Urinalysis and Body Fluids
CRg
Student review
for Competency and BF Lab Practical
Neubauer hemacytometer / counting chamber
• Large squares, such as # 1-9 below have volume of 0.1
• Small squares – in center # 5 have volume of 0.004
Improved Neubauer hemacytometer /
counting chamber
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Counting the cells
• Cells touching either the top or left boundary are included in
the count
• When triple lines are present, the MIDDLE line is used as the
boundary.
Neubauer hemacytometer / counting chamber
• Formula for calculations – results in # cells / uL
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Count and record cells from both sides of the chamber.
Average the two sides
Multiply by dilution factor (if no dilution is made, this number is 1)
Divide by number of squares counted X volume of each square
• Large squares, such as # 1-9 below have volume of 0.1
• Small squares – in center # 5 have volume of 0.004
ave. # cells counted x dilution
# squares counted x volume of each square
Body Fluid Differential
• Specimens for cell differential – usually collected in
EDTA tube (except CSF samples)
• Cytospin preparations produce more accurate counts,
however cell distortion often seen (can be minimized by
adding albumin to sample before processing).
• Stain = Wright/Wright-Giemsa (Gram stain may be used
if bacterial infection suspected.)
• Hyaluronidase added to synovial fluid to reduce the
viscosity and make the slide more uniform.
Body Fluid Differential
• Any nucleated peripheral blood cell, including
immature forms, plasma, and LE cells can be found.
• Check textbook / classroom notes for normal values.
• Monocytes/macrophages with inclusions are renamed
• Erythrophages contain one or more red cells
• Siderophages contain hemosiderin /siderotic bodies or
hematin crystals
• Leukophages contain white blood cell(s)
• Lipophage contains ingested fat/lipid
Body Fluid Differential
• Entire smear should be evaluated for
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abnormal cells
inclusions within cells
Clusters
Presence of intracellular organisms
Body Fluid Differential
• CSF specimen cells
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L – neutrophiles & @6 macrophages
• R – neutrophiles and intracellular bacteria
Body Fluid Differential - CSF
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Eosinophils
• Often associated with parasitic / fungal infections, allergic
reactions including reaction to shunts and other foreign
objects.
Body Fluid Differential - CSF
Ependymal cells
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Normal cell, unique to CSF
Line the ventricles, produce CSF fluid
Large cell with distinct round/oval
nucleus, sometimes found in sheets
Body Fluid Differential - CSF
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Cellular inclusions
• Erythrophage
• Siderophage
• Hematoidin crystals (see below)
1991 CAP 30 CSF hematoidin crystal / bilirubin crystal
•ASCP 21 CSF erythrophage, with few
iron granules forming
ASCP 6 macrophage, lymphocyte, siderophage
Body Fluid Differential - CSF
• India-ink / nigrosin preparation
• Negative stain to view the encapsulated
Cryptococcus neoformans (frequent complication seen in
/immunocompromised patients)
AIDs
• Instead of using stain, can also use dark field
microscopy to get same effect.
• Has @ 25-50% sensitivity
• Serological latex agglutination tests provide better
results – and are preferred.
Body Fluid Differential
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Suspicious / unclassified or malignant cells are reported as “other” or
“unclassified” AND are sent to pathology. (as seen below)
Cytology – send unstained slide to cytology / pathology
1986 CAP CM10 CSF – blasts (appearance similar to peripheral blood, always
consult with hematology specialist / pathologist) ( see below right)
Body Fluid Differential
• left is 1988 CAP CM 25 – CSF 250x malignant cells
• Remember – we classify them as ‘other’ or ‘unclassified’
and take the slide to the cytologist / pathologist
• Right is leukemic cells found in CSF
Body Fluid Differential - Serous
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Serous fluid examples
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Left -lymphocyte, macrophage/mono, basophil
Right - Mesothelial cells
Serous fluid - Mesothelial cell
• Mesothelial cell
Serous Fluids
• Malignant cells
• ACSP 7 Case 1 cont.
peritoneal fluid,
malignancy
Serous Fluids
• Malignant cells
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ASCP 12 Case 4, 30 year old with
back pain and inability to work.
Pleural effusion fluid – malignant
tumor on spinal cord
Serous Fluids-LE cells
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Seen in patients with Systemic Lupus Erythmatosis (SLE) a
systemic disease in which an autoantibody attacks the
patients organs and body systems
LE cell is a neutrophil or macrophage that has engulfed a
homogeneous mass of purple staining nuclear material
•It is not unusual to find macrophages
engulfing other cells,. If the nucleus of the
ingested cell has intact nuclear structures /
normal chromatin pattern, the macrophage is
considered to be a Tart cell . Tart cells are
not associated with SLE.
•Example is a segmented neutrophil and
demonstrates the LE cell characteristic of
containing a smooth homogenous nuclear mass.
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Synovial Fluid
In addition to counting and
identifying cells; identification of
any crystals present aids in
diagnosis.
•Monosodium urate
associated with gouty
arthritis.
•Calcium pyrophosphate
associated with pseudogout.
•Blunt ended rod-like crystals resembling monosodium urate, crystals
can be seen in patients following joint steroid injection.
•Others: oxalate and cholesterol
The Gout
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1799 caricature by James Gillray