Microscopic Examination Flashcards
What are the formed elements in the urine
Rbc
Wbc
Epithelial cells
Cast
Bacteria
Yeast
Parasites
Mucus
Spermatozoa
Crystals
Artifacts
Methods by which the sediment is prepared, the volume of sediment actually examined, the methods and equipments used to obtain visualization, and the manner in which the results are reported.
Microscopic analysis
Color (significance)
Blood
Clarity (significance)
Hematuria versus hemoglobinuria/ myoglobinuria
Confirm pathologic or non pathologic cause of turbidity
Blood (significance)
RBC, RBC casts
Protein (significance)
Cast, cells
Nitrite (significance)
Bacteria, WBC
Leukocyte esterase (significance)
WBC, WBC casts, bacteria
Glucose (significance)
Yeast
This can cause precipitation of amorphus urates and phosphates and other nonpathologic crystals
Refrigeration
This type of specimen collection minimizes external contamination of the sediment
Midstream clean-catch
A standard amount of urine that can be centrifuged in a conical tube
10-15 mL
RCF Formula
RCF= 1.118x10^-5 x radius in centimeters x RPM^2
Volume that is frequently used for uniform amount of urine and sediment
0.5 and 1.0mL
To maintain a uniform sediment concentration factor, urine should be
Aspirated off
When using the conventional glass-slide method, the recommended volume is
0.02mL
Examples of commercial systems
KOVA, urisystem, quick- prep urinalyis
Low power is used to detect (10x) what?
Epithelial cells
High power (40x) is used to detect what?
Wbc
Rbc
Yeast
Parasite
Often present to provide a point of reference
Epithelial cells
How are casts reported in the microscopic examination
Average number per low power field (lpf)
How are rbc and wbc reported in microscopic examination
Average number per 10 high-power fields (hpf)
How are epithelial cells, crystals, and other elements reported in microscopic examination
Semiquantitive terms
Who developed the first procedure to standardize the quantitation of formed elements in the urine microscopic analysis
Addis
It used a hemocytometer to count the number of RBC, WBC, casts, and epithelial cells present in a 12-he specimen
Addis count
Increases the overall visibility of sediment elements being examined using bright field microscopy by changing the refractive index
Staining
Identifies WBC, epithelial cells, and cast
Most frequent used stain in urinalysis
Sternheimer Malbin
Differentiate WBC and renal tubular epithelial cells, enhances nuclear detail
Toluidine blue
Distinguishes rbc from wbc, yeast, oil droplets and crystals
Lyses rbc and enhance wbc
2% acetic acid
Identify the free fat droplets and lipid containing cells and casts
Do not stain cholesterol
Lipid stain: oild red O and sudan
Identifies bacterial cast
Differentiate gram positive and gram negative
Gram stain
Identifies urinary eosinophils
Hansel stains
Identifies yellow brown granules of hemosiderin in cells and casts
Prussian blue stain
Used for routine urinalysis
Bright field microscopy
Enhances hyaline cast, mixed cellular cast, mucous threads and trichinomas
Phase- contrast microscopy
Aids in identification of cholesterol
Polarizing microscopy
Aids in identification of treponema paliidum
Dark field microscopy
Allows visualization of naturally fluorescent microorganisms like antigens and antibodies
Fluorescence microscopy
Produces a three dimensional microscopy image
Interference- contrast
Smooth, non nucleated , biconcave disk measuring approximately 7mm in diameter
Red blood cells
What is the appearance of the rbc in concentrated urine
Crenated
What is the appearance of rbc in dilute urine
Ghost cells
Rbc that vary in size, have cellular protrusions, pr are fragmented
Dysmorphic
Larger than rbc measuring an average of about 12mm in diameter
White blood cells
The predominant wbc found in the urine sediment
Neutrophils
Where does neutrophils lyse rapidly and begin to lose nuclear details
Dilute alkaline
Brownian movement of the granules within these larger cells produces a sparkling appearance
They have no pathologic significance
Glitter cells
The presence of this cell is primarily associated with drug induced interstitial nephritis.
May be seen with urinary tract infections
Eosinophils
Smallest wbc
Lymphocytes
Large WBCs and may appear vacuolated or contain inclusions.
Monocytes, macrophages and histiocytes
Usually larger than wbc with an eccentrically located nucleus
RTE cells
An increase in urinary WBCs, presence of an infection or inflammation in the genitourinary sytem
Pyuria
Types of epithelial cells seen in urine
Squamous
Transitional
Renal tubular
Largest cells found in the urine sediment, it contains abundant, irregular cytoplasm and a prominent nucleus
Squamous cells
Where does squamous epithelial cells usually originate
Linings of the vagina and female urethra
Lower portion of the male urethra
A variation of squamous epithelial cells, have a pathological significance, indicative of vaginal infection by the bacterium Gardnerella vaginalis
Clue cells
These are smaller than squamous cells and appear in several forms, including spherical, polyhedral and caudate
Transitional epithelial cells
Where does transitional epithelial cells usually originate
Lining of the renal pelvis, calyces, ureters, and bladder
Upper portion of male urethra
Increased number of transitional cells
Syncytia
They tend to have a rectangular shape and referred as columnar or convoluted cells
Renal tubular epithelial cells
Shape of the cell from the distal convoluted tubule
Smaller
Shape of the cell from proximal convoluted tubule
Smaller, round or oval
Presence of rte cells are often result as
Tissue destruction (necrosis)
Lipid containing RTE cells
Oval fat bodies
Appearance of droplets containing cholesterol using polarized microscopy
Maltese cross formation
RTE is report as
Semiquantitive terms
Oval fat bodies is reported as
Semiquantitive terms
Most frequently associated with damage to the glomerulus
Lipiduria
It may be present in urine due to collected specimens that are in sterile condition (catheterized)
Present in cocci or bacili
Bacteria
The bacteria that is most frequently associated with UTI
Enterobacteriaceae
Appear in the urine as small, refractile oval structures that may or may not contain a bud.
Yeast
Yeast cell that are seen in the urine of diabetic patients, immunocompromised patients, and women with vaginal moniliasis
Candida albicans
Most frequent parasite encountered in the urine
Trichomonas vaginalis
The most common contaminant is ova from what pinworm
Enterobius vermicularis
Easily identified in the urine sediment by their oval, slightly tapered heads and long, flagella like tails
Spermatozoa
It is a protein material, appears microscopically as thread like structures with a low refractive index
Mucus
It is a glycoprotein excreted by the RTE cells, it is a major constituent of mucus
Uromodulin