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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
RBC identification difficulties
- Yeast: look for buds - oil droplets: refractility - air bubbles: refractility/ possibly different plane - starch: refractive, polarizes - reagent strip correlation
26
Air bubble
27
Oil droplets
28
``` Neutrophils - granular spheres - multilobed nucleus • 2% acetic acid • reddish purple with stain ```
29
What disease?
Disease: pyuria - pyelonephritis - Cystitis - prostatitis - urethritis
30
Eosinophils - drug-induced interstitial nephritis - renal transplant rejection - big red/orangish granules - must have dye to see
31
Hansel stain
Eosinophils - percent per 100 to 500 cells - >1% significant - concentrate sediment, centrifuge, or cytocentrifuge
32
Monocytes/mononuclear cells | -Renal transplant rejection and chronic inflammation
33
Identify epithelial cells: RBC, squamous, WBC, RTE, transitional
From left to right: | Squamous, RTE, WBC, transitional, RBC
34
Where are squamous epithelial cells found in the body?
Vagina, male and female urethra
35
Where are transitional epithelial cells found in the body?
Bladder, renal pelvis, calyces, ureters, upper male urethra
36
Where are renal tubular epithelial cells found in the body?
Renal tubules
37
Squamous epithelial cells - large irregular, abundant cytoplasm, small prominent nucleus - slough from the vagina and urethra - normal finding seen more frequently in females
38
Transitional epithelial cells Morphology: pear, spheric, or caudate (tails). Round central nucleus When in large numbers or clumps = bladder cancer
39
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
RTECs that have absorbed lipids
Oval fat body | - confirmed by fat stains and polarized light
41
Oval fat body | -Lipiduria: nephrotic syndrome
42
Where are casts formed in the nephron?
Distal convoluted tubule or the collecting duct
43
Factors that cause casts to form
- Acidity increased - proteinuria - stasis - concentration increase
44
Macroscopic (appearance) and chemical correlation of all casts
Appearance: variable Chemical: pH acid, protein positive
45
Macroscopic (appearance) and chemical correlation of RBC casts
Appearance: red, pink, non clear Chemical: blood positive
46
Macroscopic (appearance) and chemical correlation of WBC casts
Appearance: turbid to cloudy Chemical: leukocyte esterase positive, nitrite variable
47
Macroscopic (appearance) and chemical correlation of bilirubin casts
Appearance: Amber to brown Chemical: bilirubin positive, urobilinogen positive
48
Macroscopic (appearance) and chemical correlation of hemoglobin/myoglobin casts
Appearance: red to brown, clear Chemical: blood positive
49
Macroscopic (appearance) and chemical correlation of fatty casts
Appearance: turbid to oily Chemical: none
50
Hyaline cast - Homogenous, transparent, colorless cylinder with parallel sides and rounded ends - strenuous exercise - pathology in large numbers
51
WBC cast - transparent cylindrical matrix with embedded WBCs - pyelonephritis or inflammatory renal disease
52
RBC cast - transparent reddish-orange brown cylindrical matrix with embedded RBCs - significance: glomerulonephritis, glomerular bleeding, strenuous exercise
53
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
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
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
Fatty casts - transparent cylinder filled with refractive fat droplets - Maltese cross formation in polarized light
57
Fatty casts significance
- Nephrotic syndrome - crush injuries - toxic tubular necrosis - diabetes mellitus
58
Pathologic and seen in liver diseases, inborn errors of metabolism, or renal damage from medications (iatrogenic)
Urinary crystals - specific geometric forms or amorphous - crystallurig is usually clinically insignificant and non pathogenic
59
How are crystals formed?
- Increased solute formation - decreased urine flow - acidic pH - decrease in temperature after voiding
60
Where are most uric acid crystals seen?
Leukemia, gout, lesch-nhyan
61
Amorphous uric acid crystals | - acid pH yellow brown
62
Macroscopic uric acid crystals | - pinkish sediment
63
Calcium oxalate: dihydrate - colorless envelope shape - associated with foods high in oxalic acid - non pathogenic - tomatoes, asparagus (odor) - acid /neutral pH
64
Calcium oxalate: monohydrate - oval dumbbell shape - can be seen in ethylene glycol poisoning - significant - acid/neutral pH
65
Phosphates: amorphous - granular, white sediment - not pathogenic, can be from refrigeration - alk/neutral pH
66
Phosphates: triple phosphates - coffin lids - alk/neutral pH
67
Ammonium biurate - normal alk pH - yellow-brown "thorny apples" seen in old urine - accumulation of ammonia
68
Calcium carbonate - normal alk pH - bow ties and dumbbell forms gas from acetic acid
69
Cystine - abnormal crystals - Acid pH - colorless hexagonal plates seen in cystinuria, a metabolic disorder resulting in renal stones
70
Chlesterol - abnormal crystal - acid pH - notched plates seen in Lipiduria produced in nephrotic syndrome
71
Leucine - abnormal crystal associated with liver disease - spheres with concentric striations
72
Tyrosine - abnormal crystal associated with liver disease - needles forming clumps
73
Bilirubin - abnormal crystals associated with liver disease - reddish brown, clumped, needles
74
Sulfa | - Iatrogenic (medication) crystals
75
Ampicillin | - Iatrogenic (medication) crystals
76
Bacteria
77
Fungi
78
``` Enterobius vermicularis (pinworm) - parasite ```
79
Schistosoma haematobium | - parasite
80
Trichomonas vaginalis | -Parasite
81
Starch/powder | - artifact
82
Fiber

CLS 304 (8 decks)

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