause hematuria
- liver failure
- radiation disease
- prostate diseases
- diseases of uterus
- overdoses of anticoagulants
White Blood Cells Normal amount _____ per high power field
0-5
More than 30 WBC per hpf indicated
pyuria
WBCs size
Larger than RBCs but smaller than renal cells
What type of WBCs is usually seen in urine
neutrophils
(Contain nuclei and granules/ Colourless)
WBC vs RBC
(picture)
WBC, RBC, Yeast presence indicate
UTI
number of WBCs in an alkaline and hypotonic urine decreases by 50% within ___ hour after collection @ room temp
1
Def: when WBCs expand in a dilute or hypotonic urine their granules are in Brownian motion
glitter cells
Glitter cells were previously considered to be specific
for
pyelonephritis
Increased WBC could be found in some physiological states:
- dehydration
- strenuous exercises
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?
No
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 not 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
