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CLLS 3231 URINALYSIS AND BODY FLUIDS

CLLS 3231 URINALYSIS AND BODY FLUIDS. MICROSCOPIC EXAMINATION Formed Elements: Cellular, Casts, Bacteria and Yeast. Standardization of Specimen Preparation. Commercial Systems Specimen volume Centrifugation Sediment Concentration Volume of Sediment Viewed. Methods to Increase Contrast.

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CLLS 3231 URINALYSIS AND BODY FLUIDS

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  1. CLLS 3231URINALYSIS AND BODY FLUIDS MICROSCOPIC EXAMINATION Formed Elements: Cellular, Casts, Bacteria and Yeast

  2. Standardization of Specimen Preparation • Commercial Systems • Specimen volume • Centrifugation • Sediment Concentration • Volume of Sediment Viewed

  3. Methods to Increase Contrast • Staining Techniques • Supravital Stains • Fat or Lipid Stains • Acetic Acid • Gram Stain • Hansel’s Stain

  4. Microsocpic Techniques • Examine within 2 hours of collection • Correlation with physical and chemical results • FIRST • Scan using low (10X) power and report LPF for certain elements • SECOND • Scan high (40X) power and report as indicated

  5. Formed Elements: RBCs • Appearance • hypertonic • hypotonic • Differentiate from yeast, oil, etc.. • Correlate with physical examination

  6. Formed Elements: RBCs • Correlate with chemical examination • False Positive Chemical • False Negative Chemical • Clinical Significance - Handout

  7. RBC’s Cont...

  8. RBC’s

  9. Formed Elements: WBC’s • Appearance • Correlation with Physical Examination • Correlation with Chemical Examination

  10. Formed Elements: WBC’s • Look-alikes: • Eosinophiluria • Lymphocytes • Monocytes and Macrophages

  11. WBC’s

  12. WBC’s Cont...

  13. Macrophage

  14. Formed Elements: Epithelial Cells • Presence: • Squamous Epithelial Cells • Most Common • Largest

  15. Squamous Epithelial Cells • Specimen Contamination • Low Power magnification

  16. Squamous Epithelal Cells

  17. Transitional (urothelial) Epithelial Cells • Location: • Description • UTI

  18. Transitional Epis.

  19. Renal Tubular Epithelial Cells • Each renal tubule is lined with a single layer of a characteristically different epithelium • Convoluted Renal Tubule • Proximal convoluted tubular cells • Distal convoluted tubular cells • Collecting Duct Cells

  20. Renal with Squamous Epis

  21. Convoluted Renal Tubular Cells • Description • Differentiation • Clinical Significance • Oval Fat Bodies

  22. Renals Continued...

  23. Collecting Duct Epithelial Cells • Description • Clinical Significance • Fragments

  24. Comparison of Epithelial Cells from the Urinary Tract EPITHELIAL CELL TYPE SIZE (DIAMETER) SHAPE NUCLEUS Squamous 40 - 60m Thin, flagstone shape, with distinct edges. Large amount of cytoplasm with fine granulation that increases with age. Small (approx. 8 m), centrally located, can be anucleated. Transitional (urothelial) 20 - 40m Variable, depending on cell layer. Superficial layer: large, round or pear shape; Intermediate layer: smaller and rounder; Deep basal layer: small and can be elongated or columnar-like. Cell edges are distinct and appear “firm”. Small (8 - 14m), centrally located, oval to round with variable density in the chromatin pattern Renal Tubular Epithelial Cells Collecting duct cells 12 - 20m Variable. Polygonal or cuboidal from small ducts; columnar from larger ducts. Relatively smooth cytoplasm Large, moderately dense, round nucleus that takes up approx. 2/3’s cytoplasm. Columnar cells the nucleus is usually slightly eccentric. Distal Convoluted tubular cells 14 - 25m Oval to round with grainy cytoplasm. Small, round, dense nucleus; centered or slightly eccentric. Proximal convoluted tubular cells 20 - 60m Oblong or cigar-shaped. These cells have a large amount of grainy cytoplasm. Cell edges are not sharply defined. They can resemble casts. Small, round, dense nucleus; eccentric; can be multinucleated.

  25. CASTS • Formation and General Characteristics • Formed in distal and collecting tubules • Accounts for shape: • Tamm-Horsfall protein: • Enhanced Cast Formation

  26. Renal Cast Formation

  27. Classification of Casts • Classified microscopically based on composition of matrix and the type of substances or cells enmeshed in them. • Homogenous: hyaline, waxy • Cellular Inclusion: RBC, WBC, RTE, Mixed cells, Bacteria • Other inclusions: granular, fat globules (cholesterol or triglycerides), hemosiderin granules, crystals • Pigmented: bilirubin, hemoglobin, myoglobin • Size: broad

  28. Homogenous Casts • Hyaline Cast • Waxy Cast

  29. Hyaline Cont...

  30. Hyaline

  31. Waxy Casts Cont...

  32. Waxy Casts

  33. Cellular Casts • RBC Cast • WBC Cast

  34. RBC Cast

  35. RBC Cast Cont...

  36. WBC Cast

  37. WBC Cast Cont...

  38. Cellular Casts Continued • RTE Cast • Mixed Cell Cast • Bacterial Cast

  39. Renal Cast

  40. Other inclusions • Granular Cast • Fatty Cast • Hemosiderin and Crystal Casts

  41. Granular Casts

  42. Granular Casts Cont...

  43. Fatty Cast

  44. Pigmented and Broad Casts • Hyaline matrix with pigment incorporated • hemoglobin • myoglobin • bilirubin • Broad Cast - dilated convoluted tubule or in collecting ducts

  45. Bacteria

  46. Yeast

  47. Yeast Cont...

  48. Oval Fat Bodies

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