Analysis of Urine and Other Bodily Fluids PDF

LECTURE | MIDTERM 9/19/23-9/21/23 Transcribed by: Faulien | Organized by: Angela I. MICROSCOPIC EXAMINATION - acidic In microscopic examination, we have to consider the specimen being used. Most of the A...

LECTURE | MIDTERM 9/19/23-9/21/23 Transcribed by: Faulien | Organized by: Angela I. MICROSCOPIC EXAMINATION - acidic In microscopic examination, we have to consider the specimen being used. Most of the Amorphous phosphates: time, we require freshly voided urine sample that - colorless has been collected first thing in the morning (first - granular morning urine). We also have to consider the manner of - alkaline collection. Washing the genitals properly. The realizing of small amount of urine sample. NOTE: When in doubt, whether it is urates or Receiving the midstream urine. To assure there is phosphates check the pH of the urine no contaminant, especially on the surface of the genitals. The outer lining of the uterus and vagina, are Cast squamous epithelial cell. When urinating and o In urinary sediment on the glass slide, first we washing the genital area some cells will be flush have to focus using the low power objective. out. After scanning make the report of the results or We use the midstream to avoid any findings. When reporting, start with the lowest contaminant in the urine sample. count- highest count found per field. (Example when reporting: 0-1 Low Power Field) First morning urine sample o Preferred urine sample, because it is concentrated. Squamous epithelial cell o Has greater possibility in finding significant o Can be easily identify under Low Power elements. Objective lens o Must be collected before the patient eats or o Report using words, because you will not be drink anything. counting them (Example when reporting: few, o Easier to determine the abnormal elements moderate, several) present in the urine, that can determine o Can also be reported according to classes abnormalities in the urine which causes disease (Example: +1, +2, +3, +4) to the patient. o After reporting using the Low Power Objective lens, use the High-Power Objective lens. After Urine counting, write all the results in the requisition form. Then, record in the log book. o Normally contains negligible amount of sediments. o Normally looks clear(transparency). When II. ORGANIZED ELEMENTS OR CELLULAR suspected with turbidity might indicate ELEMENTS pathological or non-pathological related disease. This is what we encounter most of the time in o Pus cells, RBC, crystals, etc. are NOT normally urine analysis. found in urine. These elements are sometimes present due to contamination or wrong manner of collection of Hypotonic urine the specimen o May cause lysis of the cells and the cast o When this occurs, elements can no longer be Organized Elements found under the microscope. o To avoid hypotonic urine, avoid diluting the Epithelial Cells urine. 1. Squamous Large flat cells of o When cast is present in the urine, it should be epithelial cells bladder or counted as it is considered to be clinically superficial layer of significant. Use low power objective lens, when the urethra or viewing cast in urine. vagina. They are normally present in large Amorphous crystals number in urine of - such as Amorphous urates and Amorphous women. So, if phosphates can be seen in a urine. They are in present in female groups based on their appearance. They vary in meaning normal. fields; some are in single form or in Causes turbidity groups(clumping). Considered to be a distraction or Amorphous urates: "sagabal" when examined under - has colors, range from yellow-brown to orange, the microscope. or to black. This is because it 1|Page Italicized texts – WORDS of Ma’am Tan  LECTURE | MIDTERM 9/19/23-9/21/23 Transcribed by: Faulien | Organized by: Angela overlaps other o very round, elements (such as, mononuclear RBC, pus cells, o has only 1 clear crystals, and and visible nucleus bacteria) present on the center in the specimen. o appear singly, pair, In order to avoid or in groups overlapping, you o manner of must spread the reporting when in sediment using a singly: number per glass side. The high power field(0- edge of the glass 1 hpf) slide will be used to o manner of spread the reporting when in specimen in a pair or groups: circular motion. number per high If unable to spread power; words(0-1 the specimen hpf; occasional in properly and clumps) equally, some cells will be misidentified. 3. RBC “Doughnut-like” For example: Non-nucleated biconcave disks Nucleus in the Transparent squamous epithelial cytoplasm (No cells will be identified nucleus, No as a pus cells, due to granules) squamous epithelial Smaller than Pus cells are overlapping cell each other looking like a pus cells. Clinical significance: When reporting 1) Irritation or bleeding the results use in urinary tract or words kidney (Hematuria) (occasionally, 2) Stones many, plenty) or Sometimes appear in numbers: a variety of shapes - filled 1/4 of the field = such as spherical, +1 round, or biconcave (2 - filled 1/2 of the field = cells are joined +2 together forming waistline, with both - filled 3/4 of the field = sides having +3 concavity) - filled the entire field = Hypertonic Urine = +4 appear as 2. Renal Tubular (RTE) Rectangular, Crenated/Shrink. cells columnar, round, Hypotonic Urine = oval or, cuboidal appear as with an eccentric Swollen/Ghost cells nucleus possibly or Shadow cells. bilirubin-stained Glomerular or hemosiderin- Membrane laden Damage = Slightly “Larger” Dysmorphic than Pus cells Clinical 4. WBC (Pus cells or Larger than RBCs significance: Leukocytes) Granulated, multi lobed neutrophils 1) Acute Glitter cells in glomerulonephritis hypotonic urine 2) Nephrosis Mononuclear cells 3) Hemolytic anemia with abundant 4) Hemochromatosis cytoplasm The nucleus become visible 2|Page Italicized texts – WORDS of Ma’am Tan  LECTURE | MIDTERM 9/19/23-9/21/23 Transcribed by: Faulien | Organized by: Angela after the addition Echinococcus of acetic acid granuloses can be PYURIA = increased present due to the WBC in urine wrong manner of Clinical collection significance: 7. Mucus Thread Single or clumped Infection threads with a low Causes of UTI: refractive index o RBC Colorless thread, o Bacteria not really visible. o Pus cells Appear in thin split o (0 to 5 per ends. hpf) Lower the light of the microscope to view the mucus threads more Miscellaneous Structures clearly 5. Bacteria Small spherical Common in male Spiral and; few = normal, many Rod-shaped = indicates irritation structures 8. Pseudocasts Are structures of Not normally aggregates that present in urine but resemble and may contaminated be mistaken for when passing out in casts because of the urethra. their shape. They Contaminant: Sea are without breeze – iodine & diagnostic salts significance. Considered (Google) significant for UTI Sometimes has (when RBC, pus components made cells, and bacteria of crystals, which are presence in the forms into a urine). cylindrical shape. Clinical significance:1. 9. Spermatozoa Tapered oval head Infection (Proteus with long, thin tail vulgaris) Found in urine after Use Low Power sexual intercourse. Objective Lens When few sperms are found in a urine 6. Parasites Ova in urine with it is normal, but blood when the sperms Trichomonas found are many it vaginalis – most indicates the frequent parasite patient has epilepsy encountered in the and must be urine. Associated reported with “Ping – Pong” immediately to the disease. physician. Trichomonas - Pear- shaped, motile, flagellated CAST APPEARANCE CLINICAL Schistosoma SIGNIFICANCE haematobium – 1. Hyaline “Capsule 1.Glomerulonep may cause cast -like” hritis hematuria because Colorless it lacerates the 2. Pyelonephritis homoge bladder. 3. Chronic renal nous Enterobius disease matrix vermicularis – most 4. Congestive Most common fecal frequentl heart failure contaminant. 5. Stress and y seen Wuchereria cast exercise bancrofti and 3|Page Italicized texts – WORDS of Ma’am Tan  LECTURE | MIDTERM 9/19/23-9/21/23 Transcribed by: Faulien | Organized by: Angela When There are cellular elements which can be with cast enclosed with a cast, such as RBC, WBC, Pus it is cells, Epithelial cell, and Bacterial cells consider ed to be 4. RBC cast Orange- 1) abnormal red color, Glomerulonephritis , and it is observed cast 2) Strenuous under the matrix exercise low power containing objective RBCs lens Cast in 5. WBC cast Cast matrix 1) Pyelonephritis urine containing 2) Acute interstitial indicates kidney WBCs nephritis disease, if 6. Bacterial Casts 1) Pyelonephritis seen few cast it is which consider contain ed to be normal. numerous 2. Granular Coarse and 1)Glomerulonep bacteria. cast fine granules hritis in a cast Bacilli 2) Pyelonephritis matrix bound to 3) Stress and 1)Coarse exercise protein Granular Casts - 1st stage of matrix degeneration of 7. Epithelial RTE cells 1) Renal tubular cellular cast. Cell cast attached damage - Contains larger granules and to protein darker matrix in color (Dark- Brown owing to 8. Pus casts Contain the present of large blood pigment) 2) Fine Granular number of Casts pus cells - 2nd stage of inside the degeneration of cellular cast. casts. - Grayish or Pale yellow in color 3. Waxy cast Highly 1) Stasis of urine refractile flow cast with 2) Chronic renal jagged ends failure and notches Final degenerativ e ends product of evolution of cellular casts. Broader than hyaline casts. 4|Page Italicized texts – WORDS of Ma’am Tan