Microscopic Examination of Urine - RBC, WBC, and Epithelial Cells Flashcards
Crenated RBCs are seen in urine that is:
Hypertonic
“Ghosts” or swollen RBCs are seen in urine that is:
Hypotonic
How many RBCs are seen in normal urine?
0-2/hpf
What are two reasons for a positive chem strip, but no visible RBCs in the urine?
- Blood is alkaline.
2. Hypotonic urine. Check specific gravity.
What are two reasons for a negative chem strip, but visible RBCs in urine?
- Ascorbic acid.
2. Check for yeast or calcium oxalate crystals.
RBCs in urine indicates:
- Patient is in early renal disease.
- Dysomorphic = diseased glomerulus.
- Can be a contaminant.
- Can be caused by smoking and excessive exercise.
RBCs can be mistaking for:
- WBCs.
- Yeast.
- Round from of calcium oxalate.
- Oil droplets.
- Air bubbles.
What is the physical appearance of neutrophils?
- Larger than red blood cells.
- Vary in size with tonicity.
- Grainy cytoplasm and segmented nuclei.
- Grayish single or clumps (report clumps).
What is the physical appearance of aging neutrophils?
- Nuclear lobes fuse.
- Swell and may lyse.
- “Glitter cells”.
- Cytoplasma forms granular blebs or filaments.
What is the total number of neutrophils in hpf?
0-5 or 0-8.
During physical examination of the urine, how will neutrophils make the urine look?
- Cloudy.
- Foul oder.
- macroscopic white button.
Why would a reagent strip test positive for neutrophils (WBC), but be negative under the microscope?
Lysis
Why would a reagent strip test negative for neutrophils (WBC), but be negative under the microscope?
- Other types of cells.
- Check test strip function.
- Not enough cells to cause reaction.
Neutrophils look like:
- Tubular epithelial cells.
- Red bleed cells.
- Trichomonads and fungi.
What is used to differentiate neutrophils from renal tubular epithelial cells?
- 2% acetic acid.
- 0.5% toluidine blue.
Neutrophils is urine can be a clinical significance for?
- Renal diseases.
- Inflammatory conditions.
- Bacterial.
- Nonbacterial.
Eosinophils can be differentiated from neutrophils with what stain?
Hansel
Why would you need to use the Hansel stain?
To differentiate eosinophils from neutrophils.
What conditions would the presence of eosinophils in urine indicate?
- Drug induced acute interstitial nephritis.
- Rare chronic UTI.
- Rejection of transplants.
WBC in urine is only significant at what levels?
Greater than 1%.
Clinical significance of lymphocytes in the urine?
Rejection of transplants.
What is done if you see clumps of white blood cells?
Report them. They aren’t good for patient.
Which cells line the entire urinary tract?
Epithelial cells.
What is the most common and largest epithelial cell?
Squamous
Where are the squamous cells located?
The entire female urethra and the distal portion of male urethra.
Which cells are described as flag-stone?
Squamous
When are squamous cells considered an issue?
- When they are covered with bacteria.
- Usually a vaginal infection with Gardnerella vaginalis.
Where are the transitional epithelial cells located?
Renal calyces to bladder and male urethra.
What could be the cause of large amounts of renal tubular epithelial cells?
- Acute tubular necrosis.
- Heavy metal poisoning.
- Viral infections.
- Renal transplant rejection.
How many renal tubular epithelial cells are normal at hpf?
15
How can you verify it is a renal tubular epithelial cell?
- Polarizing scope.
- Fat stains.
