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CLS 304 > Chapter 8 UA Sediment Microscopic > Flashcards

Chapter 8 UA Sediment Microscopic Flashcards

1
Q

When is a microscope used to analyze urine/blood

A

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)

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2
Q

CLIA’88 complexity of microscopic exam

A

1) Moderate

2) provider performed microscopy (physician, midlevel practitioner, or dentist)

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3
Q

What are hematopoietic cells?

A

1) RBCs - dysmorphic, biconcave disc

2) WBCs - neutrophils, eosinophils, lymphocytes, histiocytes, macrophages, glitter

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4
Q

Types of epithelial cells

A

1) transitional → pear shaped
2) squamous → square shaped
3) renal tubular (round) → oval fat bodies

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5
Q

Physical and chemical results and exceptions for RBCs seen in microscope

A

Physical - turbidity, red color
Chemical - + blood, + protein
Exceptions- number, hemolysis

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6
Q

Physical and chemical results and exceptions for WBCs seen in microscope

A

Physical - turbidity
Chemical - + protein, + nitrite, + LE
Exception - number, lysis

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7
Q

Physical and chemical results and exceptions for Epithelial cells seen in microscope

A

Physical - turbidity
Chemical - none
Exception - number

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8
Q

Physical and chemical results and exceptions for casts seen in microscope

A

Physical - none
Chemical - + protein
Exception - number

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9
Q

Physical and chemical results and exceptions for Bacteria seen in microscope

A

Physical - turbidity
Chemical - ph, + nitrite, leukocytes
Exceptions - number and type

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10
Q

Physical and chemical results and exceptions for Crystals seen in microscope

A

Physical - turbidity, color
Chemical - ph, + bilirubin
Exception - number and type

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11
Q
A

Papanicolaou stain - atypical cytoplasm, large nuclei

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12
Q

Normal range of RBCs

A

0-3 RBC/high power field

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13
Q

Normal range of WBCs

A

0-5 WBC/ high power field

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14
Q

Normal range of hyaline casts

A

0-2 hyaline casts/low power field

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15
Q

Diagnostic elements

A

Clumps of WBC, RBC, most casts, increased renal tubular cells (RTC), oval fat bodies, microorganisms, abn crystals

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16
Q

Less important findings

A

Most crystals, mucous and squamous epithelial cells

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17
Q

RBCs morphology

A

Biconcave disc depending on osmotic gradient (ghost, swollen, crenated
Micro or gross hematuria

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18
Q

Dysmorphic red blood cells

A

Fragmented red cells accompanied with protein

- Glomerular bleeding

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19
Q

Hypertonic

A

Too much solute

- cell shrinks

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20
Q

Hypotonic

A

Too much H2O

- cell enlarges

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21
Q

RBCs can be confused with

A

Yeast

-Acetic acid will lyse red cells

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22
Q
A

Fresh RBCs

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23
Q
A

Dysmorphic and ghost RBCs

- watery urine or lysed cells, very alkaline

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24
Q

Identify the RBCs, squamous epithelia’s cells, and transitional

A

Yellow round = RBCs
Big squares = squamous epithelial
Medium round in right corner = transitional

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25
Q

RBC identification difficulties

A
  • Yeast: look for buds
  • oil droplets: refractility
  • air bubbles: refractility/ possibly different plane
  • starch: refractive, polarizes
  • reagent strip correlation
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26
Q
A

Air bubble

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27
Q
A

Oil droplets

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28
Q
A 
Neutrophils
- granular spheres
- multilobed nucleus
• 2% acetic acid
• reddish purple with stain
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29
Q

What disease?

A

Disease: pyuria

  • pyelonephritis
  • Cystitis
  • prostatitis
  • urethritis
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30
Q
A

Eosinophils

  • drug-induced interstitial nephritis
  • renal transplant rejection
  • big red/orangish granules
  • must have dye to see
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31
Q

Hansel stain

A

Eosinophils

  • percent per 100 to 500 cells
  • > 1% significant
  • concentrate sediment, centrifuge, or cytocentrifuge
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32
Q
A

Monocytes/mononuclear cells

-Renal transplant rejection and chronic inflammation

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33
Q

Identify epithelial cells: RBC, squamous, WBC, RTE, transitional

A

From left to right:

Squamous, RTE, WBC, transitional, RBC

34
Q

Where are squamous epithelial cells found in the body?

A

Vagina, male and female urethra

35
Q

Where are transitional epithelial cells found in the body?

A

Bladder, renal pelvis, calyces, ureters, upper male urethra

36
Q

Where are renal tubular epithelial cells found in the body?

A

Renal tubules

37
Q
A

Squamous epithelial cells

  • large irregular, abundant cytoplasm, small prominent nucleus
  • slough from the vagina and urethra
  • normal finding seen more frequently in females
38
Q
A

Transitional epithelial cells
Morphology: pear, spheric, or caudate (tails). Round central nucleus
When in large numbers or clumps = bladder cancer

39
Q
A

Renal tubular epithelial cells
- round or oval, large prominent eccentric nucleus
Clinical significance: acute tubular necrosis, acute viral or bacterial infection, renal toxicity, glomerulonephritis

40
Q

RTECs that have absorbed lipids

A

Oval fat body

- confirmed by fat stains and polarized light

41
Q
A

Oval fat body

-Lipiduria: nephrotic syndrome

42
Q

Where are casts formed in the nephron?

A

Distal convoluted tubule or the collecting duct

43
Q

Factors that cause casts to form

A
  • Acidity increased
  • proteinuria
  • stasis
  • concentration increase
44
Q

Macroscopic (appearance) and chemical correlation of all casts

A

Appearance: variable
Chemical: pH acid, protein positive

45
Q

Macroscopic (appearance) and chemical correlation of RBC casts

A

Appearance: red, pink, non clear
Chemical: blood positive

46
Q

Macroscopic (appearance) and chemical correlation of WBC casts

A

Appearance: turbid to cloudy
Chemical: leukocyte esterase positive, nitrite variable

47
Q

Macroscopic (appearance) and chemical correlation of bilirubin casts

A

Appearance: Amber to brown
Chemical: bilirubin positive, urobilinogen positive

48
Q

Macroscopic (appearance) and chemical correlation of hemoglobin/myoglobin casts

A

Appearance: red to brown, clear
Chemical: blood positive

49
Q

Macroscopic (appearance) and chemical correlation of fatty casts

A

Appearance: turbid to oily
Chemical: none

50
Q
A

Hyaline cast

  • Homogenous, transparent, colorless cylinder with parallel sides and rounded ends
  • strenuous exercise
  • pathology in large numbers
51
Q
A

WBC cast

  • transparent cylindrical matrix with embedded WBCs
  • pyelonephritis or inflammatory renal disease
52
Q
A

RBC cast

  • transparent reddish-orange brown cylindrical matrix with embedded RBCs
  • significance: glomerulonephritis, glomerular bleeding, strenuous exercise
53
Q
A

Renal tubular cell cast

  • transparent clinidical protein matrix with embedded RTE cells
  • significance: renal tubular damage, acute nephritis, tubular necrosis
  • pink photo = terminally sick
54
Q
A

Granular cast

  • transparent cylindrical matrix with course or fine embedded granules
  • few seen after strenuous exercise
  • increased seen in urine stasis of cellular casts with same significance
  • deterioration, looks like fine granules
55
Q
A

Waxy cast

  • homogeneous, smooth, glassy opaque cylinder with cracked margins and broken off edges
  • Extreme urinary stasis, indicating chronic renal failure
  • cellular → granular → waxy
56
Q
A

Fatty casts

  • transparent cylinder filled with refractive fat droplets
  • Maltese cross formation in polarized light
57
Q

Fatty casts significance

A
  • Nephrotic syndrome
  • crush injuries
  • toxic tubular necrosis
  • diabetes mellitus
58
Q

Pathologic and seen in liver diseases, inborn errors of metabolism, or renal damage from medications (iatrogenic)

A

Urinary crystals

  • specific geometric forms or amorphous
  • crystallurig is usually clinically insignificant and non pathogenic
59
Q

How are crystals formed?

A
  • Increased solute formation
  • decreased urine flow
  • acidic pH
  • decrease in temperature after voiding
60
Q

Where are most uric acid crystals seen?

A

Leukemia, gout, lesch-nhyan

61
Q
A

Amorphous uric acid crystals

- acid pH yellow brown

62
Q
A

Macroscopic uric acid crystals

- pinkish sediment

63
Q
A

Calcium oxalate: dihydrate

  • colorless envelope shape
  • associated with foods high in oxalic acid
  • non pathogenic
  • tomatoes, asparagus (odor)
  • acid /neutral pH
64
Q
A

Calcium oxalate: monohydrate

  • oval dumbbell shape
  • can be seen in ethylene glycol poisoning
  • significant
  • acid/neutral pH
65
Q
A

Phosphates: amorphous

  • granular, white sediment
  • not pathogenic, can be from refrigeration
  • alk/neutral pH
66
Q
A

Phosphates: triple phosphates

  • coffin lids
  • alk/neutral pH
67
Q
A

Ammonium biurate

  • normal alk pH
  • yellow-brown “thorny apples” seen in old urine
  • accumulation of ammonia
68
Q
A

Calcium carbonate

  • normal alk pH
  • bow ties and dumbbell forms gas from acetic acid
69
Q
A

Cystine

  • abnormal crystals
  • Acid pH
  • colorless hexagonal plates seen in cystinuria, a metabolic disorder resulting in renal stones
70
Q
A

Chlesterol

  • abnormal crystal
  • acid pH
  • notched plates seen in Lipiduria produced in nephrotic syndrome
71
Q
A

Leucine

  • abnormal crystal associated with liver disease
  • spheres with concentric striations
72
Q
A

Tyrosine

  • abnormal crystal associated with liver disease
  • needles forming clumps
73
Q
A

Bilirubin

  • abnormal crystals associated with liver disease
  • reddish brown, clumped, needles
74
Q
A

Sulfa

- Iatrogenic (medication) crystals

75
Q
A

Ampicillin

- Iatrogenic (medication) crystals

76
Q
77
Q
78
Q
A 
Enterobius vermicularis (pinworm)
- parasite
79
Q
A

Schistosoma haematobium

- parasite

80
Q
A

Trichomonas vaginalis

-Parasite

81
Q
A

Starch/powder

- artifact

82
Q

CLS 304 (8 decks)

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