Download Urine particle identification, November, 4

Urine particle identification, November, 4-2016
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Case S001|Finding
Result
Dysmorphic erythrocyte
Granulocyte
Leukocyte
Red cell
Yeast (candida)
n
204
Total
213
2
1
1
5
Finding 1604-13: Yeast cells (expected result = E) were reported by 96 % of respondents. Bright bubbles of yeast cells are smaller than red blood cells and do not intake colour.
They also bud themselves creating chains in variable forms.
Case S002|Finding
Result
Artefact
Dysmorphic erythrocyte
Erythrocyte cast
Granulocyte
Leukocyte
Lymphocyte
Macrophage
Red cell
Renal tubular epithelial cell
Small epithelial cell
Yeast (candida)
Total
n
1
24
1
2
15
15
1
150
1
1
1
212
Finding 1604-14:The arrow 14 pointed at a red blood cell (E) that is larger than a yeast cell and takes in variable amount of Sternheimer supravital stain (pyronin B is red). The
expected result was given by 71 % of laboratories. Intensified cell membrane and small granularity do not justify classification into dysmorphic RBC (10 % of reports). Lymphocytes
show a separate nucleus (7 % of reports), like all other leukocytes (also 7 % of reports). The picture showed two granulocytes with their nuclei in the direction of the upper arrow 13
after the yeast cells for comparison.
Copyright © Labquality Oy
Labquality does not permit any reproduction for commercial purposes of any portion of the material subject to this copyright. Labquality prohibits any use of its name, or reference to
Labquality EQA program, or material in this report in any advertising, brochures or other commercial publications. Labquality EQA data do not necessarily indicate the superiority of
instruments, reagents, testing equipments or materials used by participating laboratories. Use of Labquality EQA data to suggest superiority or inferiority of equipments or materials may
be deceptive and misleading. Proficiency test results are handled confidentially. Labquality will not issue any statements to third parties of the performance of laboratories in external
quality assessment schemes unless otherwise agreed.
03.01.2017
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Urine particle identification, November, 4-2016
2553
Case S003|Finding
Result
Atypic epithelial cell
Cast
Erythrocyte cast
Granular cast
Granulocyte cast
Hyaline cast
Intestinal epithelial cell
Other than hyaline cast
Renal tubular cell cast
Renal tubular epithelial cell
Small epithelial cell
Squamous epithelial cell
Transitional epithelial cell
Waxy cast
n
8
13
2
19
3
28
3
15
1
9
5
40
58
8
Total
212
Finding 1604-15: The single cell pointed at by the arrow 15 was difficult to perceive uniformly. Another similar finding was missing. The length of the cell could be estimated to be
about 100 µm with the help of leukocytes in the figure. The cell also contained a nucleus. Different types of casts were reported by 41 % of participants who presumably perceived the
finding as a cast with a cell? The spindle-shaped form were compatible with a transitional epithelial cell (30 % of reports, E), or an intestinal epithelial cell (the patient had an artificial
Bricker bladder with intestinal columnar epithelium; 2 % of reports, E), rather than a squamous epithelial cell that does not exist in stomal urine (16 % of reports). Usually, intestinal
epithelial cells detach as round cells that are indistinguishable from transitional epithelial cells or even macrophages in the middle of cellular debris. Some laboratories reported
adequately “small epithelial cell” (3 %, E at the basic level). The cell was not atypical since the nucleus was round and a single nucleolus was seen only (4 % of reports). Renal
tubular epithelial cell could be accepted on morphological basis of a columnar cell that appear in renal tubuli as well (4 % of reports, A= acceptable). Renal tubular cells may also be
large.
The great variability of reports does not allow assessment of laboratory performance based on this finding.
Case S004|Finding
Result
Dysmorphic erythrocyte
Granulocyte
n
3
65
Leukocyte
Lymphocyte
Macrophage
Red cell
Renal tubular epithelial cell
Small epithelial cell
Transitional epithelial cell
123
Total
212
2
11
3
2
2
1
Finding 1604-15: The majority of laboratories identified leukocytes (56 % of reports, E at the basic level), or granulocytes (32 % of reports, E). The lobuli of the nuclei were not
completely discernible, creating difficulty in classification. Granularity of cytoplasms was obvious. The size of the cells did not fit with macrophages that are larger cells (6 % of
reports).
Clinical significance: Yeast infection, as well as persistent bacterial infection disturbs a patient living with his intestinal bladder (Bricker’s bladder). Identification of microbes and
reporting their susceptibility to antimicrobial agents is performed by bacteriology laboratories. Identification of epithelial cells in urinary stomal samples does not have clinical
significance beyond cytological diagnostics of malignancies. Automated particle analyser counted yeast cells into RBC, but created a flag that yielded into microscopic
review. Automated analysers should be avoided when investigating samples from stomas since they can block the thin needles of the instruments (with detached large pieces of
tissue). Infection can be rapidly reported after arbitrary microscopic classification of cells and microbes (yeasts and bacteria), avoiding unnecessary work.
Copyright © Labquality Oy
Labquality does not permit any reproduction for commercial purposes of any portion of the material subject to this copyright. Labquality prohibits any use of its name, or reference to
Labquality EQA program, or material in this report in any advertising, brochures or other commercial publications. Labquality EQA data do not necessarily indicate the superiority of
instruments, reagents, testing equipments or materials used by participating laboratories. Use of Labquality EQA data to suggest superiority or inferiority of equipments or materials may
be deceptive and misleading. Proficiency test results are handled confidentially. Labquality will not issue any statements to third parties of the performance of laboratories in external
quality assessment schemes unless otherwise agreed.
03.01.2017
2/2