Microscopic Examination Flashcards
Screening test:
Color
Significance:
Blood
Screening test:
Clarity
Significance:
Hematuria vs hemoglobinuria/ myoglobinuria
Confirm pathogenic or non-pathogenic cause of turbidity
Screening test:
Blood
Significance:
RBCs/RBC casts
Screening test:
Protein
Significance:
Casts/Cells
Screening test:
Nitrite
Significance:
Bacteria/ WBCs
Screening test:
Leukocyte esterase
Significance:
WBCs/WBC casts/ Bacteria
Screening test:
Glucose
Significance:
Yeast
Person involve in Hemocytometer
Thomas Addis (1926)
Used primarily to monitor the course of diagnosed cases of renal disease.
Hemocytometer
Type of specimen used in Hemocytometer?
12-hour specimen
Microscopic material observed in Hemocytometer?
RBCs, WBCs, Casts, and Epithelial cells
Urine used in Preparation of Urine sediment
Freshly voided urine
Type of urine specimen used in Preparation of Urine sediment
Midstream clean-catch specimen
Urine volume needed for urine sediment
10 - 15 mL (12 mL)
In Preparation of Urine sediment the urine is being centrifuged for…
5 mins at 400RCF
How to get the representative of urinary sediments?
Decantation
Volume of urine left after decantation
0.5 - 1.0 mL
1 drop = __ mL
0.02 mL (20 micro liter)
Size of cover slip used
22x22 mm
In examination of urine sediment, observe minimum of how many field?
10 field (both LPO and HPO)
Objective lense used for detection of casts and general composition
Low power objective lense (LPF) 10X
Objective lense used for identification
High power objective lense (HPF) 40X
Microscopy used for unstained sediment
Bright field microscopy
T/F:
Urinary sediments are smaller than Artifacts
True
Epithelial cells, crystals, and other elements manner of reporting
Semi-quantitative terms
Manner of reporting:
Occasional
Comment:
0-1, 0-3/ HPF at 10 field
Manner of reporting:
Few
Comment:
0-4, 2-5/ HPF at 10 fields
Manner of reporting:
Some
Comment:
3-5, 8-10/ HPF at 10 fields
Manner of reporting:
Moderate
Comment:
More than 10/HPF at 10 fields
Manner of reporting:
Many
Comment:
Abundant/HPF
Manner of reporting:
TMTC
Comment:
Too numerous to count (loaded)
Stains:
Delineates structure and contrasting colors of the nucleus and cytoplasm
Sternheimer-Malbin (Crystal violet & Safranin O)
Stains: Function
Identifies WBCs, epithelial cells, and casts
Sternheimer-Malbin (Crystal violet & Safranin O)
Stains:
Enhances nuclear detail
Toluidine blue (metachromatic stain)
Stains: Function
Differentiates WBCs and renal tubular epithelial (RTE) cell
Toluidine blue (metachromatic stain)
Stains:
Lyses RBCs and enhances nuclei of WBCs
2% acetic acid
Stains: Function
Distinguishes RBCs from WBCs, yeast, oil droplets, and crystals.
2% acetic acid
Stains:
Stains triglycerides and neutral fats orange-red
Lipid Stains: Oil Red O and Sudan III
Stains: Function
Identifies free fat droplets and lipid-containing cells and casts
Lipid Stains: Oil Red O and Sudan III
Stains:
Differentiates gram-positive and gram-negative bacteria
Gram stain
Stains: Function
Identifies bacterial casts
Gram stain
Stains:
Methylene blue and eosin Y stains eosinophilic granules
Hansel stain
Stains: Function
Identifies urinary eosinophils
Hansel stain
Stains:
Stains structures containing iron
Prussian blue stain
Stains: Function
Identifies yellow-brown granules of hemosiderin in cells and casts
Prussian blue stain
Expected Staining Reactions of Sediment Constituent:
RBCs
Neutral -
Pink to purple
Expected Staining Reactions of Sediment Constituent:
RBCs
Acid -
Pink (unstained)
Expected Staining Reactions of Sediment Constituent:
RBCs
Alkaline -
Purple
Expected Staining Reactions of Sediment Constituent:
Hyaline casts
Pale pink or pale purple
Expected Staining Reactions of Sediment Constituent:
Coarse granular Inclusion casts
Dark purple granules in purple matrix
Expected Staining Reactions of Sediment Constituent:
Finely granular Inclusion casts
Fine dark purple granules in pale pink or pale purple matrix
Expected Staining Reactions of Sediment Constituent:
WBCs (dark-staining cells)
Nuclei -
Cytoplasm -
Purple
Purple granules
Expected Staining Reactions of Sediment Constituent:
Glitter cells (sternheimer-malbin positive cells)
Nuclei -
Cytoplasm -
Colorless or light blue
Pale blue or gray
Expected Staining Reactions of Sediment Constituent:
Renal Tubular epithelial cells
Nuclei -
Cytoplasm -
Dark shade of blue-purple
Light shade of blue purple
Expected Staining Reactions of Sediment Constituent:
Bladder tubular epithelial cells
Nuclei -
Cytoplasm -
Blue-purple
Light purple
Expected Staining Reactions of Sediment Constituent:
Squamous epithelial cells
Nuclei -
Cytoplasm -
Dark shade of orange-purple
Light purple or blue
Expected Staining Reactions of Sediment Constituent:
Waxy casts
Pale pink or pale purple
(Darker than hyaline casts; broken ends)
Expected Staining Reactions of Sediment Constituent:
Fat Inclusion casts
Fat globules unstained in a pink matrix
Expected Staining Reactions of Sediment Constituent:
Red cell Inclusion casts
Pink to orange-red
(Intact cells can be seen in matrix)
Expected Staining Reactions of Sediment Constituent:
Blood (hemoglobin) casts
Orange-red
(No intact cells)
Expected Staining Reactions of Sediment Constituent:
Bacteria
Motile: Do not stain
Nonmotile: Stain purple
Expected Staining Reactions of Sediment Constituent:
Trichomonas vaginalis
Light blue-green
Expected Staining Reactions of Sediment Constituent:
Mucus
Pale pink or pale blue
Expected Staining Reactions of Sediment Constituent:
Background
Pale pink or pale purple
Cytodiagnostic Urine Testing, preparation of permanent slides using…
Cytocentrifugation
Cytodiagnostic Urine Testing stain used
Papanicolaou stain
It detect the malignancies of the lower urinary tract
Cytodiagnostic Urine Testing
Cytodiagnostic Urine Testing urine specimen
First morning specimen
T/F:
Cytodiagnostic Urine Testing, provides more indefinite information about RT changes associated with transplant rejection
False
Information obtained in Cytodiagnostic Urine Testing:
Viral, fungal, and parasitic infections
Cellular inclusion
Pathologic casts
Inflammatory condition
Technique’s Function:
Used for routine urinalysis
Bright-field microscopy Technique
Technique’s Function:
Enhances visualization of elements with low refractive indices, such as hyaline casts, mixed cellular cats, mucous threads, and Trichomonas.
Phase-contrast microscopy Technique
Technique’s Function:
Aids in identification of cholesterol in oval fat bodies, fatty casts, and crystals
Polarizing microscopy Technique
Technique’s Function:
Aids in identification of Treponema pallidum
Dark-field microscopy Technique
Technique’s Function:
Allows visualization of naturally florescent microorganisms or those stained by a fluorescent dye.
Florescence microscopy Technique
Technique’s Function:
Produces a three-dimensional microscopy-image and layer-by-layer imaging of a specimen
Interference-contrast technique
Urine sediment constituents
RBCs
WBCs
Epithelial cells (squamous)
Epithelial cells (Transitional/Urothelial)
Epithelial cells (Renal tubular)
Oval Fat Bodies
Bacteria
Yeast
Parasite (Trichomonas)
Spermatozoa
Mucus
Urine casts
Hyaline casts
RBCs casts
WBCs casts
Bacterial casts
Epithelial cell casts
Fatty casts
Granular casts
Waxy casts
Broad casts
Normal Crystal Seen in Acidic urine
Uric acid
Amorphous urates
Calcium oxalate
Normal Crystal Seen in Neutral/Alkaline urine
Amorphous phosphates
Calcium phosphate
Normal Crystal Seen im Alkaline urine
Triple phosphate
Ammonium biurate
Calcium carbonate
Abnormal crystal seen in Acid urine
Cystine
Cholesterol
Bilirubin
Radiographic dye
Abnormal crystal seen in Acid/Neutral urine
Leucine
Tyrosine
Sulfonamides
Ampicillin
Urinary sediment artifacts
Starch Granule
Oil Droplets
Air Bubbles
Pollen grains
Hair and fibers from clothing and diapers
Fecal artifacts
RBC
__________ in hypertonic urine
__________ in hypotonic/hyposthenuric urine
_________ with glomerular membrane damage
Crenated in hypertonic urine
Ghost cells in hypotonic/hyposthenuric urine
Dysmorphic with glomerular membrane damage
RBCs sources of identification error
Yeast cells
Oil droplets
Air bubbles
RBCs, Complete urinalysis correlation
Color
Reagent strip blood reaction
Morse type: WBCs
Larger than RBCs
Agranulocytes
Ghost cells in hypotonic urine
Mononuclear cells with a abundant cytoplasm
2 correct
WBCs, sources of identification error
Renal tubular epithelial cells
WBCs, Complete urinalysis correlation
Leukocyte esterase
Nitrite
Specific gravity
pH
Largest cells in the sediment with abundant, irregular cytoplasm and prominent nuclei
Squamous Epithelial cell
Squamous epithelial cell, sources of identification error
Rarely encountered, folded cells may resemble casts
Squamous epithelial cell, Complete urinalysis correlation
Clarity
Spherical, polyhedral, or caudate with centrally located nucleus
Transitional (Urothelial) epithelial cell
Transitional (Urothelial) Epithelial cell, sources of identification error
Spherical forms resemble RTE cells
Transitional (Urothelial) epithelial cell, Complete urinalysis correlation
Clarity
Blood, if malignancy-associated
Rectangular, columnar, round, oval or, cuboidal with an eccentric nucleus possibly bilirubin-stained or hemosiderin-laden
Renal tubular epithelial cell
Renal tubular epithelial cell, sources of identification error
Spherical transitional cells Granular casts
Renal tubular epithelial cell, Complete urinalysis correlation
Leukocyte esterase and nitrite (pyelonephritis)
Color
Protein
Blood
Clarity
Bilirubin (Hepatitis)
Renal tubular epithelial cell
Pyelonephritis
Leukocyte esterase and nitrite
Renal tubular epithelial cell
Bilirubin
Hepatitis
Highly refractile RTE cells
Oval fat bodies
Oval fat bodies, sources of identification error
Confirm with fat stains and polarized microscopy
Oval fat bodies, Complete urinalysis correlation
Clarity
Blood
Protein
Free fat droplets/fatty casts
Small spherical and rod-shaped structures
Bacteria
Bacteria, sources of identification error
Amorphous phosphates and urates
Bacteria, complete urinalysis correlation
pH
Nitrite
Leukocyte
WBCs
Small, oval, refractile structures with buds and/or mycelia
Yeast
Yeast, sources of identification error
RBCs
Yeast, Complete urinalysis correlation
Glucose
Leukocyte
WBCs
Pear-shaped, motile, Flagellated
Parasite (Trichomonas)
Parasite, sources of identification error
WBCs
Renal tubular epithelial cells
Parasites, Complete urinalysis correlation
Leukocyte
WBCs
Tapered oval head with long, thin tail
Spermatozoa
Spermatozoa, sources of identification error
None
Spermatozoa, Complete urinalysis correlation
Protein
Single or clumped threads with a low refractive index
Mucus
Mucus, sources of identification error
Hyaline casts
Mucus, Complete urinalysis correlation
None
It is unique yo kidney
Urine casts
Urine casts are formed within …
The lumen of Distal convoluted tubule and Collecting ducts
Urine casts provide microscopic view of condition within
Nephron
Detection/Scanning around cover slip edge
LPF
Low refractive index, observe in subdued light
Cast matrix
Glycoprotein excreted by the RTE cells of the CDT and upper collecting ducts
Tamm-Horsfall protein
Factors affecting the Tamm-Horsfall protein
Stress and exercise
Urine-flow stasis, acidity, Na+, Ca++
Protein gel
Formed at the junction of ALH and DCT
Tapered end
Presence of urinary cast
Cylindruria
Colorless homogenous matrix
Hyaline casts
Hyaline casts, sources of identification error
Mucus
Fibers
Hair
Increased lighting
Hyaline casts, Complete urinalysis correlation
Protein
Color (exercise)
Blood (exercise
Clinical significance:
Glomerulonephritis
Pyelonephritis
Chronic renal disease
Congestive heart failure
Stress and exercise
Hyaline casts
Orange-red color, cast matrix containing RBCs
RBC casts
RBC casts, sources of identification error
RBC clumps
RBC casts, complete urinalysis correlation
RBCs
Blood
Protein
Clinical significance:
Glomerulonephritis
Strenuous exercise
RBC casts
Casts matrix containing WBC
WBC casts
WBC casts, sources of identification error
WBC clumps
WBC casts, complete urinalysis correlation
WBCs
Protein
Leukocyte
Clinical significance:
Pyelonephritis
Acute interstitial nephritis
WBC casts
Bacilli bound to protein matrix
Bacterial casts
Bacterial casts, sources of identification error
Granular casts
Bacterial casts, complete urinalysis correlation
WBC cast
Leukocyte
Protein
WBCs
Nitrite
Bacteria
Clinical significance:
Pyelonephritis
Bacterial casts
RTE cells attached to protein matrix
Epithelial cell casts
Epithelial cell casts, sources of identification error
WBC casts
Epithelial cell cast, complete urinalysis correlation
Protein RTE cells
Clinical significance:
Renal Tubular damage
Epithelial cell casts
Fat droplets and oval fat bodies attracted to protein matrix
Fatty casts
Fatty casts, sources of identification error
Fecal debris
Fatty casts, complete urinalysis correlation
Protein
Free fat droplets
Oval fat bodies
Clinical significance:
Nephrotic syndrome
Toxic tubular necrosis
Diabetes mellitus - Crush injuries
Fatty casts
Coarse and line granules in a cast matrix
Granular casts
Granular casts, sources of identification error
Clumps of small crystals
Columnar RTE cells
Granular casts, complete urinalysis correlation
Protein
Cellular casts
RBCs and WBCs
Clinical significance:
Glomerulonephritis
Pyelonephritis
Stress and Exercise
Granular casts
Highly refractile cast with jagged ends and notches
Waxy casts
Waxy casts, sources of identification error
Fibers
Fecal material
Waxy casts, complete urinalysis correlation
Protein
Cellular casts
Granular casts
WBCs and RBCs
Clinical significance:
Stasis of urine flow
Chronic renal failure
Waxy casts
Wider than normal casts matrix
Broad casts
Broad cast, sources of identification error
Fecal material
Fibers
Broad casts, complete urinalysis correlation
Protein
WBCs and RBCs
Granular casts
Waxy casts
Clinical significance:
Extreme urine stasis
Renal failure
Broad casts
It detect the presence of the relativity few abnormal types of liver disease, inborn errors of metabolism, and renal damage
Urine crystals
Formed by the precipitation of urine solutes
Urine crystals
Urine crystals are subject to:
Changes of temperature
Solute concentration
pH (affect solubility)
T/F:
Urine crystal, Rapid precipitation at low temperature
T
T/F
High specific gravity - presence of crystal in fresh urine
T
Crystals in acidic pH
Organic and Iatrogenic compounds
Crystals in neutral and alkaline solution
Inorganic salts
CaOx present in what urine pH condition
Acidic and neutral urine
Color and shape:
Yellow-brown (rhombic/4-sided/rosette)
Solubility:
Alkali soluble
Uric acid
Color and shape:
Brick dust or yellow brown granules
Solubility:
Alkali and heat
Amorphous urates
Color and shape:
Colorless (envelopes, oval, dumbbell, octahedral)
Solubility:
Dilute HCl
Calcium oxalate
Color and shape:
White-colorless (granular/white ppt)
Solubility:
Dilute acetic acid
Amorphous phosphates
Color and shape:
Colorless (flat rectangle plates/ thin prisms often in rosette formation)
Solubility:
Dilute acetic acid
Calcium phosphate
Color and shape:
Colorless (prism shape “coffin lids)
Solubility:
Dilute acetic acid
Triple phosphate
Color and shape:
Yellow-brown (spicule-covered spheres “thorny apples”)
Solubility:
Acetic acid with heat
Ammonium biurate
Color and shape:
Colorless (dumbbells/spherical)
Solubility:
Gas from acetic acid
Calcium carbonate
Color and shape:
Colorless
Hexagonal plates
Solubility:
Ammonia dilute HCl
Cystine
Cystinuria and Confirmation test
Cystine
Cystine:
Confirmation test
Cyanide-nitroprusside test
Color and shape:
Colorless notched plates
Solubility:
Chloroform
Cholesterol
Seen in refrigerated specimen (droplet form lipids) and in Nephrotic syndrome
Cholesterol
Color and shape:
Yellow
Clumped needles or granules
Solubility:
Acetic acid, HCl, NaOH, ether, Chloroform
Bilirubin
Present in hepatic disorders
Bilirubin
Color and shape:
Colorless
Cholesterol crystal like
Solubility:
10% NaOH
Radiographic dye
Markedly high specific gravity when measured by refractometer
Radiographic dye
Color and shape:
Yellow-brown
Spheres (concentric circles and radial striations)
Solubility:
Hot alkali or alcohol
Leucine
Crystals associated with liver disorder
Accompanied by tyrosine crystals
Leucine
Color and shape:
Colorless-yellow
Fine needle (clump or rosette form)
Solubility:
Alkali or heat
Tyrosine
Seen in conjunction with leucine crystals in positive chemical test results fro bilirubin
Tyrosine
Encountered in inherited disorders of amino-acid metabolism
Tyrosine
Color and shape:
Varied (colorless to yellow-brown)
Needles, rhombics, whetstones, sheaves of wheat, and rosettes
Solubility:
Acetone
Sulfonamides
Seen in inadequate patient hydration
If forming in nephron may indicate tubular damage
Sulfonamides
Color and shape:
Colorless
Needles (form bundles following refrigeration)
Solubility:
Refrigeration forms bundles
Ampicillin
Seen in massive doses of this penicillin compound without adequate hydration
Ampicillin
Contaminant from improper collection
Urinary sediment artifacts
Resemble fat droplets when polarized and dimpled center
Starch Granule
From cornstarch used as glove powder and highly refractile sphere
Starch Granule
From OIO contamination
Oil droplets
Highly refractile and may resemble RBCs
Oil droplets
Occur when the specimen is placed under a cover slip
Air bubbles
Concentric circles
Pollen grains
Spheres with a cell wall and occasional concentric circles
Pollen grains
Mistaken for casts usually much linger and more refractile
Hair and fibers from clothing and diapers
Presence at a fistula between the intestinal and urinary tracts
Fecal Artifacts
Appears as plant and meat fibers or as brown amorphous material
Fecal Artifacts
