Microscopic Sediment – Red Blood Cells

Red blood cells Pathological finding - cannot appear in filtrate

if nephron is intact. result of damage / injury to glomerular membrane,

▸ or urinary tract▸ strenuous exercise

(marathon runners)

Microscopic Sediment – Red Blood Cells

differentiate: Hemoglobinuria – free hemoglobin in urine Hematuria – presence of intact RBCs in urine

Can you have positive blood on dipstick & negative microscopic for RBCs?

Can you have positive microscopic for RBCs and yet negative dipstick?

Microscopic Sediment – Red Blood Cells

Result of bleeding along urinary tract Bleeding in nephron – red cell casts formed when

the RBCs get caught in precipitating protein Bleeding in lower GU tract – no protein or casts

160x mag

Microscopic Sediment – Red Blood Cells

Red Blood Cells Although NV = 0-2 hpf, an occasional RBC

is more significant than occasional WBC. Detection

High power magnification Reduced light yellow - red sheen (sometimes blue-green) Intact disc or may be crenated Highly retractile, smooth surface, round In dilute or alkaline urine appear as ghost or

shadow cells

Microscopic Sediment – Red Blood Cells

Urine RBCs can be easily confused with: Yeast - - generally refract light differently,

may have buds, and often are more egg shaped

Bubbles or oil droplets - large variation in size. Even more refractile / and have ‘hard’ appearing edges.

Confirmation – test for hemoglobin - by dipstick, which is most sensitive to free hemoglobin, rather than intact RBCs

Microscopic Sediment – Red Blood Cells

Red Blood Cells High magnification Hypertonic urine resulting in some crenated

Microscopic Sediment – Red Blood Cells

RBCs of various shapes & different levels of magnification

Microscopic Sediment – Red Blood Cells

fresh RBCs in the urine are often due to lower urinary tract problems

Microscopic Sediment – Red Blood Cells

When RBCs are subjected to osmotic pressures from having been in the urine for longer periods of time, they become more dismorphic

Microscopic Sediment – Red Blood Cells

RBC can even get small ‘blebs’ on them, making them appear similar to budding yeast.

Microscopic Sediment – Red Blood Cells

Microscopic Sediment – Red Blood Cells

Must be differentiated from yeast @ 160 x