1. 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)

2. 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?

3. 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

4. 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

5. 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

6. Microscopic Sediment – Red Blood Cells
High magnification
Hypertonic urine resulting in some crenated

7. Microscopic Sediment – Red Blood Cells
RBCs of various shapes & different levels of magnification

8. Microscopic Sediment – Red Blood Cells
fresh RBCs in the urine are often due to lower urinary tract problems

9. 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

10. Microscopic Sediment – Red Blood Cells
RBC can even get small ‘blebs’ on them, making them appear similar to budding yeast.

11. Microscopic Sediment – Red Blood Cells

12. Microscopic Sediment – Red Blood Cells
Must be differentiated from yeast
@ 160 x