urinalysis 2.5

which elements are birefringent?

uric acid, calcium oxalate, triple phosphate, fatty casts, oval fat bodies,

if glucose +, or the patient has diabetes mellitis or vaginal moniliasis look for what?

yeast

what condition do you see renal tubular epithelial cells?

tubular injury: heavy metal exposure, drug-induced toxicity, viral infections, pyelonephritis, malignancy

hematuria, menstrual contamination

what condition do you see increased cuboidal cells?

renal transplant rejection, acute tubular necrosis (diuretic), injuries interrupting kidney blood flow, acute glomerulonephritis with tubular damage

drug ingestion causing significant shedding

salicylate intoxication

what conditions do you see increased cast formation?

acidic pH, increased solute concentration, urinary stasis, increased plasma protein

what conditions do you see the Tamm-Horsfall protein?

stress and exercise, underlying renal condition

in which conditions do you see hyaline casts?

CHF, in renal disease

in which condition do you see coarsely granular casts?

urinary stasis, glomerular and tubular disease

in which condition do you see finely granular casts?

amyloid disease, Chronic renal disease

in which condition do you see waxy casts?

blocked nephron, chronic renal failure, acute/chronic renal rejection, LAST stage of cast degeneration

in which condition do you see unusual broad waxy casts?

ESRD

in which condition do you broad casts?

extreme urine can’t leave collecting ducts

in which condition do you see fatty casts?

nephrotic syndrome, severe crush injuries, toxic tubular necrosis, diabetes mellitis, degenerative tubular disease, heavy proteinuria

in which condition do you see cylindroids?

similar to DCT casts

in which condition do you see cellular casts- RBC?

nephron bleeding, glomerulus damage (glomerulonpehritis), strenuous exercise

in which condition do you see cellular casts- WBC?

infection/inflammation of the nephron

pyelonpehritis, acutei nterstitial nephritis

in which condition do you see WBCs in urine?

pyuria (pus in urine), UTI

in which condition do you see cellular casts- RTE casts?

tubular damage: heavy metal, chemical, drug-induced toxicity, viral infection, graft rejection

in which conditions do you see oval fat bodies?

nephrotic syndrome, preeclampsia, DM

which conditions do you see uric acid in urine?

increased purine metabolism, chemotherapy (cell turnover), gout

which conditions do you see calcium oxalate in urine?

eating foods with oxalic acid (tomatoes, asparagus)

oval shape with ethylene glycol poisoning

renal calculi (kidney stones)

discrepancy in + RBC strip but none on the microscope?

cell lysis- hypotonic/alkaline urine

Hgb or myoglobin presence

strong oxidizing agents (bleach, peroxide)

discrepancy in = RBC strip but they’re present on the microscope?

mis ID RBCs, measurement is below strip sensitivity, ascorbic acid, high SG crenating the cells, unmixed specimen for strip analysis

discrepancy in + strip leukocyte esterase and no WBCs on microscope

cell lysis

discrepancy in = strip leukocyte esterase and WBCs on microscope

misID WBCs, lymphs, etc don’t contain LE

6 steps to prepare urine specimen

1. mix well

2. 12mL into urine centrifuge

3. centrifuge 5 min at 2000RPM

4. consistent speed and time

5. pour off supernatant (except last 0.5-1mL)

6. resuspend sediment

which substances are an ultra filtrate of plasma?

CSF, interstitial fluid?, glomerular filtrate?

purpose of 2% acetic acid stain

removes interfering RBCs (lysis), enhances nuclei of WBC and epis

purpose of Sternheimer-Malbin stain

delineates structure and contrasting color of nucleus and cytoplasm. used to ID WBC, epithelials, and casts

purpose of toluidine blue stain

nuclear structure differentiation

WBC vs renal epi cells

purpose of sudan III or oil red O lipid stains

stains triglycerides and neutral fats orange-red to ID lipid containing cells

purpose of gram stain

bacteria gram rxn

purpose of hansel stain

methylene blue and eosin stain, stains eosinophilic granule to ID eosinophils

purpose of prussian blue stain

stains iron granules blue, hemosiderin granules are yellow until stained

purpose of brightfield microscope

parafocal objectives to maintain focus on object, subdued light to see structures better

purpose of phase-contrast microscope

ID translucent elements like casts

purpose of polarized light microscopes

ID crystals and lipids

acetic acid helps identify what?

nuclei of WBC and epi

yeast won’t dissolve in acetic acid

what’s the significance of ghost cells?

alkaline urine causes RBCs to lyse, so they appear “ghosty”

where are collecting tubule cells formed? sloughed off?

convoluted tubule (proximal, distal)

where is the squamous epithelial cell found? sloughed off?

lines the entire female urethra and distal portiion of urethra in males

can easily contaminate urine specimen

where is transitional epi cell found? slughed off?

bladder, ureters, renal pelvis

where is renal tubular epi cell found? slughed off?

each renal tubule has this

present in vascular injury

significance of Tamm-Horsfall protein

aka uromodulin

it’s ALWAYS abnormal

could be a cellular cast containing RBC, WBC, RTE, or a mix of cells

homogenous casts

hyaline and waxy

pigmented casts

bilirubin (brown/yellow), hemoglobin (pink), myoglobin

size of casts

broad (broad and waxy go together)

which part of the urinary tract are casts formed?

i may need a more specific answer

which crystals can be seen in alkaline urine?

calcium oxalate

amorphous phosphate

triple phosphate

ammonium biurate

calcium carbonate

which crystals are formed in acidic urine?

amorphous urate

uric acid

calcium oxalate

how to differentiate uric acid crystals from cystine?

cystine is nonpolarizing

uric acid is birefringent

what condition do you see amorphous urate in urine?

uroerythrin on crystal surface

what condition do you see ammonium biurate in urine?

neutral urine

****when looking at alot of crystals, amorphous material, or cells, how do you clarify urine sediments?

by centrifuging, pouring off supernatant, and then resuspending the sediment?

SSA used for the protein; it’s clear, and then adding equal parts

nephrotic syndrome explains the blood

the foam that doesn’t go away indicates a protein

glucose levels are 1+ or 2+

confirmatory tests are used to settle discrepancy

yellow foam indicates jaundice

bilirubin is discrepant

positive Icto is more sensitive to Bilirubin, so you report a positive Bilirubin

trace of blood goes with RBC levels

cloudy is cloudy and white cells are seen, so there is a descrepancy in the LE test

there’s some type of interfering substance

G+ doesn’t reduce the nitrates, 4 hrs?

there are more hyaline casts than usual

which stain is helpful for fats?

lipid stains: Oil Red O and Sudan III

used to identify neutral fats

what’s the significance of fat in your urine? (4 clinical applications)

it polarizes with the maltese cross

it’s seen in nephrotic syndrome, severe crush injuries, toxic tubular necrosis, and DM

why is sperm in urine significant?

should always be reported when seen

which contaminant looks like oval fat bodies?

lubricants, creams, and lotions

significance of hemosiderin granules

macrophages contain these large brown/black granules ~48 hrs after a hemorrhage

• erythrophagia occurs, where the macrophage eats the RBC

glitter cells

neutrophils exposed to hypotonic urine → they absorb water and swell

• you get cytoplasm brownian movement

• but it has no pathological significance

clue cells indicate what?

some type of bacterial vaginosis

>20%

also no/few WBCs

Trichomonas vaginalis

a flagellated protozoan (single-celled) parasite of the urogenital tract. The cells are motile, have 4 flagella and a single nucleus.

Attach to mucosal and cause tissue damage

‘Jerky’ motion can be seen on wet prep

Specimen should be at RT and viewed within 2 hours to ensure motility

major functions of CSF

protects underlying CNS tissue

mechanical buffer to: prevent trauma, regulate pressure, circulate nutrients, remove CNS waste, lubricate CNS

expected CSF volume in adult

90-150mL

CSF normal appearance and composition

ultrafiltrate of plasma and active secretion of transport

how to store CSF?

room temp to preserve analytes/formed elements

should be a STAT specimen

if CSF volume is small, send first sample to _______. Other than that, the order is:

micro department

1. Chem and immunology

2. Micro

3. Hematology

4. Cytology

which CSF tube do you centrifuge and why?

micro tubes

15 min at 1500g to recover bacteria

what causes xanthachromic CSF?

how to do Neubauer chamber CSF values

count all 9 squares

manual counts

chemical components of CSF

80% protein: transthyretin (prealbumin) albumin, transferrin, some IgG

20% intrathecal synthesis

60% glucose

how are CSF macrophages clinically significant?

during erythrophagia, the macrophage eats the RBC in a hemorrhage

the macrophages have large brown/black hemosiderin granules that are present around 48 hours after the hemorrhage

normal CSF differential cell counts (adult and baby)

• lymph

• mono

• neutrophil

3 pathalogical conditions causing elevated CSF protein

MS, chronic meningoencpehalitis (from viruses), bacterial/viral meningitis/poliomyelitis/encephalitis inflammation

increased CSF protein can be caused by what 2 things?

1. BBB

2. IgG intrathecal synthesis

BBB CSF protein increase detected by:

albumin

intrathecal synthesis CSF protein increase detected by:

protein content of myelin sheath

CSF/serum Ig concentration ratio

CSF electrophoresis for MM

which organism has a positive india ink test

Cryptococcus

What’s the purpose of bacterial and cryptococcal antigen testing?

determine if a patient has bacterial meningitis (do a blood culture), cryptococcus, and TB infections

what tests to do for syphilis in CSF testing?

VDRL test and fluorescent treponemal antibody-absorption tests

lab results of meningitis Bacterial, Viral, Tubercular, Fungal

• WBC count, Glucose, Protein, Lactic Acid

Head Trauma, Subarachnoid Hemorrhage, MS, Brain Tubors lab results

• glucose

• protein

sperm production in the testes relates to which hormones

Seminiferous tubules make sperm: FSH causes germ cell maturation

Interstitial cells of Leydig make testosterone: LH stimulates Leydig

sperm maturation happens where?

Epididymis

sperm become motile here

4 components of sperm

nucleus/head: binds to egg

acrosome

midpiece

tail: motility

sperm acrosome purpose and source

penetrates ovum

from Golgi apparatus

sperm midpiece purpose

energy for motility is generated

macroscopic tests for routine semen analysis

viscosity, liquefaction, volume, pH

microscopic tests for routine semen analysis

count, motility, morphology, viability

semen reference ranges

4 sperm abnormalities

1. head: narrow base

2. neck/midpiece: sharp bend

3. tail: coiling

4. cytoplasma droplets: cytoplasmic material >30% of head area

3 sperm head abnormalities

absence, double head, micro/megalo

7 causes of low semen volume?

1. Vasectomy

2. Varicocele: dilation and tortuosity of pampiniform plexus (drains testicle)

3. Primary testicular failure (Klinefelters)

4. Secondary Testicular failure

5. congenital vas obstruction

6. Retrograde ejaculation: redirected to bladder

7. Endocrine: prolactinemia, low testosterone

what’s the importance of semen liquefacation

enzymes from prostatic fluid break down the gel portion of the seminal plasma

what’s the implication of semen liquefaction

incomplete liquefaction has a gelatinous material in a liquid base- seen when the sample is swirled

what’s the importance of semen viscosity?

it’s the fluid nature of the whole sample, measuring how long it takes to break a thread of semen when you stretch it out