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AUBF LAB > M4U1: SEDIMENT PREPARATION AND EXAMINATION > Flashcards

M4U1: SEDIMENT PREPARATION AND EXAMINATION Flashcards

1
Q

This is a specialized centrifuge procedure used to produce a monolayer of the cellular constituents in various body fluids on a microscopic slide

A

cytocentrifugation

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2
Q

a chemical reaction used to identify the presence of iron in body fluids

A

Rous Test/Prussian blue staining

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3
Q

a glycoprotein that is secreted by the renal tubular cells of the thick ascending loop of Henle and distal convoluted tubules

A

Uromodulin/Tamm-Horsfall protein

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4
Q

This is the cellular pellet remaining after urine centrifugation

A

urinary sediment

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5
Q

A normal urinary sediment should be free of ___, contain ___

A

crystals

less cells and very low concentration of proteins

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6
Q

This refers to the ability of a substance to refract light in two directions

A

Birefringent/Double refractile

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7
Q

Type of microscopic illumination in which a lamp condenser located above the light source focuses the image of the light source onto the front focal plane of the condenser

A

Kohler illumination

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8
Q

Term describing objective lenses that remain in focus when the user switches from one objective to another of a different magnification

A

Parfocal

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9
Q

A traditional method developed to standardize the quantitation of formed elements in the urine

A

Addis count

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10
Q

Addis count uses a ___ to count the number of RBC, WBC, casts and epithelial cells present in a ___

A

hemocytometer

12-hour specimen

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11
Q

The ___ contribute formed elements of urine

A

blood, kidney, lower genitourinary tract and external contamination

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12
Q

These are to ensure the accuracy and precision of the urine microscopic examination

A

appropriate microscopy techniques

protocols on the standardization of sediment preparation should be implemented

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13
Q

What is the ideal specimen for sediment preparation ?

A

freshly collected or adequately preserved first morning specimen (midstream clean catch)

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14
Q

Formed elements such as RBC, WBC, and hyaline casts disintegrate rapidly in ___ urine

A

dilute, alkaline

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15
Q

How much specimen volume is used for sediment preparation ?

A

12 ml or volume ranging from 10-15 ml

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16
Q

If obtaining a 12 ml specimen is not possible for pediatric patients, the volume can be reduced to ___

A

6 ml

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17
Q

What must be done if the volume for sediment preparation is below 12 ml ?

A

noted on the report form to allow necessary corrections

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18
Q

What is the centrifuge speed used for sediment preparation and why ?

A

400-450 x g for 5 minutes

allow optimal sediment concentration without damaging fragile formed elements such as cellular casts

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19
Q

Why is it important that the centrifuge brake is not used ? and how does it affect the results ?

A

it will cause the sediment to resuspend, resulting in erroneously decreased numbers of formed elements in the concentrated sediment

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20
Q

What sediment concentration is desirable in manual techniques ?

A

24:1 or 12:1

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21
Q

This is done to maintain a uniform sediment concentration factor when decanting supernatant urine

A

should be aspirated off rather than poured off, unless otherwise specified by the method in use

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22
Q

Other than using a pipetter what else can be done for resuspension ?

A

gently flicking the bottom of the tube

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23
Q

Why is thorough resuspension of urinary sediment essential ?

A

provide equal distribution of elements in the microscopic examination field

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24
Q

What can too vigorous agitation of the sediment do ?

A

ma cause fragile and brittle formed elements, such as RBS casts and waxy casts, to break into pieces

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25
Q

When using the conventional glass slide method, the reccomended volume is ___

A

20 ul

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26
Q

Why must you ensure that the specimen does not flow outside of the coverslip ?

A

may result in the loss of heavier elements such as casts

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27
Q

A minimum of __ fields under both low and high-power objectives is examined

A

10

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28
Q

What is the purpose of examining the the slide under low power first ?

A

detect casts

ascertain the general composition of the sediment

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29
Q

The magnification is switched to high power field to ____ if the conventional glass-slide method is being used

A

delineate the structures seen

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30
Q

What happens to RBC in hypertonic urine ?

A

become smaller

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31
Q

How does an RBC look like when viewed from above and from the side ?

A

above: disk with central pallor
side: hourglass

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32
Q

What happens with RBC crenates ?

A

lose their biconcave shape

become spheres covered with spicules or crenation’s

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33
Q

What are the conditions that need to happen for an RBC to become a ghost cell ?

A

hypotonic urine

release their hemoglobin

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34
Q

What are the characteristics of a ghost cell ?

A

colourless
empty
intact membrane
no hemoglobin

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35
Q

What type of microscopy is best used to observe ghost cells ?

A

phase contrast

interference contrast

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36
Q

___ urine promotes RBC lysis and disintegration, resulting in ghost cells and RBC remnants

A

alkaline

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37
Q

What formed element is associated with acanthocytes or sickle cells in increased numbers ?

A

dysmorphic or distorted erythrocytes

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38
Q

Abnormal urine concentration affects RBC appearance, and small numbers of ____ cells are found with non-glomerular hematuria

A

dysmorphic

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39
Q

Hematuria accompanied by red blood cell casts, glomerular or tubular bleeding may be indicated, such as in cases of ___

A

glomerulonephritis
pyelonephritis
cystitis
presence of calculi

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40
Q

When an increased number of RBC’s is present without casts or proteinuria, what may be the cause of the bleeding ?

A

there is bleeding below the kidney

caused by contamination (menstrual blood, hemorrhoid)

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41
Q

Non-renal disorders such as ____ may also be attributed to the occurrence of hematuria

A 
hypertension
smoking
appendicitis
tumors
trauma
drugs (anticoagulant drugs and drugs inducing a toxic reaction like sulfonamides)
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42
Q

What may be the reason to a specimen having a positive chemical test for blood but microscopic examinations reveals no RBCs ?

A

lysis might have occurred especially if the sample is hypotonic or alkaline

lysis have already occurred within the urinary tract before collection

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43
Q

What may cause a false positive blood chemical test ?

A

myoglobin
microbial peroxidases
strong oxidizing agents

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44
Q

What may be the reason to a specimen having a negative chemical test but RBCs are present microscopically ?

A

ascorbic acid interference

possible that formed elements observed are not RBCs but look-alike components

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45
Q

What are formed elements that may look-alike RBC ?

A

yeast
oil droplets
bubbles
monohydrate calcium oxalate crystals

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46
Q

What are the solutions to confirm identity of RBC from look-alikes ?

A

staining

polarizing microscopy

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47
Q

What is the use of sternheimer-malbin stain ?

A

characteristically colours RBC

neither yeast nor calcium oxalate crystals stain

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48
Q

How to differentiate calcium oxalate crystals from RBC ?

A

polarizing microscopy - calcium oxalate crystals polarize light while RBC doesn’t

sternheimer-malbin stain - doesnt stain while RBC does

add 2% acetic acid - lyse RBC but doesn’t eliminate calcium oxalate crystals

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49
Q

How to differentiate yeasts from RBC ?

A

sternheimer-malbin stain - doesnt stain while RBC does

add 2% acetic acid - lyse RBC but doesn’t eliminate yeasts

tends to be spherical or ovoid rater than biconcave, often exhibits budding

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50
Q

How to differentiate droplets of oil from RBC ?

A

Bubbles and fat droplets:
variation in size
uniformity in appearance
high refractility

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51
Q

How to distinguish WBCs from crenated RBCs in a hypertonic urine specimen ?

A

acetic acid or toluidine blue stain

make it easier to see the nuclei of WBC

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52
Q

What WBC is most often observed in urine and why ?

A

neutrophils because they predominate in the peripheral blood

53
Q

What is the reason for naming neutrophils in dilute, hypotonic, alkaline urine “glitter cells” ?

A

Brownian movement of the refractive cytoplasmic granules

54
Q

This refers to the uncontrolled and fat movement of granules within the cytoplasm as a result of collision forces

A

Brownian movement

55
Q

What are the degenerative changes of neutrophils as they age ?

A

lobed nuclei fuse, resemble a mononuclear cell

formation of blebs
blebs can detach and become free floating in urine
blebs may develop and remain within the cell, pushing the cytoplasm to one side and giving rise to large pale areas intracellularly

development of myelin forms, from the breakdown of the cell membrane

additional vacuolization

rupturing

pseudopod formation

56
Q

What stains are used for eosinophils ?

A

Hansel strain is the primary stain

Wright stain can be alternatively used

57
Q

What conditions allow neutrophils to lyse rapidly ?

A

room temp
dilute, hypotonic, alkaline urine

50% in 2-3 hours

58
Q

These mononuclear cells are large cells and may appear vacuolated or contain inclusions

A

monocytes
macrophages
histiocytes

59
Q

When are macrophages called histiocytes ?>

A

reside in interstitial tissue

60
Q

What are the characteristics of enlarged macrophages ?

A

irregular, kidney-shaped nuclei

abundant cytoplasm

61
Q

This refers to the increased pus excretion in urine

A

Pyuria

62
Q

This refers to the increase in urinary WBCs

A

Leukocyturia

63
Q

When would trichomonads and mycoses appear in urine ?

A

women: contaminants from vaginal secretions
men: UTI

64
Q

These formed elements predominate in renal transplant rejection

A

lymphocytes

65
Q

____ is a good predictor of acute interstitial nephritis associated with drug hypersensitivity, particularly to penicillin and its derivatives

A

eosinophiluria

66
Q

Urinary eosinophils are primarily associated with ___

A

drug induced interstitial nephritis

67
Q

In cases of acute allograft rejection, the presence of large numbers of ____ in a kidney biopsy specimen is considered a poor prognostic indicator

A

eosinophils

68
Q

What would consist of the physical and chemical examination of urine with increased WBC ?

A

cloudy
gray-white sediment button
depending on extent of infection, strong foul odor

increased specific gravity
increased pH

69
Q

How much WBC is usually detected in LE screening test ?

A

10-25 WBC/microliter

70
Q

What is the reason for LE test + but no WBC present microscopically ?

A

WBC lysis

71
Q

What is the reason for LE test - but with WBC present microscopically ?

A

lymphocyte is present, they have no leukocyte esterase

72
Q

Owing to ____, hypotonic urine could cause the leukocyte to be diluted such that it is below the detection limit of the LE reaction

A

hydration

73
Q

What is the reason for LE test - with increased WBC found microscopically ?

A

check if reagent strip is functioning properly

look-a-like elements such as RTE may be present

74
Q

WBCs in the process of ameboid motion may be difficult to distinguish from epithelial cells because __

A

of their irregular shape

75
Q

How to make monocytes and macrophages more identified in the presence of RTE cells ?

A

suprivital stains on the urine sediment

making a cytocentrifuged preparation followed by Wright’s or Papanicolaou’s stain

addition of acetic acid to enhance nuclear detail

76
Q

What is the reason for epithelial cells being commonly resulted in urine ?

A

normal turnover of old cells (sloughing)

epithelial damage caused by inflammatory processes/renal disease

77
Q

What are the granulations found in squamous epithelial cells referred to as ?

A

keratohyalin granules

78
Q

This formed element is the first structure observed when the sediment is examined under low-power magnification

A

squamous epithelial cells

79
Q

Where do squamous epithelial cells originate from ?

A

linings of the vagina and the entire female urethra

lower/distal portion of the male urethra

80
Q

What pathologic significance does increased squamous epithelial cells mean ?

A

women: indicate vaginal or perineal contamination
men: uncircumcised, specimen contamination

81
Q

How can a squamous cell be considered a clue cell ?

A

covered with Gardnerella coccobacillus

bacteria should cover most of the cell surface and extend beyond the edges of the cell

82
Q

What is the routine testing for clue cells and what is it used to assess for ?

A

examine vaginal wet preparation

assess vaginal infection by bacterium Garnerella vaginalis

83
Q

What forms do transitional epithelium cells appear in ?

A

spherical
polyhedral
caudate

84
Q

Why do transitional epithelium cells have several forms ?

A

caused by the ability to absorb large amounts of water

85
Q

What are the three principal layers of transitional epithelium in the bladder ?

A

superficial cells
intermediate cells
basal cells

86
Q

Where do transitional epithelium cells originate from ?

A

lining of the renal pelvis, calyces, ureters, and bladder

upper portion of the male urethra except the distal portion

87
Q

Transitional epithelium cells are usually present in small numbers in normal urine of ____, representing normal cellular sloughing

A

0-2/hpf

88
Q

This is the increased number of transitional cells seen singly, in pairs, or in clumps

A

Syncytia

89
Q

Syncytia is present following invasive urologic procedures such as

A

catheterization or other types of instrument procedures (chemotherapy and radiation)

90
Q

An increase in transitional cells exhibiting abnormal morphology such as vacuoles and irregular nuclei may be indicative of ___

A

malignancy (transitional cell carcinoma and neoplasia in the genitourinary tact)
viral infection

91
Q

Urine specimens with increased transitional epithelial cells will appear ___ and is ___ for blood and protein if malignancy is considered

A

turbid

positive

92
Q

How to differentiate PCT cells from a granular or fatty cast ?

A

casts do not have nucleus

93
Q

How to differentiate DCT cells from WBC’s and spherical transitional epithelium cells ?

A

observation of the eccentrically placed round nucleus

94
Q

In observing a collecting duct cell, what must be noted for it to be identified as a fragment ?

A

at least three cells must be sloughed together with a bordering edge intact

95
Q

What is the one distinguishing characteristic of a small duct cell ?

A

flat/corner edge on the membrane of the cell

96
Q

Small duct cells become wider as they approach the ____

A

renal calyces

97
Q

____ cells are the most clinically significant of the epithelial cells

A

RTE

98
Q

The presence of increased amounts of RTE is indicative of ___

A

necrosis of the renal tubules (acute ischemic or toxic tubular necrosis) from heavy metals

drug toxicity (aminoglycosides)

99
Q

____ are found following trauma, shock, or sepsis, and indicate ischemic necrosis and severe tubular injury with basement membrane disruption

A

collecting duct fragments

100
Q

____ are often observed in cases pyelonephritis, acute tubular necrosis, kidney transplant, rejection, and salicylate poisoning

A

large duct cells

101
Q

RTE cells nucleus is not easily visible in unstained sediment, what is done to make it easier to identify ?

A

cytocentrifugation followed by Papanicolau’s staining of the urine sediment

102
Q

RTE can absorb ____ (as a result of liver damage) present in the filtrate and appear deep yellow

A

bilirubin

103
Q

RTE can absorb ___ and be converted to hemosiderin

A

hemoglobin

104
Q

Following hemoglobinuria, the RTE cells may contain the characteristic ____

A

yellow-brown hemosiderin granules

105
Q

Urine specimen with increased RTE would appear ___ and ____ would be positive for chemical tests

A

turbid

blood
protein
LE
nitrite

106
Q

___ that absorbed lipids/fats presents in the glomerular filtrate are referred to as oval fat bodies

A

RTE cells
monocytes
macrophages

107
Q

Oval fat body presence may indicate +++

A

glomerular dysfunction
renal tubular cell death

lipiduria caused by nephrotic syndrome, sever tubular necrosis, diabetes mellitus, and trauma that cause release of bone marrow fat from long bones

108
Q

In cases of acute tubular necrosis, RTE cells containing large, ___ may be seen along with normal renal tubular cells and oval fat bodies

A

nonlipid-filled vacuoles

109
Q

Referred to as ___, they appear to represent injured cells in which the endoplasmic reticulum has dilated prior to cell death

A

bubble cells

110
Q

Identification of oval fat bodies is confirmed by staining the sediment with ___ or ____ and examining the sediment using ____ microscopy

A

Sudan III
Oil Red O fat stains
- triglycerides and neutral fats are stained orange-red

polarized

111
Q

What characteristic is observed when cholesterol is under polarized microscopy ?

A

maltese cross

112
Q

Staining increases the overall visibility of elements using bright-field microscopy by ___

A

changing their refractive index

113
Q

This is a supravital stain, consisting of crystal violet and safranin, most frequently used in urinalysis

A

Sternheimer-Malbin stain

114
Q

What colour does sternheimer-malbin stain epithelial cells, WBCs, RBCs, casts inclusions, and low refractile elements to ?

A

pink to purple

115
Q

A metachromatic stain that provides the enhancement of the nuclear details of a cell

A

0.5% solutions of toluidine blue

116
Q

This stain can be useful in the differentiation between WBCs and renal tubular epithelial cells and is also used in the examination of cells from other body fluids

A

0.5% solutions of toluidine blue

117
Q

This stain with the use of polarizing microscopy, it can be used to confirm the presence of fat

A

Oil Red O and Sudan III

118
Q

This stain is used primarily in the microbiology section for the differentiation between gram-positive and gram-negative bacteria

A

Gram stain

119
Q

This stain is used to facilitate the visualization of hemosiderin, free floating or embedded in epithelial cells and casts

A

Prussian blue stain

120
Q

This is a type of microscopy that produces a magnified image that appears dark against a bright or white background

A

Brightfield microscopy

121
Q

This type of microscopy is used to identify and classify birefringent substances that shine brilliantly against a dark background

A

Polarized microscopy

122
Q

substances in urinalysis that can polarize light are

A 
uric acid crystals
monohydrate calcium oxalate
fiber
plastic fragments
amorphous crystals (urate:strongly, phosphate:weakly)
fatty casts
cholesterol globules
starch granules
123
Q

substances in urinalysis that do not polarize light are

A 
RBCs
casts
mucus
bacteria
cellular debris
124
Q

Type of microscopy in which variations in the specimen’s refractive index are converted into variations in light intensity or contrast

A

Phase-contrast microscopy

125
Q

This type of microscopy is ideal for viewing low-refractile elements (hyaline cast, bacteria, mucus threads) and living cells (trichomonas)

A

Phase-contrast microscopy

126
Q

This type of microscopy provides a three-dimensional image of an element, either low or high refractive index, thus enhancing the cellular debris

A

Interference-contrast microscopy

127
Q

This type of microscopy is often used for unstained specimens

A

Dark-field microscopy

128
Q

Dark-field microscopy is often used to identify the specimen ___

A

spirochete Treponema pallidum

129
Q

This type of microscopy is used to detect bacteria and viruses within cells and tissues through a technique called immunofluorescence

A

Fluorescence microscopy

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