Microscopic Analysis Flashcards by Franchezka Ignacio

Microscope used for Routine UA

Bright-Field

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Microscope used with LOW REFRACTIVE INDICES hyaline cast, mixed cellular cast, mucus threads, and Trichomonas

Phase-contrast

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Microscope used for Cholesterol, oval fat bodies, fatty casts, and crystals

Polarizing Microscope

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Microscope used for Treponema Pallidum

Dark-Field

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Microscope used for naturally fluorescent microorganisms, or applied with fluorescent dye

Fluorescent Microscope

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Microscope that provides 3-dimensional imaging, or layer by layer Image

Interference contrast

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Bright field to Polarizing Microscope

add 2 filters
1. between light source and specimen
2. Analyzer filter: above specimen; between eyepiece and objective

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Convert Bright to Dark Field

Add dark field condenser with opaque disk

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2 types of Interference-Contrast Microscope

Hoffman
Nomarski

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Interference-Contrast:

Modulation contrast

Hoffman

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Interference-Contrast:

Differential

Nomarski

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Interference-contrast Microscopes both adapt

Bright Field

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Primary Components of Len System (4)

Objective
Ocular (Eyepiece)
Coarse Adjustment Knob
Fine Adjustment Knob

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Primary Lens System:

Initial magnification

Objective

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Primary Lens System:

FURTHER magnification and enhanced by objective

Ocular (Eyepiece)

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Primary Lens System:

Move stage up and down

Coarse Adjustment Knob

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Primary Lens System:

Sharpen image

Fine adjustment knob

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Illumination System composed of (4)

Light Source
Condenser
Aperture
Field Diaphragm

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Illumination System:

Found in Modern Microscope
contains RHEOSTAT to regulate intensity of Light

Light Source

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Illumination System

Focuses light and control UNIFORM illlumination

Condenser

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Illumination System

control AMOUNT OF LIGHT

Aperture (Iris)

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Illumination System

Control DIAMETER of light beam

Field Diaphragm

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Microscope BODY consist of (3)

Base
Body Tube
Nosepiece

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Delineates Nuclear and Cytoplasm structure

Sternheimer-Malbin

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Sternheimer-Malbin consist of 2 stains:

Crystal Violet Safranin O

Sternheimer-Malbin stains structures like

WEC WBC Epithelial cells Cast

Stains that Differentiates WBC and RTE cells; stains Nuclear structure

Toluidine blue

Substitute for Toluidine blue

Acetic Acid

With Eccentric Nucleus

RTE cells maaRTE

Stains for Lipid; neutral fats and triglycerides

Oil Red O Sudan III

Stains for IRON

Prussian Blue Stain

Identifies yello-brown granules of Hemosiderin

Prussian blue

Simple stain that enhance nuclear details of EPITHELIAL CELLS

Methylene Blue

Yellow-brown granules that seen in cells and cast from episodes of HEMOGLOBINURIA

Hemosiderin

KOVA stain is

Modified Sternheimer-Malbin Stain

Used in Automatic Microscopy: Stains DNA with ORANGE dye

Phenathridine

Used in Automatic Microscopy: Stains GREEN; nuclear, MITOCHONDRIA, Negative cell membrane

Carbocyanine

Automated Microscopy used

Sysmex UF-100 UF-50 Urine Cell Analyzer

First procedure to be STANDARDIZED TO QUANTIFY FORMED ELEMENTS in urine

Addis Count

Addis Count is discovered by

Thomas Addis

Addis count: Method of Collection Preservative

12 hr urine Formalin

Addis count quantifies (4)

RBC WBC Epithelial Cells Cast

Addis Count Normal Values: RBC

0 TO 500,000 RBC

Addis Count Normal Values: WBC

0 to 1.8 M WBC

Addis Count Normal Values: Hyaline Cast

0 to 5, 000 Hyaline Cast

Microscopic Examination: Specimen Preparation Centrifuge

5 minutes 400 RCF

Microscopic Examination: Specimen Preparation Fields to Examined under what Objective (2)

10 FIELDS LPO (10x) and HPO (40x)

Microscopic Examination: Specimen Preparation Microscope properties to consider

Reduced Light in Bright Field Microscopy

Microscopic Examination RFMoMA Rare, Few, Moderate, Many: = RFMoMa / HPF

RFMoMa / HPF TTBYaN Trichomonas Transitional Epithelial Cells Bacteria Yeast Normal Crystal

Microscopic Examination RFMoMA Rare, Few, Moderate, Many: = RFMoMa / LPF

RFMoMa / LPF *Squammy MuMu Mucous Threads Mucus secretion Squamous Epithelial Cells

Microscopic Examination AVERAGE / HPF

ROWR RBC Oval Fat Bodies WBC RTE cells

Microscopic Examination AVERAGE / LPF

CastCrAb Cast Abnormal Crystal

Normal Findings RBCs /HPF

0-2 or 0-3 RBC/ HPF

Normal Findings WBCs /HPF

0-5 OR 0-8 WBC/HPF

Normal Findings Hyaline Cast /LPF

0-3 Hyaline / LPF

Non-nucleated, biconcave disk

RBC cells

RBC appears in HYPERSTENURIC / HIGH SPECIFIC GRAVITY environment

Crenated

RBC appears in HYPOSTENURIC / DILUTED URINE environment

Ghost Cells

Dysmorphic RBC is clinically associated with

Glomerular Membrane Damage (Acute Glomerulonephritis)

RBC Sources of Error: RBC is mistakenly identified as

Yeast Cells Oil Droplets Air Bubbles

RBC Sources of Error Remedy

Use of Acetic Acid (lyse RBC)

Presence of abundant amount of WBC in urine

Pyuria

Larger than RBC

WBC

Type of WBC that is seen in HYPOTONIC urine and exhibit Brownian Movement

Glitter Cell

Stain used for WBC

Sternheimer-Malbin

Sternheimer-Malbin stains Glitter Cells

Light Blue

Sternheimer-Malbin stains Neutrophils

Violet

Eosinophils >1% clinical significant

Acute Interstitial Nephritis

Largest Cells found in Urine

Squamous Epithelial Cells

Squamous Epithelials surrounded with coccobacillus

Clue cells

Clue cells Clinical significant

Bacterial vaginosis / Vaginitis

Clue cells is due to

Gardnerella vaginalis

It is a type of Epithelial cells that has polyhedral, caudate, and in columnar shape with CENTRALLY located nucles

Transitional Epithelial Cells

Small amount of Transitional Epithelial cells in urine is normal ; it is found in renal pelvis, bladder, urethra f/t

TRUE

Most clinically significant Epithelial Cells

Renal Tubular Cells

Epithelial Cells that are rectangular, polyhedral, cuboidal/ columnar with ECCENTRIC NUCLEUS

Renal Tubular Epithelial Cells

> 2 RTE / HPF

Tubular Injury

It is a type RTE filled with Lipids

Oval Fat Bodies

Oval Fat Bodies is clinically associated with

Nephrotic Syndrome

Type of RTE cells that is a empty-filled vacuole

Bubble Cells

Bubble cells is clinically associated with

Acute Tubular Necrosis

It is used to detect UTI with the presence if WBC

Bacteria

What should be tested in differentiating BACTERIA FROM AMORPHOUS URATES AND PHOSPHATE

Motility

It is usually associated in patients with DM which secretes glucose in urine

Yeast

Yeast may appear with or without buds T/F

True

Most Frequently encountered parasite in URINE

Trichomonas Vaginalis

They have undulating memebrane, flagella and exhibits rapid Darting motility

Trichomonas vaginalis

Preparation of urine to observe movement of T.vaginalis

Wet Preparation

To avoid error in identifying T.vaginalis as RTE cells, WBC, Transitional, what kind of Microscope to be used

Phase-contrast

Parasite seen in patient with BLADDER CANCER

Schistosoma haematobium

Parasite associated with Hematuria

Schistosoma haematobium

Parasite that is most common fecal contamination

Enterobius vermicularis (Pinworm ova)

Vaginal contaminant; seen in female urine after recent sexual intercourse

Spermatozoa

No clinical significance; protein secreted by glands and ET cells of lower genitourinary tract RTE cells

Mucus

Urine sediment that is UNIQUE TO KIDNEY

Cast

Present of Cast in urine is known as

Cylinduria

Major constituent of Cast

Tamm--Horsfall Protein (Uromodulin)

Casts are formed in

DC Distal convulated tube Collecting ducts

Cast are prone to located at the ___ of cover slip

Near Edges

same clinical significance with cast but they are formed in ASCENDING LOOP OF HENLE AND DISTAL CONVULATED TUBE that produce TAPERED ENDS

Cylindroids

Most Frequently seen cast

Hyaline Cast

Normal Hyaline Cast Report

0-2 Hyaline / Lpf

Stain in Hyaline Cast

Sternheimer-Malbin Pink

Clinical Significance of Hyaline Cast

Glomerulonephritis Pyelonephritis Chronic Renal Disease Congestive Heart Failure Stress and Exercise

Cast seen in damaged glomerulus; Glomerulonephritis

RBC cast

Cast signifies inflammation and infection in nephrons

WBC Cast

WBC Cast, WBC, Bacteria

Peylonephritis

WBC, Bacteria

Cystitis

WBC Cast

Acute interstitial nephritis

Cast confirmed by Gram staining

Bacterial cast

Cast associated with Heavy metals, and chemical/Drug Induced toxicity, viral infection, allograft rejection

Epithelial Cell Cast

Epithelial Cell Cast Clinical Significance

Renal Tubular Damage

Cast that may be pathologic or non-pathologic

Coarse / Fine Granular Cast

Cast usually associated with Oval Fat Bodies and Free Fat Droplets

Fatty Cast

Nephrotic Syndrome Toxic Tubular Necrosis Diabetes Mellitus Crush Injuries

Fatty Cast

Cast with Jagged ends, Notched, and fragmented seen in Chronic Renal failure

Waxy Cast

Patient has Chronic Renal Failure and has stasis in urine

Waaxy Cast

Known as the 'Renal Failure Cast'

Broad Cast

Extreme Urine Stasis Renal Failure

Broad Cast

Glomerulonephritis and Nephrotic Syndrome in same urine specimen Abundant Granular, Waxy, and Broad Cast

Telescope Urine Sediment

Telescope Urine Sediment is seen in patient with

Collagen Vascular Disease Lupus Nephritis Subacute Bacterial Infections

ACIDIC URINE: Normal Crystals (3)

Amorphous urates Uric Acid Calcium Oxalate

ACIDIC URINE: Normal Crystals yellow-brown; brick dust Pink sediment (when refrigerated)

Amorphous Urates

ACIDIC URINE: Normal Crystals This can be converted to Uric Acid upon addition with ACETIC ACID Soluble to Alkali and Heat (60 deg C)

Amorphous Urates

ACIDIC URINE: Normal Crystals Rhombic, Whetstones, Lime-shaped Looked Like Cystine Crystals

Uric Acid

ACIDIC URINE: Normal Crystals Seen in Patient with Leukemia that undergoes Chemotherapy Lesch-Nyhan Syndrome

Uric Acid

ACIDIC URINE: Normal Crystals Uric Acid Crystal is soluble in

Alkali

ACIDIC URINE: Normal Crystals Crystals can be formed under Alkali, acidic, and Neutral pH

Calcium Oxalate

ACIDIC URINE: Normal Crystals Whedellite

Dihyrdrate Most Common Envelope / Pyrimidal

ACIDIC URINE: Normal Crystals Whewellite

Monohydrate Less frequent dumbell / Oval

ACIDIC URINE: Normal Crystals Majority Renal Calculi forms

CaOx

ACIDIC URINE: Normal Crystals CaOx Pathologic Significance

Etyhylene Glycol Poisoning (Dumbell, Monhydrate)

ACIDIC URINE: Normal Crystals CaOx is soluble in

dilute HCl

ALKALINE URINE: Normal Crystals (5)

Amorphous Phosphates Ammonium Biurate Triple Phosphate Calcium Phosphate Calcium Carbonate

ALKALINE URINE: Normal Crystals Same as with Amorphous Urates White Precipate that does not dissolve on warming

Ammonium phosphate

ALKALINE URINE: Normal Crystals Ammonium phosphate is soluble in

Dilute Acetic Acid

ALKALINE URINE: Normal Crystals Thorny apple; seen in Old Specimen; Urea Spitting Bacteria is present

Ammonium Biurate

ALKALINE URINE: Normal Crystals Converted to Uric Acid in the presence of GLACIAL ACETIC ACID, dissolved in Heat (60 Deg C)

Ammonium Biurate

ALKALINE URINE: Normal Crystals Also known as MAP (Magnesium Ammonium Phosphate); Struvites Staghorn calculi

Triple PhosphateALKALINE URINE: Normal Crystals

ALKALINE URINE: Normal Crystals Coffin lid shaped When disintegrated, appear Feathery Appearance Highly Alkaline Urine (Urea-spitting)

Triple phosphate

ALKALINE URINE: Normal Crystals Triple phosphate is soluble in

Dilute Acetic Acid

ALKALINE URINE: Normal Crystals Also known as Apatite or Hyroxyapatite

Calcium phosphate

ALKALINE URINE: Normal Crystals colorless, flat rectangular plates or thins prisms often in Rosette forms; MAY BE CONFUSED WITH SULFONAMIDES IN NEUTRAL pH

Calcium Phosphate

ALKALINE URINE: Normal Crystals Confirmation to diff. Calcium Phosphate and Sulfonamides

Dilute Acetic Acid Calcium Phosphate = DISSOLVE Sulfonamide = do not

ALKALINE URINE: Normal Crystals Colorless with dumbbell or spherical shapes May occur in clumps resemble amorphous material

Calcium Carboanate