# MedLabBuddy

> Study and Reference material for Medical Laboratory Sciences


## Posts

- [Amorphous Phosphates & What To Do](https://medlabbuddy.com/amorphous-phosphates-what-to-do/): A urinalysis is ordered on a cloudy urine with a pH of 8.0. All other values on the urine chemistry are completely normal. Heating did nothing to clear the specimen. After spinning the urine sample, a layer of white sediment can be seen at the bottom. This sediment is filled with small granules. The brownian movement of these granules can be easily confused for bacteria or hide the presence of it. With the alkaline pH, these small granules are most likely amorphous phosphates. These crystals dissolve in dilute acetic acid. With the addition of dilute acetic acid to an aliquot […]
- [UA Practice- 358481](https://medlabbuddy.com/ua-practice-358481/): Practice grading different elements in a urine microscopic with positive crystals. Identify calcium phosphate crystals by pH and appearance.
- [UA Practice- 348176](https://medlabbuddy.com/ua-practice-348176/): Practice grading different elements in a urine microscopic with casts present. Use phase microscopy to identify hyaline casts. 
- [UA Practice- 348369](https://medlabbuddy.com/ua-practice-348369/): Practice grading different elements in a urine microscopic with positive crystals. Identify both monohydrate and dihydrate forms
- [UA Practice- 342216](https://medlabbuddy.com/ua-practice-342216/): Practice grading different elements in a urine microscopic with positive crystals. Identify the thorny apple appearance of ammonium biurate.
- [Blast or Activated Lymph?](https://medlabbuddy.com/blast-or-activated-lymph/): View and understand the differences between a blast cell and an activated lymph, including differences in cytoplasm and nucleus.
- [UA Practice-339603](https://medlabbuddy.com/ua-practice-339603/): Practice grading different elements in a urine microscopic with positive leukocytes, high turbidity, and bacteria present.
- [Abnormal Diff Practice-919613](https://medlabbuddy.com/abnormal-diff-practice-919613/): Practice a 100 white cell differential on a slide with increased band neutrophils.
- [Abnormal Diff Practice-323702](https://medlabbuddy.com/abnormal-diff-practice-323702/): Practice a 100 white cell count on a patient with chronic lymphocytic leukemia.
- [Abnormal Diff Practice-855276](https://medlabbuddy.com/abnormal-diff-practice-855276/): Practice a 100 white cell differential on a slide with a left shift.
- [Severe Sepsis with Intravascular Hemolysis](https://medlabbuddy.com/severe-sepsis-with-intravascular-hemolysis/): A Complete Blood Count with Differential is performed on the DXH 900 for a patient with severe sepsis & intravascular hemolysis. Due to the high percentage of neutrophils detected, a manual slide review is performed. Increased band neutrophils are seen, indicating a left shift. A manual differential is performed with the following results: 46% segmented neutrophils, 37% band neutrophils, 12% metamyelocytes, 3% lymphocytes, and 2% monocytes. The neutrophils also show toxic granulation and vacuolization. In conjunction with the immature granulocytes, these features indicate response to infection. Evidence of the severe bacteremia can be seen in some neutrophils as phagocytosed bacteria. […]
- [Amorphous Urates & What To Do](https://medlabbuddy.com/amorphous-urates/): A urinalysis is added on to a refrigerated urine. The urine is extremely turbid with a pH of 5.5. Note that it is best practice to let the specimen come to room temp before testing. For the sake of example, this is not done. After spinning the urine sample, a layer of “brick dust” sediment can be seen at the bottom. This sediment is filled with small granules. The brownian movement of these granules can be easily confused for bacteria or hide the presence of it. The urine is resuspended and repoured into another tube. This time, it is heated […]
- [Beta Thalassemia](https://medlabbuddy.com/beta-thalassemia/): A CBCD is ran on the DXH900 for a patient with Beta Thalassemia. Numerous nucleated red blood cells (NRBCs) are detected which interfere with the automated differential, producing ‘R’ flags. This interference can be seen in the 5PD1 scatterplot. Because of the presence of NRBCs and flags on the automated differential, a manual differential must be performed. Out of a 100 cell count differential, 105 NRBCs are noted. The patient also has a microcytic anemia with a hemoglobin of 8.4. The following morphology is noted when performing the slide review: (Click on a morphology to learn more!) Look at the […]
- [Ciprofloxacin Crystals in Urine](https://medlabbuddy.com/ciprofloxacin-crystals-in-urine/): A patient had the following urine chemistries. Upon performing the microscopic Triple Phosphate crystals were easily identified with the alkaline pH. However, another type of crystal was noted that took the form of wheat sheaves and needles. Looking in the reference books, it looks like the crystals for medications such as ampicillin or indinavir. However, these were noted to have been seen in acidic urine instead of alkaline. Looking at the patient’s medication list, ciprofloxacin was noted which can also precipitate as crystals in alkaline urine after administration. Color Light Orange Clarity Ex. Turbid Glucose Negative Bilirubin Negative Ketones Negative […]
- [Fern Test](https://medlabbuddy.com/fern-test/): A preterm mother comes into the hospital with concern of premature rupture of fetal membrane. Essentially, this means her water broke before 37 weeks. An AmniSure test is performed on the vaginal secretion to detect the presence of amniotic fluid in the secretion. The test comes out positive, indicating the amniotic sac has ruptured. The fern test is another method to detect amniotic fluid in vaginal secretions, though less specific and less sensitive than more modern methods. This means it is prone to false positives and false negatives. A drop of the vaginal secretion is placed on a glass slide […]
- [Gout Crystals in Body Fluid](https://medlabbuddy.com/gout-crystals-in-body-fluid/): Extracellular needle-like crystals are noted in a synovial fluid. Polarization is crucial to differentiate gout from pseudogout. Monosodium urate (gout) crystals are yellow when parallel to the axis and blue when perpendicular to the axis. This is known as negative birefringence. In contrast, calcium pyrophosphate (pseudogout) crystals have positive birefringence, meaning they are blue when parallel to the axis. See in the image comparison how the color of the crystals changes from yellow to blue based on the axis of polarization. The majority of the crystals pictured here are horizontal. When the axis is also horizontal, the parallel crystals are […]

## Pages

- [Amorphous Phosphates](https://medlabbuddy.com/urinalysis/urinary-crystals/amorphous-phosphates/): Amorphous phosphates are found in alkaline urine. They are soluble in dilute acetic acid and do not dissolve with heat. These crystals are not clinically significant. Macroscopic Appearance Macroscopically, amorphous phosphates form a white sediment. Crystal Appearance Amorphous Phosphates appear as granular material in the sediment. The addition of dilute acetic acid usually dissolves these crystals, allowing for proper identification of elements the sediment that may otherwise be obscured. Check out more images in the gallery below. Lookalikes Brownian motion of these amorphous granules may make them appear as bacteria, so care must be taken with identification. Bacteria will have […]
- [Mitotic Figures](https://medlabbuddy.com/body-fluid/cells/mitotic-figures/): Mitotic figures are actively dividing cells. Few of these cells may be found in normal body fluids. Numerous or abnormal mitotic figures can indicate malignancy. They may be found in clumps of tumor cells which rapidly divide. Appearance Chromosomal structures are visible in the nucleus of mitotic figures, which can cause a daisy-like appearance. The appearance of these clusters in nucleus will depend on the stage of mitosis. Gallery Other Body Fluid Cells Neutrophils Lymphocytes Monocytes / Macrophages Eosinophils Basophils Mast Cells Mesothelial Cells Synoviocytes Blast Cells Malignant Cells Additional Resources
- [Body Fluid Blast Cells](https://medlabbuddy.com/body-fluid/cells/blast-cells/): The presence of blast cells in cerebrospinal fluid (CSF) can indicate central nervous system involvement in cases of acute leukemia. However, contamination of blast cells from peripheral blood is also possible if there is a traumatic tap. Appearance Blast cells in body fluid appear similar to those that may be seen in peripheral blood. Cytocentrifugation may exaggerate cellular features, such as larger nucleoli or irregular nuclear shape. Chromatin is fine with one or more nucleoli. Lookalikes Lymphocytes may appear larger due to cytocentrifugation which can be mistaken for blasts if not careful. Patient history can aid in identification. BF Lymphocytes […]
- [Synoviocytes](https://medlabbuddy.com/body-fluid/cells/synoviocytes/): Synoviocytes are lining cells seen in synovial fluid. They are not clinically significant. Appearance Synoviocytes are visually similar to mesothelial cells. The nucleus is round to oval with smooth borders. Nucleoli may be present. Cytoplasm may have irregular edges or vacuoles. Lookalikes Macrophages are about the same size as synoviocytes, so the two can often be confused. Macrophages can usually be differentiated by the presence of vacuoles and a lacey chromatin. If both cell types are present and differentiation is difficult, take a look around the slide to get an idea of each kind of morphology before starting a differential. […]
- [Malignant Cells](https://medlabbuddy.com/body-fluid/cells/malignant/): Malignant cells may be found in body fluids due to blood cancers or other cancers that have metastasized. These slides should be sent to the pathologist for examination and further study. Appearance Appearance of malignant cells can vary widely. However, they commonly have one or more of the following features: Cells clumping together with no discernable borders between or one giant cell with many nuclei, Dark-staining, 3-D appearance, irregular nuclei or chromatin pattern, etc. Malignant cells are often apparent on low power due to these distinctive features. Because these cells may be few in number or clump together, it is […]
- [Mesothelial Cells](https://medlabbuddy.com/body-fluid/cells/mesothelial/): Mesothelial cells are lining cells seen in pleural, peritoneal, and pericardial fluids. Appearance Mesothelial cells are described as having a “fried egg” appearance. They have a round to oval nucleus with smooth borders and evenly distributed chromatin. Nucleloli are usually present. Mesothelial cells may also be multinucleated. Cells may be seen in clumps, but “windows” between cells still allows for individual counting. Lookalikes Macrophages are about the same size as mesothelial cells, so the two can often be confused. Macrophages can usually be differentiated by the presence of vacuoles and a lacey chromatin. If both cell types are present and […]
- [Mast Cells](https://medlabbuddy.com/body-fluid/cells/mast-cells/): Increased amounts of mast cells can be seen in Mast Cell Disease, parasitic infections, and allergic reactions. Appearance Mast cells are larger than other white blood cells with a round nucleus. The cytoplasm is filled with dark blue granules. Lookalikes Mast Cells are larger and more granulated than basophils but with similar function. BF Basophils Gallery Other Body Fluid Cells Neutrophils Lymphocytes Monocytes / Macrophages Eosinophils Basophils Mesothelial Cells Synoviocytes Blast Cells Mitotic Figures Malignant Cells Additional Resources
- [Body Fluid Basophils](https://medlabbuddy.com/body-fluid/cells/body-fluid-basophils/): Increased amounts of basophils in body fluid may be seen with foreign body or allergic reactions. Appearance Basophils in body fluid appear the same as seen in peripheral blood with their characteristic large dark purple granules. Lookalikes Mast cells can look similar to basophils with their numerous coarse basophilic granules. However, mast cells are larger than basophils and have a round nucleus. Mast Cells Other Body Fluid Cells Neutrophils Lymphocytes Monocytes / Macrophages Eosinophils Mast Cells Mesothelial Cells Synoviocytes Blast Cells Mitotic Figures Malignant Cells Additional Resources
- [Body Fluid Lymphocytes](https://medlabbuddy.com/body-fluid/cells/lymphocytes/): Increased numbers of lymphocytes in cerebrospinal fluid (CSF) are indicative of viral meningitis. Appearance Due to cytocentrifugation, lymphocytes in body fluid may be larger or have more abundant cytoplasm than lymphocytes in peripheral blood. Nucleoli may also be visible. Lookalikes Cytocentrifugation may make lymphocytes appear larger and make their nucleoli more apparent. These changes can cause lymphocytes to be mistaken for blasts if not careful. Looking at patient history can help with identification. Blast Cells Gallery Other Body Fluid Cells Neutrophils Monocytes / Macrophages Eosinophils Basophils Mast Cells Mesothelial Cells Synoviocytes Blast Cells Mitotic Figures Malignant Cells Additional Resources
- [Body Fluid Eosinophils](https://medlabbuddy.com/body-fluid/cells/eosinophils/): Increased amounts of eosinophils in body fluid may be seen with asthma, parasitic infection, and allergic or foreign body reactions. Appearance Eosinophils have coarse refractile reddish-orange granules. They appear essentially the same as they do in peripheral blood. Lookalikes Cytocentrifugation may make granules in neutrophils appear larger which may be confused for eosinophils. However, neutrophil granules will not have the refractile quality seen in eosinophils or the vibrant reddish-orange coloring. Neutrophils Gallery Other Body Fluid Cells Neutrophils Lymphocytes Monocytes / Macrophages Basophils Mast Cells Mesothelial Cells Synoviocytes Blast Cells Mitotic Figures Malignant Cells Additional Resources
- [Body Fluid Monocytes / Macrophages](https://medlabbuddy.com/body-fluid/cells/mono-macro/): Monocytes in peripheral blood can migrate to tissue and differentiate into macrophages. Macrophages phagocytize debris or foreign material. Thus, they can be seen in body fluids ingesting bacteria, red blood cells, and even white blood cells at times. These cells may be increased with inflammation. Monocytes Monocytes in body fluids appear as they do in peripheral blood. Cytocentrifugation may exaggerate the vacuoles or make the cells appear larger. Macrophages Macrophages are larger than monocytes and about the same size as mesothelial cells. Their cytoplasm often contains numerous vacuoles. Erythrophages Erythrophages are macrophages with engulfed red blood cells. These cells can […]
- [Body Fluid Neutrophils](https://medlabbuddy.com/body-fluid/cells/neutrophils/): Large numbers of neutrophils in body fluid may indicate bacterial infection. In CSF, it is indicative of bacterial meningitis. Appearance Neutrophils in body fluids appear the same as they do in peripheral blood with fine pink granules. Cytocentrifugation may stretch the cell or cause the granules to appear larger than normal. Lookalikes Cytocentrifugation may make granules in neutrophils appear larger which may be confused for eosinophils. However, neutrophil granules will not have the refractile quality seen in eosinophils or the vibrant reddish-orange coloring. Eosinophils Gallery Other Body Fluid Cells Lymphocytes Monocytes / Macrophages Eosinophils Basophils Mast Cells Mesothelial Cells Synoviocytes […]
- [Calculators](https://medlabbuddy.com/calculators/): When using these calculators, please double check the result to make sure it makes sense. The calculation performed is listed underneath the result bar. Don’t forget to round as necessary.
- [Pappenheimer Bodies](https://medlabbuddy.com/red-blood-cells/rbc-inclusions/pappenheimer-bodies/): Pappenheimer Bodies are also known as siderotic granules, as they are composed of iron. Thus, they are seen when iron incorporation to heme is affected or with iron overload. Associate conditions include sideroblastic anemia, hemolytic anemia, sickle cell anemia thalassemia, and myelodysplastic syndrome. Appearance Pappenheimer Bodies appear as small dark purple granules found in clusters, usually on the periphery of the cell. These granules are usually irregularly shaped. With a Prussian blue stain, they stain positive as siderotic granules. Lookalikes Howell-Jolly (HJ) bodies may look like pappenheimer bodies, but they usually appear singularly instead of in clusters. Additionally, HJ bodies […]
- [Malaria](https://medlabbuddy.com/red-blood-cells/rbc-inclusions/malaria/): Malaria is a mosquito-borne disease caused by the Plasmodium parasite. There are five different species of plasmodium that can cause malaria in humans: P. falciparum, P. malariae, P. ovale, P. vivax, and P. knowlesi. Most cases of malaria in the United States are caused by recent travel to endemic locations. For more information on the different species of plasmodium and detailed descriptions of appearance for each stage, see this article on Malaria in the National Library of Medicine. P. falciparum P. falciparum is endemic to Africa. P. falciparum is named after its characteristic banana-shaped gametocytes, coming from the Latin word […]
- [Howell-Jolly Bodies](https://medlabbuddy.com/red-blood-cells/rbc-inclusions/howell-jolly-bodies/): Howell-Jolly (HJ) bodies are nuclear fragments that are normally removed by the spleen. Hence, their presence is usually associated with hyposplenism or a previous splenectomy. They may also be seen in megaloblastic anemias, hemolytic anemias, thalassemia, alcoholism, and sickle cell anemia. Appearance Howell-Jolly bodies are densely staining round purple inclusions in the cytoplasm of a red blood cell, usually appearing singularly. Lookalikes Pappenheimer bodies are another type of basophilic inclusion. However, pappenheimer bodies are smaller than HJ bodies and usually appear in clusters. Pappenheimer Bodies Stain can precipitate on the slide. When this precipitate overlays a red blood cell, it […]
- [Hemoglobin C Crystals](https://medlabbuddy.com/red-blood-cells/rbc-inclusions/hemoglobin-c-crystals/): Hemoglobin C crystals are seen in individuals who are homozygous for the abnormal hemoglobin C gene which causes hemoglobin C disease. The trait is more common in those of African descent. The disease can cause mild hemolytic anemia, splenomegaly, jaundice, and pigmented gallstones. Appearance Hemoglobin C is less soluble than normal hemoglobin which can cause it to crystallize. These crystals stain densely red as the hemoglobin is concentrated to a rhomboid rod-shaped area. Image from medical-labs.net Other Inclusions Babesia Image from cdc.gov Basophilic Stippling Cabot Rings Howell-Jolly Bodies Malaria Image from horiba.com Pappenheimer Bodies Additional Resources
- [Cabot Rings](https://medlabbuddy.com/red-blood-cells/rbc-inclusions/cabot-rings/): Cabot rings consist of nuclear remnants or part of the mitotic spindle. Their presence is indicative of dyserythropoeisis. Thus, it may be seen in megaloblastic anemia, lead poisoning, and myelodysplastic syndrome (MDS). Appearance Cabot rings are thin oval or figure-8 shaped inclusions in the cytoplasm of a red blood cell. Lookalikes Water artifacts can appear as rings in a red blood cell. However, they are highly refractile. If morphology cannot be distinguished, make a new slide. Water Artifact Other Inclusions Babesia Image from cdc.gov Basophilic Stippling Hemoglobin C Image from medical-labs.net Howell-Jolly Bodies Malaria Image from horiba.com Pappenheimer Bodies Additional […]
- [Basophilic Stippling](https://medlabbuddy.com/red-blood-cells/rbc-inclusions/basophilic-stippling/): Basophilic stippling refers to the presence of ribosomal aggregates in red blood cells. These aggregates appear as dark blue granules dispersed throughout the erythrocyte. This coarse stippling is seen in lead poisoning, thalassemia, sideroblastic anemia, megaloblastic anemias, and defective heme synthesis. Fine basophilic stippling is usually not reported, as it is the result of immature polychromatophilic cells and not indicative of defective heme synthesis. Coarse Stippling Coarse stippling is readily apparent with evenly dispersed large granules. Fine Stippling Fine stippling appears as evenly distributed purple dust and is hard to see in a cell. Fine stippling is seen in polychromatic […]
- [Babesia](https://medlabbuddy.com/red-blood-cells/rbc-inclusions/babesia/): Babesia is a tick-borne parasite that causes babesiosis. Infection is rare in the United States and usually only affects susceptible populations such as the elderly, immunocompromised, or splenoctomized patients. Appearance Babesia may appear as rings or tetrads in the cytoplasm of a red blood cell. Image from cdc.gov Lookalikes Water artifacts can appear as rings in a red blood cell. However, they are highly refractile. If morphology cannot be distinguished, make a new slide. Water Artifact Plasmodium species can look similar to babesia. Patient history can help in identification. Malaria Image from phil.cdc.gov Platelets can sometimes sit on top of […]
- [Polychromasia](https://medlabbuddy.com/red-blood-cells/morphology/polychromasia/): Polychromasia refers to the presence of polychromatophilic red blood cells that stain with a blue hue due to residual RNA. As polychromatic cells are immature, they should be proportional to the reticulocyte percentage. However, a supravital stain would be required to positively identify these cells as reticulocytes. Polychromasia is seen in conditions with increased erythropoiesis such as hemolytic anemias or hemorrhages. Appearance Polychromatic red blood cells stain diffusely purple or blue/gray due to residual RNA. They may be slightly larger than mature red blood cells. Lookalikes Polychromatic cells can have very fine basophilic stippling which is evenly dispersed throughout the […]
- [Agglutination](https://medlabbuddy.com/red-blood-cells/morphology/agglutination/): Agglutination causes red blood cells to clump together. This can cause erroneous results such as increased Mean Cell Hemoglobin Volume (MCHC) and Mean Cell Volume (MCV) with a falsely decreased hematocrit. On the smear review, the red cells clumping together can hide other morphology. Warming the specimen at 37 oC can help to resolve this issue, as it is usually caused by a cold autoagglutinin. Macroscopic Appearance Even macroscopically, the clumping can usually be seen on the slide. In this image, the left slide was prepared before warming the specimen while the right slide is after warming. Microscopic Appearance Agglutination […]
- [Rouleaux](https://medlabbuddy.com/red-blood-cells/morphology/rouleaux/): Rouleaux is caused by increased plasma proteins allowing red blood cells to stack together. In most cases, this protein is excess fibrinogen due to pregnancy or inflammation. Pathologically, plasma cells in multiple myeloma produce excess immunoglobulins. Cells can be seen stacking together normally in thicker areas of the slide. Saline replacement can be used to correct rouleaux if indices are affected. Macroscopic Appearance Excess proteins in the blood may cause the slide to stain more blue than usual. Compare the two slides in the image on the right. The left slide is on a patient with significant rouleaux while the […]
- [Teardrop Cells](https://medlabbuddy.com/red-blood-cells/morphology/teardrop-cells/): Teardrop cells are also known as dacrocytes, as the Greek word for tear is “dakryo.” In myelofibrosis and other bone marrow conditions, red blood cells are deformed as they navigate out of the crowded bone marrow. They can also form when inclusions are pinched off and removed by the spleen. Teardrop cells are seen in myelofibrosis, myelophthisic anemia, megaloblastic anemia, and thalassemia. Appearance Teardrop cells are named after their characteristic appearance. They are pear-shaped with one tail-like projection. The tail should be blunt; sharp projections all going in the same direction are artifactual from slide-making. Gallery Other Morphology Acanthocytes Blister […]
- [Target Cells](https://medlabbuddy.com/red-blood-cells/morphology/target-cells/): Target cells are bell-shaped instead of being biconcave due to excess membrane. Because of this, they are also known as codocytes, as the Greek word for bell is “kodon.” On a slide, the bell flattens out to look like a target. Target cells are seen in Iron Deficiency Anemia (IDA), thalassemia, liver disease, & hemoglobinopathies. Additionally, they may be artifactual due to slow slide drying, high humidity, or excess EDTA. Appearance Target cells look like a target or bullseye with a pale ring around a central area of hemoglobin. The ring should be fairly clear. If it looks “blurry,” the […]
- [Stomatocytes](https://medlabbuddy.com/red-blood-cells/morphology/stomatocytes/): Stomatocytes are red blood cells that are bowl-shaped instead of biconcave. The term comes from the appearance of the cells when lying flat on a slide. A slit of central pallor makes the cell look like a mouth which is the word “stoma” in Greek. These cells can be hereditary or seen in liver disease or alcoholism. They can also form as an artifact from slow slide drying. Appearance Stomatocytes are red blood cells with a central slit, making it look like a mouth. If slits are all oriented in the same direction, it is likely artifactual from slow slide […]
- [Spherocytes](https://medlabbuddy.com/red-blood-cells/morphology/spherocytes/): Spherocytes form as a result of extravascular hemolysis. Macrophages remove part of the red blood cell, decreasing its volume. The remaining hemoglobin is now concentrated to a smaller area which is why spherocytes stain more densely. Mean Cell Hemoglobin Concentration (MCHC) will be increased in spherocytes. These cells are seen in immune hemolytic anemia, post-transfusion, and severe burns. Alternatively, spherocytosis may be hereditary. In this case, a fault in the vertical proteins that hold the membrane together cause the red blood cell to lose its biconcave shape. These cells have increased osmotic fragility. They may also appear as artifacts in […]
- [Sickle Cells](https://medlabbuddy.com/red-blood-cells/morphology/sickle-cells/): Sickle cells are also known as drepanocytes, coming from the Greek word for sickle (drepano). These cells have the abnormal hemoglobin S which polymerizes under oxidative stress to form their characteristic shape. Sickle cells are rigid and do not easily deform to pass through blood vessels. The cells can clog the vessel, leading to pain crisis. Appearance Sickle cells are thin, crescent-shaped cells with pointed ends, usually lacking central pallor. Lookalikes Sickle cells may be mistaken for elliptocytes, as they are both thin. However, elliptocytes will have parallel edges and rounded ends instead of being pointy or crescent-shaped. They will […]
- [Schistocytes](https://medlabbuddy.com/red-blood-cells/morphology/schistocytes/): Schistocytes are fragmented red blood cells that form when cells are torn by mechanical forces. This could be caused by a mechanical heart valve or fibrin strands in the blood vessels. They are seen in Disseminated Intravascular Coagulation (DIC), Thrombotic Thrombocytopenic Purpura (TTP), and microangiopathic hemolytic anemias. Appearance Schistocytes are fragmented red blood cells that lack central pallor and have pointed ends or projections. They may be triangular, irregular, or helmet-shaped (AKA bite cells). Gallery Other Morphology Acanthocytes Blister & Bite Cells Burr Cells Elliptocytes / Ovalocytes Sickle Cells Spherocytes Stomatocytes Target Cells Teardrop Cells Agglutination Polychromasia Rouleaux Additional Resources
- [Elliptocytes / Ovalocytes](https://medlabbuddy.com/red-blood-cells/morphology/elliptocytes-ovalocytes/): Elliptocytes and ovalocytes are often lumped together. Elliptocytes can be seen in hereditary elliptocytosis due to a defect in the membrane. Macroovalocytes specifically are seen in megaloblastic anemias. Otherwise, ovalocytes are seen in myelofibrosis, iron deficiency anemia, and thalassemia. Appearance Ovalocytes are typically more egg-shaped while elliptocytes are skinnier and more pencil shaped. However, the two terms are often used interchangeably. Lookalikes Elliptocytes may be mistaken for sickle cells, as they are both thin. However, sickle cells will have sharp edges and lack central pallor. Sickle cells are usually also crescent-shaped. Sickle Cells Gallery Other Morphology Acanthocytes Blister & Bite […]
- [Burr Cells](https://medlabbuddy.com/red-blood-cells/morphology/burr-cells/): Burr cells are also known as echinocytes. This term comes from the prefix echino which refers to something spiny or prickly which comes from the Greek word for hedgehog, ekhinos. These cells can be artifactual due to slide preparation and should be suspected when found in large numbers or only in certain areas of the slide. True burr cells are seen in uremia, renal insufficiency, cirrhosis, severe dehydration, burns, etc. Appearance Burr cells have evenly distributed “bumps” along their surface. Central pallor is still visible. Lookalikes Acanthocytes can be confused with burr cells. However, acanthocytes lack central pallor. Their projections […]
- [Blister & Bite Cells](https://medlabbuddy.com/red-blood-cells/morphology/blister-bite/): Blister and bite cells are most often caused by removal of Heinz bodies or other erythrocyte inclusions by the spleen. Blister cells can also be caused by fibrin strands rupturing the red cell membrane. Bite cells can form from these blistered red blood cells. These cells are seen in G-6-PD deficiency and hemoglobinopathies. Blister Cell Appearance Blister cells have a vacuole on one side of the cell. Bite Cell Appearance Bite cells are indented and look like someone has taken a bite out of it. Lookalikes Residual water on a slide can affect the red blood cell membrane, making it […]
- [Acanthocytes](https://medlabbuddy.com/red-blood-cells/morphology/acanthocytes/): Acanthocytes are seen in severe liver disease, alcoholic cirrhosis, and chronic starvation. The root word “acantha” is Greek for thorn or spine and stems from their appearance. Appearance Acanthocytes are small, densely staining erythrocytes with several irregular projections. They typically lack central pallor. Lookalikes Acanthocytes can be confused with burr cells. However, the projections on burr cells are evenly distributed and more numerous. Burr cells also contain central pallor. Burr Cells Gallery Other Morphology Blister & Bite Cells Burr Cells Elliptocytes / Ovalocytes Schistocytes Sickle Cells Spherocytes Stomatocytes Target Cells Teardrop Cells Agglutination Polychromasia Rouleaux Related Posts Additional Resources
- [Pyknotic](https://medlabbuddy.com/white-blood-cells/neutrophils/inclusions-abnormalities/pyknosis/): Pyknosis is a step in apoptosis in which the chromatin in the nucleus of a cell condenses. Therefore, pyknotic neutrophils are degenerated neutrophils. They can be seen normally in blood smears, especially in old samples. Appearance In pyknotic neutrophils, the nucleus is completely condensed and stains densely blue or purple. Filament between lobes may no longer be visible. Gallery Neutrophil Abnormalities Dohle Bodies Toxic Granulation Vacuolization Critical Green Inclusions Pelger-Huet / Pelgeroid Hypersegmentation
- [Hypersegmentation](https://medlabbuddy.com/white-blood-cells/neutrophils/inclusions-abnormalities/hypersegmentation/): Neutrophil hypersegmentation can be hereditary. It is also seen in megaloblastic hematopoiesis due to nutritional deficiencies, especially when seen with macrocytic ovalocytes. Both vitamin B12 and folate are crucial in DNA synthesis, so deficiencies in these vitamins cause delays in nuclear maturation. Intrinsic factor is necessary for proper absorption of vitamin B12. This is why pernicious anemia, an autoimmune condition targeting intrinsic factor, leads to vitamin B12 deficiency. Since intrinsic factor is produced in the stomach, gastric bypass surgery can also lead to vitamin B12 deficiency. Vegetarians and vegans may suffer from this nutritional deficiency, as B12 is primarily found […]
- [Pelger-Huet / Pelgeroid](https://medlabbuddy.com/white-blood-cells/neutrophils/inclusions-abnormalities/pelger/): True Pelger-Huet neutrophils are an inherited disorder and completely benign.Pseudo Pelger-Huet, or pelgeroid cells, can be caused by certain medications or Myelodysplastic Syndromes. Pelger-Huet Appearance With Pelger-Huet anomaly, the majority of neutrophils will be hyposegmented. Bilobed neutrophils are described as having a characteristic pince-nez shape (a particular style of glasses). Pelgeroid Appearance Neutrophils with a pelgeroid appearance have a hyposegmented nucleus which can be bilobed or monolobed. Lookalikes Monolobed neutrophils may be mistaken as myelocytes if care is not taken. However, chromatin is notably more condensed than that of myelocytes. The cytoplasm also lacks those primary azurophilic granules. Myelocytes Gallery […]
- [Critical Green Inclusions](https://medlabbuddy.com/white-blood-cells/neutrophils/inclusions-abnormalities/green-inclusions/): Critical green inclusions in neutrophils are also informally known as “Green Crystals of Death” due to being associated with poor prognosis. They are a finding typically seen in critically ill patients. Appearance Critical green inclusions are bright green/blue refractile inclusions in the cytoplasm. Lookalikes Critical green inclusions can be misidentified as dohle bodies, especially as these inclusions are not seen very often. They are bright green in color instead of pale blue, however. Dohle Bodies Gallery Neutrophil Abnormalities Dohle Bodies Toxic Granulation Vacuolization Pelger-Huet / Pelgeroid Hyper-segmentation Pyknotic
- [Vacuolization](https://medlabbuddy.com/white-blood-cells/neutrophils/inclusions-abnormalities/vacuoles/): Neutrophil vacuolization is seen most often in inflammation or bacterial infection, as vacuoles indicate phagocytosis. They may be accompanied by dohle bodies or toxic granulation. They can also be seen artifactually as a result of cell degradation, especially if the sample is old. Appearance In neutrophil vacuolization, the cytoplasm contains vacuoles. Gallery Neutrophil Abnormalities Dohle Bodies Toxic Granulation Critical Green Inclusions Pelger-Huet / Pelgeroid Hyper-segmentation Pyknotic Related Posts
- [Toxic Granulation](https://medlabbuddy.com/white-blood-cells/neutrophils/inclusions-abnormalities/toxic-gran/): Toxic granulation is seen most often in bacterial infection and may be accompanied by a left shift with dohle bodies or vacuolization. Appearance Toxic granulation refers to a neutrophil with coarse, dark blue granules filling the cytoplasm. These granules are similar in appearance and function to the primary granules seen in promyelocytes. Lookalikes The larger toxic granules can be confused for those seen in eosinophils, especially if the staining is poor. However, eosinophil granules are coarser with a reddish-orange color instead of dark blue. Eosinophils Gallery Neutrophil Abnormalities Dohle Bodies Vacuolization Critical Green Inclusions Pelger-Huet / Pelgeroid Hyper-segmentation Pyknotic Related […]
- [Dohle Bodies](https://medlabbuddy.com/white-blood-cells/neutrophils/inclusions-abnormalities/dohle-bodies/): Dohle bodies are remnants of rough endoplasmic reticulum left over in the cytoplasm of the neutrophil. They are seen most often in bacterial infection and may be accompanied by a left shift with toxic granulation or vacuolization. Dohle Body Appearance Dohle bodies appear as one or more blue/gray inclusions in the cytoplasm of neutrophils, usually along the periphery. Lookalikes Critical green inclusions can be misidentified, especially as they are not seen very often. They are bright green in color instead of pale blue, however. Green Inclusions Gallery Neutrophil Abnormalities Toxic Granulation Vacuolization Critical Green Inclusions Pelger-Huet / Pelgeroid Hyper-segmentation Pyknotic
- [Segmented Neutrophils](https://medlabbuddy.com/white-blood-cells/neutrophils/segs/): Segmented neutrophils (commonly referred to as “segs”) make up the majority of circulating white blood cells (roughly 50-70%). They are the first line of defense in fighting bacterial infections through phagocytosis. Appearance Segmented neutrophils have a pink cytoplasm with fine specific granules. The nucleus is heavily clumped with thin filaments connecting usually 2-5 lobes. Chromatin is heavily clumped. Lookalikes Eosinophils can look like neutrophils, especially if the staining is poor. Neutrophils with toxic granulation can also mimic the larger granules seen in eosinophils. However, eosinophil granules are more coarse with a reddish-orange color. Eosinophils Gallery Neutrophil Lineage Promyelocyte Myelocyte Metamyelocyte […]
- [Hairy Cells](https://medlabbuddy.com/white-blood-cells/lymphocytes/hairy/): Hairy cells are B-lymphocytes and are almost exclusively seen in hairy cell leukemia. They are usually accompanied by pancytopenia. Appearance Cytoplasm of lymphocytes have hair-like projections. Gallery Other Lymphocytes Small Resting Lymph Activated Lymph Large Granular Lymph Plasma Cell Mott Cell Smudge Cell Cleaved Lymph
- [Cleaved Lymphocytes](https://medlabbuddy.com/white-blood-cells/lymphocytes/cleaved/): Cleaved lymphocytes, also known as butt cells, are seen in Chronic Lymphocytic Leukemia (CLL), pertussis (whooping cough), or lymphoma. Appearance The nucleus of the lymphocyte is indented or cleaved. Gallery Other Lymphocytes Small Resting Lymph Activated Lymph Large Granular Lymph Plasma Cell Mott Cell Smudge Cell Hairy Cell Related Posts
- [Smudge Cells](https://medlabbuddy.com/white-blood-cells/lymphocytes/smudge/): Smudge cells (AKA basket cells) are the nuclear remnants of leukocytes destroyed by the slide-making process. A few in normal blood may be artifactual. When accompanied by lymphocytosis however, smudge cells may indicate chronic lymphocytic leukemia, as the abnormal lymphocytes have increased fragility. Appearance Smudge cells are composed only of nuclear remnants. They look like smudges, hence the name. Other Lymphocytes Small Resting Lymph Activated Lymph Large Granular Lymph Plasma Cell Mott Cell Cleaved Lymph Hairy Cell Related Posts
- [Mott Cells](https://medlabbuddy.com/white-blood-cells/lymphocytes/mott/): Mott cells can be seen in response to infection or in patients with multiple myeloma. Appearance Mott cells are plasma cells that produce excess amounts of immunoglobulin, filling the cytoplasm with inclusions known as Russell Bodies. Gallery Other Lymphocytes Small Resting Lymph Activated Lymph Large Granular Lymph Plasma Cell Smudge Cell Cleaved Lymph Hairy Cell
- [Plasma Cells](https://medlabbuddy.com/white-blood-cells/lymphocytes/plasma/): Plasma cells are effector B Cells capable of producing antibodies. Plasma cells can be seen in multiple myeloma. Appearance Plasma cells have a deeply basophilic cytoplasm with an eccentrically placed nucleus. Perinuclear hof is present. Other Lymphocytes Small Resting Lymph Activated Lymph Large Granular Lymph Mott Cell Smudge Cell Cleaved Lymph Hairy Cell
- [Large Granular Lymphocytes](https://medlabbuddy.com/white-blood-cells/lymphocytes/large-granular/): Large granular lymphocytes are typically Cytotoxic (CD8+) T cells or NK cells. Increased numbers of these cells usually indicate viral infection. Appearance Large granular lymphocytes, as the name suggests, contains few azurophilic granules in their abundant cytoplasm. Gallery Other Lymphocytes Small Resting Lymph Activated Lymph Plasma Cell Mott Cell Smudge Cell Cleaved Lymph Hairy Cell
- [Activated Lymphocytes](https://medlabbuddy.com/white-blood-cells/lymphocytes/activated/): Activated lymphocytes are typically activated effector T cells. Increased numbers of these cells usually indicate viral infection. Appearance The abundant cytoplasm of is a translucent-looking blue with a basophilic periphery that is indented by red blood cells. Lookalikes Activated lymphocytes can be confused with monocytes, as they can both be large. Monocytes, however, have a ground glass cytoplasm instead of a basophilic periphery. They also have a lacey nucleus instead of clumpy. If monocytes are indented by red blood cells, it is not to the same extent. Monocytes Gallery Other Lymphocytes Small Resting Lymph Large Granular Lymph Plasma Cell Mott […]
- [Small Resting Lymphocytes](https://medlabbuddy.com/white-blood-cells/lymphocytes/resting/): Lymphocytes are the second most common circulating white blood cell (roughly 20-40%). Most circulating lymphocytes are resting until stimuli causes them to differentiate. They are important in fighting viral infections. Appearance Resting lymphocytes are small with scant dark blue cytoplasm. The nucleus is about the size of a red blood cell with dark and clumpy chromatin. Lookalikes Nucleated red blood cells can be mistaken for lymphocytes, as they both have scant basophilic cytoplasm and are similar in size. However, earlier red cell precursors will have a distinct nucleus with a cartwheel pattern. More mature nucleated red cells typically have a […]
- [Band Neutrophils](https://medlabbuddy.com/white-blood-cells/neutrophils/bands/): A few band neutrophils (commonly referred to as “bands”) in peripheral blood are normal. Increased amounts of these immature neutrophils, however, may indicate infection, inflammation, or myeloproliferative disorders. Appearance Band neutrophils have a pink cytoplasm with specific granules. The nucleus lacks segmentation and has uniform thickness, usually forming a “C” or “S” shape. Chromatin is looser than that of segmented neutrophils. Lookalikes Monocytes can look like bands, especially if care is not taken. The nucleus of the monocyte can take on that classic ‘U’ shape. However, monocytes can be differentiated by their ground glass cytoplasm and lack of granules. Monocytes […]
- [Metamyelocytes](https://medlabbuddy.com/white-blood-cells/neutrophils/metamyelocytes/): Metamyelocytes are not normally found in peripheral blood and are usually seen in response to stress or infection (known as a left shift). In these cases, they are often accompanied by bands. Certain leukemias can also lead to increased metamyelocytes. It is also at this stage in which the neutrophil is no longer capable of cell division. Appearance Metamyelocyte cytoplasm is pink with specific granules distributed throughout, though it may still have few azurophilic primary granules. The nucleus is indented less than half of the nucleus, forming a kidney-shape. The chromatin in the nucleus is clumped. Lookalikes Metamyelocytes, with their […]
- [Myelocytes](https://medlabbuddy.com/white-blood-cells/neutrophils/myelocytes/): Myelocytes are not normally found in peripheral blood. Their presence indicates infection when seen with other immature neutrophils. Increased amounts of these cells can also be seen in conditions like chronic myeloid leukemia (CML). This is also the last neutrophil stage capable of cell division. Myelocyte Appearance Myelocytes have a pinkish blue cytoplasm with both azurophilic (primary) and specific (secondary) granules. The nucleus is usually eccentrically placed and may appear flattened on one side. Nucleoli are usually not visible, and chromatin is fine with some clumping. Lookalikes Myelocytes can be differentiated from promyelocytes by the presence of the pinkish secondary […]
- [Promyelocytes](https://medlabbuddy.com/white-blood-cells/neutrophils/promyelocytes/): Promyelocytes are not normally found in peripheral blood, and their presence indicates severe infection when seen with other immature neutrophils. Many abnormal versions of this cell can be seen in acute promyelocytic leukemia (APL). Promyelocyte Appearance Promyelocytes have a basophilic cytoplasm with a perinuclear hof. Azurophilic (primary) granules can be seen. The nucleus is usually round to oval-shaped with nucleoli and relatively fine chromatin. Lookalikes Promyelocytes mature into myelocytes, so differentiation between these cells can be difficult. Both cells contain the primary azurophilic granules, but only myelocytes have the pinkish secondary granules. Myelocytes Promyelocyte Gallery Neutrophil Lineage Myelocyte Metamyelocyte Band […]
- [Blast Cells](https://medlabbuddy.com/white-blood-cells/blast-cells/): Blast cells do not normal circulate in peripheral blood. Their presence in peripheral blood usually indicates a type of leukemia. Blast Appearance Blast cells have scant and basophilic cytoplasm that is usually agranular. The nucleus contains visible nucleoli with fine chromatin. Lookalikes Activated lymphocytes can be mistaken for blasts. However, there are several notable differences. Activated lymphocytes have a lighter blue cytoplasm with a dark periphery, clumpier chromatin, and lack nucleoli. Activated Lymphs The lacey chromatin of monocytes can look similar to the fine chromatin in blasts. However, monocytes will lack nucleoli. They will also have more abundant cytoplasm which […]
- [Basophils](https://medlabbuddy.com/white-blood-cells/basophils/): Basophils are the least common circulating white blood cell at <2%. They function similar to eosinophils with roles in allergic reactions and in fighting parasitic infections. Basophil Appearance Basophils are most easily recognized by their large dark purple granules which fill the cell and often overlap the nucleus. Basophil Gallery Other White Blood Cells Neutrophils Lymphocytes Monocytes Eosinophils Blast Cells
- [Eosinophils](https://medlabbuddy.com/white-blood-cells/eosinophils/): Eosinophils normally make up <5% of circulating white blood cells. They are important in fighting parasitic infections and are involved in allergic reactions. Eosinophil Appearance Eosinophils are most easily recognized by their characteristic large reddish-orange granules. They typically have a bilobed nucleus with dark purple clumpy chromatin. Mature Eosinophil Gallery Immature Eosinophil Gallery Lookalikes Neutrophils with toxic granulation can be confused for eosinophils, especially if the staining is poor. However, the toxic granules in neutrophils are dark blue instead of a reddish-orange color. The granules in neutrophils are also not as large. Neutrophil Toxic Granulation Other White Blood Cells Neutrophils […]
- [Monocytes](https://medlabbuddy.com/white-blood-cells/monocytes/): Monocytes make up between 2-10% of circulating white blood cells. They phagocytize foreign materials and aid in removal of dead cells and debris. Monocyte Appearance Monocytes are the largest of the circulating white blood cells. Their cytoplasm stains a grayish blue and has a “ground glass” appearance due to numerous fine purplish granules. They often have vacuoles. The nucleus is often irregularly shaped with folds or indents and lacy chromatin. Lookalikes Activated lymphocytes can be mistaken for monocytes due to their larger nature and more abundant cytoplasm. However, activated lymphocytes have a clear blue cytoplasm with a dark blue periphery […]
- [Renal Tubular Epithelial Cell Casts](https://medlabbuddy.com/urinalysis/casts/renal-tubular-epithelial-cell-casts/): Renal Tubular Epithelial Cell (RTE) casts appear in conditions where there is injury to the kidney tubules, such as acute tubular necrosis, viral nephritis, hepatorenal syndrome, or kidney transplant rejection. Appearance RTE casts contain renal tubular epithelial cells in a protein matrix. If the cells are too degraded to properly identify as RTEs, the casts may simply be called cellular casts. Lookalikes White blood cell casts can look similar to RTE casts. However, white blood cells lack the large nucleus found in renal cells. WBC Casts RTE Cast Gallery Other Casts Hyaline Casts Granular Casts White Blood Cell Casts Red […]
- [Fat Droplets](https://medlabbuddy.com/urinalysis/misc/fat-droplets/): Fat droplets are usually artifactual from oils, creams, or lubricants. Otherwise, they can be seen in conditions causing lipiduria such as nephrotic syndrome. Appearance Fat droplets are highly refractile and form a “Maltese Cross” pattern when polarized. Gallery Other Miscellaneous Fibers Spermatozoa Starch Granules
- [Starch Granules](https://medlabbuddy.com/urinalysis/misc/starch/): Starch is a contaminant found in many body powders. Appearance Starch granules are round with irregular indentation in the center. Under polarized light, they form “Maltese crosses.” Gallery More Images Coming Soon Miscellaneous Fibers Spermatozoa Starch Granules Fat Droplets
- [Spermatozoa](https://medlabbuddy.com/urinalysis/misc/spermatozoa/): Spermatozoa may be seen as a contaminant following recent sexual activity in both sexes. They are usually a contaminant but can also be seen in men with some genital diseases. Spermatozoa Appearance Spermatozoa have a small, bulbous head with a long, thin tail that may detach. Gallery Other Miscellaneous Fibers Starch Granules Fat Droplets
- [Fibers](https://medlabbuddy.com/urinalysis/misc/fibers/): Fibers are urinary artifacts and not clinically significant. Appearance Fibers are typically flat with dark, well-defined edges. Under polarized light, they are typically highly refractile. Lookalikes Fibers should be differentiated from casts. Fibers are typically longer with sharper edges and are birefringent under polarized light Urinary Casts Gallery Other Miscellaneous Spermatozoa Starch Granules Fat Droplets
- [Trichomonas](https://medlabbuddy.com/urinalysis/urinary-microorganisms/trich/): Trichomonas vaginalis is a sexually transmitted parasite that causes trichomoniasis. Since the organism does not live for long after leaving the body, detection by urine microscopy is not very sensitive. Appearance Trichomonas are pear-shaped and have four flagella. Motility is usually necessary for identification. Lookalikes Trichomonas can look like a white blood cell when non-motile which is why motility is usually necessary to positively identify by microscopy. White Blood Cells Gallery Videos Other Microorganisms Bacteriuria Yeast
- [Yeast](https://medlabbuddy.com/urinalysis/urinary-microorganisms/yeast/): Yeast may be a contaminant. Pseudohyphae is more indicative of serious infection. It can cause urinary tract infections in patients who are susceptible, such as those with indwelling catheters, patients with diabetes mellitus, and those who are immunocompromised. Appearance Yeast cells are highly refractile and usually appear as small ovoids which may have buds. This form can be mistaken for dysmorphic RBCs if not careful. Candida may form branching pseudohyphae and is the most common fungus found in urine. Lookalikes Dysmorphic red blood cells may be mistaken for budding yeast. Dysmorphic RBCs Gallery Other Microorganisms Bacteriuria Trichomonas
- [Bacteriuria](https://medlabbuddy.com/urinalysis/urinary-microorganisms/bacteriuria/): Bacteriuria (bacteria in urine) is usually indicative of urinary tract infections, especially when white blood cells are also present. However, it can be a contaminant, especially if accompanied by large amounts of squamous epithelial cells. Appearance Bacteria in urine can appear as rods or cocci with varying degrees of motility. Cocci may form pairs, tetrads or chains. Lookalikes Bacteria may be difficult to distinguish from amorphous urates or amorphous phosphates, especially as the crystals may exhibit Brownian motion that can mimic the movement of bacteria. However, bacteria is more uniform in appearance. Amorphous Urates Bacteria Gallery Other Microorganisms Yeast Trichomonas […]
- [Oval Fat Bodies](https://medlabbuddy.com/urinalysis/urinary-cells/oval-fat-body/): Oval fat bodies are usually renal tubular epithelial cells containing fat droplets, though they may also be leukocytes that have digested lipids. Oval fat bodies can be seen in patients with conditions causing lipiduria, such as nephrotic syndrome. Appearance The fat droplets in the oval fat bodies are highly refractile and form a “Maltese cross” pattern when polarized. Oval Fat Body Gallery Other Urinary Cells Red Blood Cells White Blood Cells Squamous Epithelial Transitional Epithelial Renal Tubular Epithelial
- [Renal Tubular Epithelial Cells](https://medlabbuddy.com/urinalysis/urinary-cells/renal-cells/): Increased amounts renal tubular epithelial (RTE) cells indicates tubular damage, such as acute tubular necrosis, viral infection, transplant rejection, or drug or heavy metal toxicity. Appearance RTEs are slightly larger than a WBC and may be round, oval, or polyhedral. Cytoplasm is finely granular, and nucleus is distinctly round. Difficult to distinguish from transitional epithelial cells. Other Urinary Cells Red Blood Cells White Blood Cells Squamous Epithelial Transitional Epithelial Oval Fat Bodies
- [Transitional Epithelial Cells](https://medlabbuddy.com/urinalysis/urinary-cells/transitional/): Transitional epithelial cells line the urinary tract from the renal pelvis to the upper portion of the urethra. Increased amounts of transitional cells may indicate recent catheterization, infection, kidney stones, or bladder cancer. Transitional Cell Appearance Transitional cells are round or pear-shaped. They have less cytoplasm and a larger nucleus than squamous cells. Their defined border and readiness to absorb water can give them a bubble-like appearance. Lookalikes Transitional cells can be mistaken for renal tubular epithelial cells, as the two can look very similar. Renal cells are typically smaller than transitional cells and have fine granules in the cytoplasm. […]
- [Squamous Epithelial Cells](https://medlabbuddy.com/urinalysis/urinary-cells/squamous/): High numbers of squamous epithelial cells typically indicate the specimen is not a proper “clean catch.” Bacteria seen may be a contaminant of normal skin flora. The urine can be cultured to differentiate contaminating bacteria from bacteria capable of causing a urinary tract infection. Squamous epithelial cells are not clinically significant. Appearance Squamous epithelial cells are large with abundant cytoplasm and a small nucleus about the size of a red blood cell. Edges of the cell may be folded over or curled up. Squamous Epithelial Gallery Other Urinary Cells Red Blood Cells White Blood Cells Transitional Epithelial Renal Tubular Epithelial […]
- [WBCs in Urine](https://medlabbuddy.com/urinalysis/urinary-cells/wbcs/): White blood cells (WBCs) in urine should coincide with positive leukocyte esterase on the urine chemistries. A few white blood cells in urine can be normal. Increased amounts of WBCs indicate bacterial infections of the kidney or urinary tract, interstitial nephritis, or glomerulonephritis. WBC Appearance WBCs can vary in size depending on the cell (lymphocyte, neutrophil, macrophage, etc.) They are round with granular cytoplasm and a nucleus, unlike RBCs. WBCs may also appear in clumps. Lookalikes Non-motile trichomonas can look like white blood cells, as their flagella may not be visible. For this reason, motility is usually a requirement for […]
- [RBCs in Urine](https://medlabbuddy.com/urinalysis/urinary-cells/rbcs/): RBCs should be proportional to blood in the urine chemistries from the dipstick. It is important to note that positive blood on the dipstick may be present without intact RBCs on the microscopic. Large amounts of RBCs can also cause a false positive on protein. A few RBCs in urine can be normal. Increased amounts may be seen in kidney disease, urinary tract infections, or may be contamination from menstrual blood. Normal Red Blood Cells RBCs are typically donut-shaped. However, they may also be crenated in hypertonic solutions or appear as an hourglass when viewed from the side. RBCs can […]
- [Waxy Casts](https://medlabbuddy.com/urinalysis/casts/waxy/): Waxy casts may be seen in a variety of disease states, such as end-stage renal disease, diabetic neuropathy, acute glomerulonephritis, etc. Appearance Waxy casts have a high refractive index, giving them their waxy look. While the cast is still cylindrical in shape, it is more broad and may have blunt ends or cracks. Lookalikes Fibers may be confused for waxy casts. However, fibers are typically longer with sharper edges. Additionally fibers are birefringent under polarized light. Fibers Gallery Other Casts Hyaline Casts Granular Casts White Blood Cell Casts Red Blood Cell Casts No Image Yet 🙁 RTE Casts
- [Red Blood Cell Casts](https://medlabbuddy.com/urinalysis/casts/rbc/): Red Blood Cell Casts RBCs can be seen in a protein matrix. Many RBCs may color the cast yellow or reddish-brown. RBC casts indicate renal hematuria. Diagnostic for acute glomerulonephritis but may be seen in renal trauma, infarction, and malignant hypertension. No Image Yet 🙁
- [White Blood Cell Casts](https://medlabbuddy.com/urinalysis/casts/wbc/): White blood cell casts usually accompanied by more white blood cells in the urine and positive leukocyte esterase on the urine chemistries. These casts indicate renal inflammation or renal infection. Appearance White blood cells (mostly polymorphonuclear neutrophils) can be seen in a protein matrix. Some of these cells may be partially broken down into granules. Lookalikes White blood cell clumps may be mistaken for white blood cell casts. However, they will have irregular edges and no visible protein matrix. WBCs Gallery Other Casts Hyaline Casts Granular Casts Red Blood Cell Casts No Image Yet 🙁 RTE Casts Waxy Casts
- [Granular Casts](https://medlabbuddy.com/urinalysis/casts/granular/): Granular casts are the second most common cast found in urine, after hyaline casts. Granules are thought to be degraded cellular casts or aggregates of plasma proteins. Granules start coarse and become fine as breakdown continues. Few of these casts can be seen in healthy individuals. Increased amounts may be seen after strenuous exercise and in renal disease. Appearance Granular casts are composed of fine or coarse granules in a protein matrix. They should have a clearly defined shape. Lookalikes Amorphous crystals can be mistaken for granular casts when they clump together. However, casts will have a clear form while […]
- [Hyaline Casts](https://medlabbuddy.com/urinalysis/casts/hyaline/): Few hyaline casts can be seen in healthy individuals. Increased amounts may be seen in stress (physical or psychological), dehydration, and most renal diseases. Appearance Hyaline casts are the most common cast, composed only of a protein matrix and maybe a few granules. They are translucent and have a low refractive index, making them difficult to see. Phase microscopy can be used to help with this. Lookalikes Fibers may be confused for hyaline casts. However, they have sharper edges and are highly refractile. Fibers Gallery Other Casts Granular Casts White Blood Cell Casts Red Blood Cell Casts No Image Yet […]
- [Amorphous Urates](https://medlabbuddy.com/urinalysis/urinary-crystals/amorphous-urates/): Amorphous urates are found in acidic urine. They are soluble in alkali and heat. Insoluble in acetic acid. These crystals are not clinically significant. Macroscopic Appearance Macroscopically, amorphous urates have a “brick dust” appearance. These crystals can cause the urine to be turbid, but warming the specimen can solve this issue. Crystal Appearance Amorphous Urates appear as granular material in the sediment. Warming the specimen usually dissolves these crystals, allowing for proper identification of elements the sediment that may otherwise be obscured. Check out more images in the gallery below. Lookalikes Brownian motion of these amorphous granules may make them […]
- [Ammonium Biurate Crystals](https://medlabbuddy.com/urinalysis/urinary-crystals/ammonium-biurate/): Ammonium Biurate crystals are usually found in alkaline urine that has been sitting out for a while but can be seen in urine of any pH. They are soluble in heat and acetic acid. These crystals are typically clinically insignificant. Appearance Ammonium Biurate crystals have a characteristic “thorny apple appearance” with strong birefringence under polarized light. Check out more images in the gallery below. Ammonium Biurate Gallery Other Crystals Amorphous Phosphates Amorphous Urates Bilirubin Calcium Oxalate Calcium Phosphate Cystine Leucine Triple Phosphate Uric Acid Hippuric Acid Tyrosine Related Posts
- [Bilirubin Crystals](https://medlabbuddy.com/urinalysis/urinary-crystals/bilirubin/): Bilirubin crystals are found in acidic urine. They are soluble in acetic acid, hydrochloric acid, and sodium hydroxide. Insoluble in alcohol. The presence of the crystals themselves is not significant. Rather, the presence of bilirubin in the urine in general is indicative of liver disease. Appearance Bilirubin crystals usually appear as small clusters of yellow-brown or reddish-brown needles. Bilirubin in urine typically stains other elements in the urine as well. Other Crystals Ammonium Biurate Amorphous Phosphates Amorphous Urates Calcium Oxalate Calcium Phosphate Cystine Leucine Triple Phosphate Uric Acid Hippuric Acid Tyrosine
- [Cystine Crystals](https://medlabbuddy.com/urinalysis/urinary-crystals/cystine/): Cystine Crystals are found in acidic urine. They are soluble in hydrochloric acid and alkali. They are insoluble in boiling water, acetic acid, and alcohol. These crystals are found in urine of patients with congenital cystinuria. Appearance Cystine crystals are clear, colorless hexagons that may stack. Birefringence under polarized light is weak or absent but may be more apparent when crystals are stacked. Check out more images in the gallery below. Gallery Other Crystals Ammonium Biurate Amorphous Phosphates Amorphous Urates Bilirubin Calcium Oxalate Calcium Phosphate Leucine Triple Phosphate Uric Acid Hippuric Acid Tyrosine
- [Leucine Crystals](https://medlabbuddy.com/urinalysis/urinary-crystals/leucine/): Leucine Crystals are found in acidic urine. They are soluble in hot acetic acid, hot alcohol, and sodium hydroxide. They are insoluble in sodium chloride. These crystals can be found in urine of patients with severe liver disease or maple syrup urine disease. Appearance Leucine crystals typically appear as yellow-brown spheres with concentric rings. Under polarized light, these crystals show a pseudo “Maltese Cross.” Commonly found alongside tyrosine crystals. Leucine Gallery Other Crystals Ammonium Biurate Amorphous Phosphates Amorphous Urates Bilirubin Calcium Oxalate Calcium Phosphate Cystine Triple Phosphate Uric Acid Hippuric Acid Tyrosine
- [Calcium Phosphate Crystals](https://medlabbuddy.com/urinalysis/urinary-crystals/calcium-phosphate/): Calcium Phosphate Crystals are found in alkaline or neutral urine. They are soluble in dilute acetic acid. These crystals may be found in normal urine but may also form renal calculi. Wedge / Needle Calcium Phosphate crystals typically appear as thin, wedge-like rods with variable birefringence Rosette These rods can also form in star-like clusters with variable birefringence. Plates The crystals may also appear as large, irregular plates that may form a scum on the surface of sitting urine. These plates show no birefringence. Lookalikes Bilirubin crystals can look similar to calcium phosphate rosettes when they form in clusters. However, […]
- [Uric Acid Crystals](https://medlabbuddy.com/urinalysis/urinary-crystals/uric-acid/): Uric Acid Crystals are found in acidic urine. They are soluble in sodium hydroxide. These crystals can appear in normal urine but may also be seen in conditions such as gouty nephropathy, hyperuricemia, or kidney stones. Diamond & Rosette Uric acid crystals are typically diamond or lemon-shaped. Clumps of them may form a rosette. They are strongly birefringent. Check out more images in the gallery below. Barrel Less commonly, the crystals may appear as barrels, star-like clusters, or other hexagonal shapes. They are strongly birefringent. Check out more images in the gallery below. Diamond & Rosette Gallery Barrell Gallery Other […]
- [Triple Phosphate Crystals](https://medlabbuddy.com/urinalysis/urinary-crystals/triple-phosphate/): Triple Phosphate Crystals are found in alkaline or neutral urine. They are soluble in dilute acetic acid. These crystals are usually not clinically significant but may indicate struvite calculi. Coffin Lid Triple phosphate crystals are typically rectangular prisms with a “coffin lid” appearance. Check out more images in the gallery below. Fern Rarely, partially dissolved triple phosphate crystals may have a fern or feather-like appearance. Check out more images in the gallery below. Lookalikes Sometimes, dihydrate calcium oxalate can look similar to coffin lids. The pH of the urine can help distinguish the type of crystal, as calcium oxalate is […]
- [Calcium Oxalate Crystals](https://medlabbuddy.com/urinalysis/urinary-crystals/calcium-oxalate/): Calcium Oxalate crystals are found in acidic or neutral urine. They are soluble in dilute hydrochloric acid. These crystals may appear normally in urine after ingestion of food rich in oxalic acid or after a large intake of vitamin C. They may also indicate renal calculi. Dihydrate Calcium Oxalate crystals usually take on the dihydrate form, appearing like two pyramids joined at the base. They may be described as “envelope-shaped.” They show birefringence under polarized light. Check out more images in the gallery below. Monohydrate The monohydrate form is less common and has a wider variety of shapes, such as […]
- [UA Practice Microscopics](https://medlabbuddy.com/lab-posts/ua-practice-microscopics/): Explanation Each practice microscopic first shows the urine chemistries. These can give an important hint as to what to expect in the microscopic. After that, there are a few images from low power to quantitate casts, if any. In my lab, this is the only element quantified on lower power. After that, everything else is quantified on high power from the given images. Assume each image is a new field. Select the correct range from the drop down, or leave as negative (=). Finally, compare with the given answer sheet to see if you match! All Microscopics
- [Dilutions](https://medlabbuddy.com/chemistry/dilutions/): Purpose Dilutions are used in the clinical laboratory for a variety of purposes. In chemistry, the most common use is when an analyte on a patient exceeds the analyzer’s analytical measuring range. Depending on the analyzer and lab protocol, the dilution may be made manually or by the analyzer itself (if at all). In blood bank, serial dilutions may be performed for antibody titration. This helps determine the strength of an antibody. In urinalysis, dilution may help when a urine has too many particulates to perform a microscopic quantitation. Certain reagents may also require a dilution before use. No matter […]
- [Practice Differentials](https://medlabbuddy.com/lab-posts/practice-differentials/): Explanation Reset Total: 0 Above, you can see the layout used for the practice differentials. Since neutrophils and lymphocytes will be the most common cells in most differentials, it is best to leave your hand on the bottom row of the keyboard when counting so that your index finger is on [V] and your pinky is on [Z]. For the other cells, try to move only one finger to press it so that you do not lose your place. Until you get used to this layout, you will have to look up quite often to see which key to press. […]
- [Chemistry Calculations](https://medlabbuddy.com/chemistry/chemistry-calculations/)
- [Chemistry](https://medlabbuddy.com/chemistry/): Chemistry Calculations Use several chemistry calculators such as anion gap, calculated osmol, etc. by entering known values. All formulas are listed for reference. Dilutions Learn about the different uses for dilutions in the laboratory and how to perform them. Use the built-in calculator to help with dilutions.
- [Lab Posts](https://medlabbuddy.com/lab-posts/): Check out the different lab posts below. Use the buttons to sort by different categories.
- [RBC Morphology](https://medlabbuddy.com/red-blood-cells/morphology/): Acanthocytes Small, densely-staining cells with several irregular projections. -> More Images and Info Blister & Bite Cells Blister: Cell has vacuole on one side. Caused by removal of inclusions. Bite: Cell is indented, like someone has taken a bite out of it. Caused by removal of inclusions or bursting of blister cell. Seen in G-6-PD deficiency and hemoglobinopathies. -> More Images and Info Burr Cells Cell has evenly distributed “bumps” along surface. Central pallor is still visible. Can be artifactual due to slide preparation. Suspect when found in large numbers or only in certain areas of the slide. -> More […]
- [RBC Morph-Indices](https://medlabbuddy.com/red-blood-cells/rbc-morphology-based-on-indices/): Red Blood Cell Indices Normocytic / Normochromic Normocytic: MCV 80-100 fL Cells should be about the size of the nucleus of a small resting lymph (80-100 fL) Normochromic: MCHC 32-36 g/dL Central pallor should be less than 1/3 of the RBC Anisocytosis RDW increased (variation in cell size) May have dimorphic cell population. Microcytosis MCV < 80 fL (decreased) Seen in Iron Deficiency Anemia, Anemia of Chronic Inflammation, Sideroblastic Anemia, Thalassemia Macrocytosis MCV > 100 fL If cell is polychromatophilic, it may be a retic (See polychromasia for more info.) Hypochromasia MCHC <32 g/dL (decreased) Increased central pallor. Usually (but […]
- [BF Artifacts & Microorganisms](https://medlabbuddy.com/body-fluid/body-fluid-artifacts-and-microorganisms/): Bacteria May be intracellular or extracellular. Important to distinguish between true bacteria and contamination or artifact (such as stain precipitate.) Fiber Fibers on the slide can cause nearby cells to stain darker than usual, making cell identification difficult. Try to avoid counting cells near fibers. Related Pages
- [RBC Artifacts](https://medlabbuddy.com/red-blood-cells/rbc-artifacts/): Stain Precipitate Stain can precipitate on the slide when it is not adequately rinsed. It can be mistaken for bacteria if not careful. Bacterial Contamination Bacteria on the slide can be a contaminant, especially if it is constricted to one area. The bacteria here also appears above everything else on the slide instead of being on the same level. Water Artifact Water contamination can occur when the slide is not fully dry or in a humid environment. This can affect the appearance of RBC morphology, so these spots should be avoided or a new slide should be made. Platelet on […]
- [Body Fluid Crystal ID](https://medlabbuddy.com/body-fluid/body-fluid-crystal-id/): Monosodium Urate Crystals (Gout) Needle-like crystals that can be seen in synovial fluids of patients with gout. Can be differentiated from pseudo-gout with a polarizing microscope. Monosodium Urate crystals are yellow when parallel to the axis and blue when perpendicular, opposite of calcium pyrophosphate. Calcium Pyrophosphate Crystals (Pseudo-Gout) Typically small rhomboid, square, or rodlike crystals. Can be seen in synovial fluid of patients with pseudogout. Can be differentiated from true gout with a polarizing microscope. Calcium pyrophosphate is blue when parallel to the axis and yellow when perpendicular, opposite of monosodium urate crystals. Cholesterol Crystals Cholesterol crystals have a notched […]
- [RBC Lineage](https://medlabbuddy.com/red-blood-cells/rbc-lineage/): Red Blood Cell Lineage Overall, the size of an erythrocyte decreases as it matures. Chromatin becomes more coarse and clumped as it becomes less transcriptionally active. The cytoplasm will also become pinker with more Hemoglobin being formed and less blue due to decreased RNA. The nucleus will shrink in size until it is ejected and becomes a reticulocyte. Pronormoblast (rubriblast) Cytoplasm is deep blue with perinuclear hof. Nucleoli present. Basophilic Normoblast (Prorubricyte) Cytoplasm is deep blue and may have perinuclear hof. Nucleoli usually not present. Polychromatophilic Normoblast (Rubricyte) Nucleus is smaller than precursors with much clumpier chromatin forming cartwheel or […]
- [RBC Inclusions](https://medlabbuddy.com/red-blood-cells/rbc-inclusions/): Babesia Rings or tetrads in the cytoplasm of a red blood cell Tick-borne parasite that causes babesiosis. Usually only affects susceptible populations. Image from cdc.gov -> More images & info Basophilic Stippling Coarse stippling is more readily apparent with evenly dispersed larger granules. Seen in Lead Poisoning, Thalassemia, Sideroblastic Anemia, Megaloblastic Anemias, Defective Heme Synthesis. Fine stippling appears as evenly distributed purple dust and is hard to see in a cell. Often times fine stippling is seen in reticulocytes from residual RNA. Typically not clinically significant. See polychromatic cells. -> More images & info Cabot Ring Oval or figure-8 inclusion […]
- [Body Fluid Nucleated Cells](https://medlabbuddy.com/body-fluid/cells/): Neutrophils Cytocentrifugation may make granules in neutrophils appear larger which may be confused for eosinophils. However, they will not have the refractile quality seen in eosinophils or the vibrant reddish-orange coloring. ->More images and info Lymphocytes Cytocentrifugation may make lymphocytes appear larger which can be mistaken for blasts if not careful. ->More images and info Monocytes / Macrophages Monocytes in body fluid appear as they do in peripheral blood. Macrophages are monocytes that have differentiated. They are larger and typically have vacuoles. ->More images and info Eosinophils Eosinophils have coarse refractile reddish-orange granules. ->More images and info Basophils Basophils have […]
- [Urinary Artifacts & Miscellaneous](https://medlabbuddy.com/urinalysis/misc/): Fibers Fibers are urinary artifacts and should be differentiated from casts. They are typically flat with dark, well-defined edges. Under polarized light, they are typically highly refractile. -> More Images & Info Spermatozoa Spermatozoa have a small, bulbous head with a long, thin tail that may detach. -> More Images & Info Starch Granules Starch granules are round with irregular indentation in the center. Under polarized light, they form “Maltese crosses.” -> More Images & Info Fat Droplets Fat droplets are highly refractile and form a “Maltese Cross” pattern when polarized. -> More Images & Info Related Pages Urinary Cells […]


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