Urinalysis and Body Fluids CRg Unit 2; Session 7 Miscellaneous Structures found in Urine Sediment.
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Transcript of Urinalysis and Body Fluids CRg Unit 2; Session 7 Miscellaneous Structures found in Urine Sediment.
![Page 1: Urinalysis and Body Fluids CRg Unit 2; Session 7 Miscellaneous Structures found in Urine Sediment.](https://reader035.fdocuments.us/reader035/viewer/2022062802/56649ea45503460f94ba89ce/html5/thumbnails/1.jpg)
Urinalysis and Body Fluids CRg
Unit 2; Session 7Miscellaneous Structures found in Urine Sediment
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Miscellaneous Urinary Structures
• Topics Included in this session are • Cylindroids • Hemosiderin• Mucous threads• Oval Fat Bodies and Free Fat• Bacteria, Yeast, and other Parasites that
can be observed in the urine sample• Spermatozoa• Artifacts
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Cylindroids
Cylindroids, same as casts.
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Hemosiderin• Free granules of hemosiderin & inclusions in a
cast• Patient had hemolytic event, ie. Incompatible
transfusion, DIC, acute hemolytic anemia – such as sickle-cell anemia, etc.
• Picture shows free granules of hemosiderin. X400.
• Unstained & Prussian blue stain
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Mucous Threads
•Mucous threads have low refractive index: to locate them, use same microscopic techniques as for casts.•Small amount is normal
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Oval Fat Bodies (OFBs)
•RTE cells that are undergoing fatty degeneration or have absorbed lipid in the filtrate.•Can also be lipophages
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Oval Fat Bodies (OFBs)
•Maltese cross formation with polarized light•Cholesterol esters polarize•Triglycerides and neutral fats do not
•If negative check with Sudan III or oil red O stain
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LipiduriaOval fat bodies and WBCs
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Lipiduria
•Fat is not detected by chemical tests•Fatty degeneration of tubules•Chronic glomerulomephritis•Diabetes mellitus•Eclampsia•Lipid nephrosis•Nephrotic syndrome•Toxic renal poisoning•Fat embolism
•Extensive injuries (crushing of subcutaneous fat)•Fractures of the long bones
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Lipiduria
•Polarized anisotropic fat droplets
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Lipiduria
Sudan III-stained fat droplets
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Bacteria• Normally none present in urine• May be contamination from
urethra, vagina, or external sources
• Fresh, properly collected specimen that contains many bacteria usually indicates UTI• Especially if ↑# WBCs present
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Bacteria• Reported using semi-quantitative terms• Such as trace, 1+. 2+, etc.
• Nitrite may be positive, but not always• WBCs may be present and more
accurately reflect infection than does nitrite
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Yeast
• Smooth, colorless• May be budding • May be mistaken for RBCs• Candida albicans most common
Yeast cells
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Yeast• Reported using semi-quantitative terms• Such as trace, 1+. 2+, etc.
• Budding yeast or mycelial forms may be present
• Common in • Diabetics & Immunocompromised,
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Yeast (cont.)
Budding yeast
SM-stained yeast with pseudohyphae
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Urinary Sediment: Parasites
• Indigenous to urinary tract
• Vaginal or fecal contamination
• No chemical analysis available
• WBCs may be present
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Parasites - Trichomonas vaginalis
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Parasites - Enterobius vermicularis
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Parasites - Enterobius vermicularis
Head of the Enterobius vermicularis
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Parasites - Schistosoma haematobium
Schistosoma haematobium ovum
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Urinary Sediment: Spermatozoa
• Oval shaped heads with long tails• May be seen in urine of men and women• ?? Report them?
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Confusing Artefacts-Fibers
Fibers
Debris from a diaper
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Urinary Casts: Confusing Artefacts-Hair
Hair and a coarsely granular cast
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Artifact Interference
• Large pollen grain• No usual sediment
elements in view• Grain is in a
different liquid plane than the urine constituents due to its larger size
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Fecal contamination
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Air bubblesAir bubble and amouphous urates
Air bubbles, phosphate plate, and amorphous phosphates. Air bubbles can assume a variety of shapes, especially if the coverslip is moved or depressed
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Oil droplets
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Summary• Urine sediment may contain
– Blood cells (RBCs and WBCs)
– Epithelial cells (renal and transitional)
– Oval fat bodies (cellular degeneration, anisotropic)
– Infectious agents (bacteria, yeast, parasites)
– Contaminants (squamous epithelial, bacteria, sperm, parasites and fecal matter)
– Artifacts (air bubbles, oil droplets)
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Lillian Mundt & Kristy Shanahan, Graff’s Textbook of Urinalysis and Body Fluids, 2nd Ed.
Susan Strassinger & Marjorie Di Lorenzo, Urinalysis and Body Fluids, 5th Ed.
Meryl Haber, MD, A Primer of Microscopic Urinalysis, 2nd Ed. Zenggang Pan, MD, PhD., Dept of Pathology, U of Alabama
at Birmingham http://www.enjoypath.com/cp/Chem/Urine-Morphology/Urine-morphology.
htm
Department of the Army, Landstuhl Regional Medical Center http://www.dcss.cs.amedd.army.mil/field/FLIP%20Disk%204.2/FLIP42.htm
l
Nobuko IMAI, Central Laboratory for Clinical Investigation, Osaka University Hospital http://square.umin.ac.jp/uri_sedi/Eindex.html
Reference Listing