Microscopic Sediment – 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 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 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