Microscopic sediment red blood cells
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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.

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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)


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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?


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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


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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


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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


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Microscopic Sediment – Red Blood Cells

  • Red Blood Cells

    • High magnification

    • Hypertonic urine resulting in some crenated


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Microscopic Sediment – Red Blood Cells

  • RBCs of various shapes & different levels of magnification


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Microscopic Sediment – Red Blood Cells

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


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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


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Microscopic Sediment – Red Blood Cells

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



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Microscopic Sediment – Red Blood Cells

  • Must be differentiated from yeast

    • @ 160 x