Microscopic Analysis Flashcards
Microscope used for Routine UA
Bright-Field
Microscope used with LOW REFRACTIVE INDICES hyaline cast, mixed cellular cast, mucus threads, and Trichomonas
Phase-contrast
Microscope used for Cholesterol, oval fat bodies, fatty casts, and crystals
Polarizing Microscope
Microscope used for Treponema Pallidum
Dark-Field
Microscope used for naturally fluorescent microorganisms, or applied with fluorescent dye
Fluorescent Microscope
Microscope that provides 3-dimensional imaging, or layer by layer Image
Interference contrast
Bright field to Polarizing Microscope
add 2 filters
1. between light source and specimen
2. Analyzer filter: above specimen; between eyepiece and objective
Convert Bright to Dark Field
Add dark field condenser with opaque disk
2 types of Interference-Contrast Microscope
- Hoffman
- Nomarski
Interference-Contrast:
Modulation contrast
Hoffman
Interference-Contrast:
Differential
Nomarski
Interference-contrast Microscopes both adapt
Bright Field
Primary Components of Len System (4)
- Objective
- Ocular (Eyepiece)
- Coarse Adjustment Knob
- Fine Adjustment Knob
Primary Lens System:
Initial magnification
Objective
Primary Lens System:
FURTHER magnification and enhanced by objective
Ocular (Eyepiece)
Primary Lens System:
Move stage up and down
Coarse Adjustment Knob
Primary Lens System:
Sharpen image
Fine adjustment knob
Illumination System composed of (4)
- Light Source
- Condenser
- Aperture
- Field Diaphragm
Illumination System:
Found in Modern Microscope
contains RHEOSTAT to regulate intensity of Light
Light Source
Illumination System
Focuses light and control UNIFORM illlumination
Condenser
Illumination System
control AMOUNT OF LIGHT
Aperture (Iris)
Illumination System
Control DIAMETER of light beam
Field Diaphragm
Microscope BODY consist of (3)
- Base
- Body Tube
- Nosepiece
Delineates Nuclear and Cytoplasm structure
Sternheimer-Malbin
Sternheimer-Malbin consist of 2 stains:
Crystal Violet
Safranin O
Sternheimer-Malbin stains structures like
WEC
WBC
Epithelial cells
Cast
Stains that Differentiates WBC and RTE cells; stains Nuclear structure
Toluidine blue
Substitute for Toluidine blue
Acetic Acid
With Eccentric Nucleus
RTE cells
maaRTE
Stains for Lipid; neutral fats and triglycerides
Oil Red O
Sudan III
Stains for IRON
Prussian Blue Stain
Identifies yello-brown granules of Hemosiderin
Prussian blue
Simple stain that enhance nuclear details of EPITHELIAL CELLS
Methylene Blue
Yellow-brown granules that seen in cells and cast from episodes of HEMOGLOBINURIA
Hemosiderin
KOVA stain is
Modified Sternheimer-Malbin Stain
Used in Automatic Microscopy:
Stains DNA with ORANGE dye
Phenathridine
Used in Automatic Microscopy:
Stains GREEN; nuclear, MITOCHONDRIA, Negative cell membrane
Carbocyanine
Automated Microscopy used
Sysmex UF-100
UF-50 Urine Cell Analyzer
First procedure to be STANDARDIZED TO QUANTIFY FORMED ELEMENTS in urine
Addis Count
Addis Count is discovered by
Thomas Addis
Addis count:
Method of Collection
Preservative
12 hr urine
Formalin
Addis count quantifies (4)
RBC
WBC
Epithelial Cells
Cast
Addis Count Normal Values:
RBC
0 TO 500,000 RBC
Addis Count Normal Values:
WBC
0 to 1.8 M WBC
Addis Count Normal Values:
Hyaline Cast
0 to 5, 000 Hyaline Cast
Microscopic Examination: Specimen Preparation
Centrifuge
5 minutes
400 RCF
Microscopic Examination: Specimen Preparation
Fields to Examined
under what Objective (2)
10 FIELDS
LPO (10x) and HPO (40x)
Microscopic Examination: Specimen Preparation
Microscope properties to consider
Reduced Light in Bright Field Microscopy
Microscopic Examination
RFMoMA
Rare, Few, Moderate, Many:
= RFMoMa / HPF
RFMoMa / HPF
TTBYaN
Trichomonas
Transitional Epithelial Cells
Bacteria
Yeast
Normal Crystal
Microscopic Examination
RFMoMA
Rare, Few, Moderate, Many:
= RFMoMa / LPF
RFMoMa / LPF
*Squammy MuMu
Mucous Threads
Mucus secretion
Squamous Epithelial Cells
Microscopic Examination
AVERAGE / HPF
ROWR
RBC
Oval Fat Bodies
WBC
RTE cells
Microscopic Examination
AVERAGE / LPF
CastCrAb
Cast
Abnormal Crystal
Normal Findings
RBCs /HPF
0-2 or 0-3 RBC/ HPF
Normal Findings
WBCs /HPF
0-5 OR 0-8 WBC/HPF
Normal Findings
Hyaline Cast /LPF
0-3 Hyaline / LPF
Non-nucleated, biconcave disk
RBC cells
RBC appears in HYPERSTENURIC / HIGH SPECIFIC GRAVITY environment
Crenated
RBC appears in HYPOSTENURIC / DILUTED URINE environment
Ghost Cells
Dysmorphic RBC is clinically associated with
Glomerular Membrane Damage
(Acute Glomerulonephritis)
RBC Sources of Error:
RBC is mistakenly identified as
Yeast Cells
Oil Droplets
Air Bubbles
RBC Sources of Error Remedy
Use of Acetic Acid (lyse RBC)
Presence of abundant amount of WBC in urine
Pyuria
Larger than RBC
WBC
Type of WBC that is seen in HYPOTONIC urine and exhibit Brownian Movement
Glitter Cell
Stain used for WBC
Sternheimer-Malbin
Sternheimer-Malbin stains
Glitter Cells
Light Blue
Sternheimer-Malbin stains
Neutrophils
Violet
Eosinophils >1% clinical significant
Acute Interstitial Nephritis
Largest Cells found in Urine
Squamous Epithelial Cells
Squamous Epithelials surrounded with coccobacillus
Clue cells
Clue cells Clinical significant
Bacterial vaginosis / Vaginitis
Clue cells is due to
Gardnerella vaginalis
It is a type of Epithelial cells that has polyhedral, caudate, and in columnar shape with CENTRALLY located nucles
Transitional Epithelial Cells
Small amount of Transitional Epithelial cells in urine is normal ; it is found in renal pelvis, bladder, urethra
f/t
TRUE
Most clinically significant Epithelial Cells
Renal Tubular Cells
Epithelial Cells that are rectangular, polyhedral, cuboidal/ columnar with ECCENTRIC NUCLEUS
Renal Tubular Epithelial Cells
> 2 RTE / HPF
Tubular Injury
It is a type RTE filled with Lipids
Oval Fat Bodies
Oval Fat Bodies is clinically associated with
Nephrotic Syndrome
Type of RTE cells that is a empty-filled vacuole
Bubble Cells
Bubble cells is clinically associated with
Acute Tubular Necrosis
It is used to detect UTI with the presence if WBC
Bacteria
What should be tested in differentiating BACTERIA FROM AMORPHOUS URATES AND PHOSPHATE
Motility
It is usually associated in patients with DM which secretes glucose in urine
Yeast
Yeast may appear with or without buds
T/F
True
Most Frequently encountered parasite in URINE
Trichomonas Vaginalis
They have undulating memebrane, flagella and exhibits rapid Darting motility
Trichomonas vaginalis
Preparation of urine to observe movement of T.vaginalis
Wet Preparation
To avoid error in identifying T.vaginalis as RTE cells, WBC, Transitional, what kind of Microscope to be used
Phase-contrast
Parasite seen in patient with BLADDER CANCER
Schistosoma haematobium
Parasite associated with Hematuria
Schistosoma haematobium
Parasite that is most common fecal contamination
Enterobius vermicularis (Pinworm ova)
Vaginal contaminant; seen in female urine after recent sexual intercourse
Spermatozoa
No clinical significance; protein secreted by glands and ET cells of lower genitourinary tract RTE cells
Mucus
Urine sediment that is UNIQUE TO KIDNEY
Cast
Present of Cast in urine is known as
Cylinduria
Major constituent of Cast
Tamm–Horsfall Protein (Uromodulin)
Casts are formed in
DC
Distal convulated tube
Collecting ducts
Cast are prone to located at the ___ of cover slip
Near Edges
same clinical significance with cast but they are formed in ASCENDING LOOP OF HENLE AND DISTAL CONVULATED TUBE that produce TAPERED ENDS
Cylindroids
Most Frequently seen cast
Hyaline Cast
Normal Hyaline Cast Report
0-2 Hyaline / Lpf
Stain in Hyaline Cast
Sternheimer-Malbin
Pink
Clinical Significance of Hyaline Cast
Glomerulonephritis
Pyelonephritis
Chronic Renal Disease
Congestive Heart Failure
Stress and Exercise
Cast seen in damaged glomerulus; Glomerulonephritis
RBC cast
Cast signifies inflammation and infection in nephrons
WBC Cast
WBC Cast, WBC, Bacteria
Peylonephritis
WBC, Bacteria
Cystitis
WBC Cast
Acute interstitial nephritis
Cast confirmed by Gram staining
Bacterial cast
Cast associated with Heavy metals, and chemical/Drug Induced toxicity, viral infection, allograft rejection
Epithelial Cell Cast
Epithelial Cell Cast Clinical Significance
Renal Tubular Damage
Cast that may be pathologic or non-pathologic
Coarse / Fine Granular Cast
Cast usually associated with Oval Fat Bodies and Free Fat Droplets
Fatty Cast
Nephrotic Syndrome
Toxic Tubular Necrosis
Diabetes Mellitus
Crush Injuries
Fatty Cast
Cast with Jagged ends, Notched, and fragmented seen in Chronic Renal failure
Waxy Cast
Patient has Chronic Renal Failure and has stasis in urine
Waaxy Cast
Known as the ‘Renal Failure Cast’
Broad Cast
Extreme Urine Stasis
Renal Failure
Broad Cast
Glomerulonephritis and Nephrotic Syndrome in same urine specimen
Abundant Granular, Waxy, and Broad Cast
Telescope Urine Sediment
Telescope Urine Sediment is seen in patient with
Collagen Vascular Disease
Lupus Nephritis
Subacute Bacterial Infections
ACIDIC URINE: Normal Crystals (3)
Amorphous urates
Uric Acid
Calcium Oxalate
ACIDIC URINE: Normal Crystals
yellow-brown; brick dust
Pink sediment (when refrigerated)
Amorphous Urates
ACIDIC URINE: Normal Crystals
This can be converted to Uric Acid upon addition with ACETIC ACID
Soluble to Alkali and Heat (60 deg C)
Amorphous Urates
ACIDIC URINE: Normal Crystals
Rhombic, Whetstones, Lime-shaped
Looked Like Cystine Crystals
Uric Acid
ACIDIC URINE: Normal Crystals
Seen in Patient with Leukemia that undergoes Chemotherapy
Lesch-Nyhan Syndrome
Uric Acid
ACIDIC URINE: Normal Crystals
Uric Acid Crystal is soluble in
Alkali
ACIDIC URINE: Normal Crystals
Crystals can be formed under Alkali, acidic, and Neutral pH
Calcium Oxalate
ACIDIC URINE: Normal Crystals
Whedellite
Dihyrdrate
Most Common
Envelope / Pyrimidal
ACIDIC URINE: Normal Crystals
Whewellite
Monohydrate
Less frequent
dumbell / Oval
ACIDIC URINE: Normal Crystals
Majority Renal Calculi forms
CaOx
ACIDIC URINE: Normal Crystals
CaOx Pathologic Significance
Etyhylene Glycol Poisoning (Dumbell, Monhydrate)
ACIDIC URINE: Normal Crystals
CaOx is soluble in
dilute HCl
ALKALINE URINE: Normal Crystals (5)
Amorphous Phosphates
Ammonium Biurate
Triple Phosphate
Calcium Phosphate
Calcium Carbonate
ALKALINE URINE: Normal Crystals
Same as with Amorphous Urates
White Precipate that does not dissolve on warming
Ammonium phosphate
ALKALINE URINE: Normal Crystals
Ammonium phosphate is soluble in
Dilute Acetic Acid
ALKALINE URINE: Normal Crystals
Thorny apple; seen in Old Specimen; Urea Spitting Bacteria is present
Ammonium Biurate
ALKALINE URINE: Normal Crystals
Converted to Uric Acid in the presence of GLACIAL ACETIC ACID, dissolved in Heat (60 Deg C)
Ammonium Biurate
ALKALINE URINE: Normal Crystals
Also known as MAP (Magnesium Ammonium Phosphate); Struvites
Staghorn calculi
Triple PhosphateALKALINE URINE: Normal Crystals
ALKALINE URINE: Normal Crystals
Coffin lid shaped
When disintegrated, appear Feathery Appearance
Highly Alkaline Urine (Urea-spitting)
Triple phosphate
ALKALINE URINE: Normal Crystals
Triple phosphate is soluble in
Dilute Acetic Acid
ALKALINE URINE: Normal Crystals
Also known as Apatite or Hyroxyapatite
Calcium phosphate
ALKALINE URINE: Normal Crystals
colorless, flat rectangular plates or thins prisms often in Rosette forms; MAY BE CONFUSED WITH SULFONAMIDES IN NEUTRAL pH
Calcium Phosphate
ALKALINE URINE: Normal Crystals
Confirmation to diff. Calcium Phosphate and Sulfonamides
Dilute Acetic Acid
Calcium Phosphate = DISSOLVE
Sulfonamide = do not
ALKALINE URINE: Normal Crystals
Colorless with dumbbell or spherical shapes
May occur in clumps resemble amorphous material
Calcium Carboanate
