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Transcript
Urine particle identification, November, 4-2016 2553 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 1/2 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