Chapter 8 UA Sediment Microscopic Flashcards
When is a microscope used to analyze urine/blood
1) when ordered by a physician
2) when determined by laboratory protocol (specific patient population, and services)
3) when abnormal macro and chemical results are obtained (bloody/cloudy appearance, ph> 8, positive protein, leukocyte esterase, nitrite, blood, glucose)
CLIA’88 complexity of microscopic exam
1) Moderate
2) provider performed microscopy (physician, midlevel practitioner, or dentist)
What are hematopoietic cells?
1) RBCs - dysmorphic, biconcave disc
2) WBCs - neutrophils, eosinophils, lymphocytes, histiocytes, macrophages, glitter
Types of epithelial cells
1) transitional → pear shaped
2) squamous → square shaped
3) renal tubular (round) → oval fat bodies
Physical and chemical results and exceptions for RBCs seen in microscope
Physical - turbidity, red color
Chemical - + blood, + protein
Exceptions- number, hemolysis
Physical and chemical results and exceptions for WBCs seen in microscope
Physical - turbidity
Chemical - + protein, + nitrite, + LE
Exception - number, lysis
Physical and chemical results and exceptions for Epithelial cells seen in microscope
Physical - turbidity
Chemical - none
Exception - number
Physical and chemical results and exceptions for casts seen in microscope
Physical - none
Chemical - + protein
Exception - number
Physical and chemical results and exceptions for Bacteria seen in microscope
Physical - turbidity
Chemical - ph, + nitrite, leukocytes
Exceptions - number and type
Physical and chemical results and exceptions for Crystals seen in microscope
Physical - turbidity, color
Chemical - ph, + bilirubin
Exception - number and type
Papanicolaou stain - atypical cytoplasm, large nuclei
Normal range of RBCs
0-3 RBC/high power field
Normal range of WBCs
0-5 WBC/ high power field
Normal range of hyaline casts
0-2 hyaline casts/low power field
Diagnostic elements
Clumps of WBC, RBC, most casts, increased renal tubular cells (RTC), oval fat bodies, microorganisms, abn crystals
Less important findings
Most crystals, mucous and squamous epithelial cells
RBCs morphology
Biconcave disc depending on osmotic gradient (ghost, swollen, crenated
Micro or gross hematuria
Dysmorphic red blood cells
Fragmented red cells accompanied with protein
- Glomerular bleeding
Hypertonic
Too much solute
- cell shrinks
Hypotonic
Too much H2O
- cell enlarges
RBCs can be confused with
Yeast
-Acetic acid will lyse red cells
Fresh RBCs
Dysmorphic and ghost RBCs
- watery urine or lysed cells, very alkaline
Identify the RBCs, squamous epithelia’s cells, and transitional
Yellow round = RBCs
Big squares = squamous epithelial
Medium round in right corner = transitional
RBC identification difficulties
- Yeast: look for buds
- oil droplets: refractility
- air bubbles: refractility/ possibly different plane
- starch: refractive, polarizes
- reagent strip correlation
Air bubble
Oil droplets
Neutrophils - granular spheres - multilobed nucleus • 2% acetic acid • reddish purple with stain
What disease?
Disease: pyuria
- pyelonephritis
- Cystitis
- prostatitis
- urethritis
Eosinophils
- drug-induced interstitial nephritis
- renal transplant rejection
- big red/orangish granules
- must have dye to see
Hansel stain
Eosinophils
- percent per 100 to 500 cells
- > 1% significant
- concentrate sediment, centrifuge, or cytocentrifuge
Monocytes/mononuclear cells
-Renal transplant rejection and chronic inflammation