1. Urinalysis and Body Fluids CRg
Unit 2; Session 3
WBCs in the Urine Microscopic

2. Microscopic Sediment – White Blood Cells
WBCs can enter anywhere in the urinary system (diapedesis).
Men 0-2 /hpf ; Women < 5 /hpf
Increased numbers. (pyuria / leukocyturia)
Without bacteria
Inflammation – trauma / certain disease states / appendicitis / pancreatitis / malignancy /allergic reaction / dehydration / stress/ fever/non-infectious irritation to urinary structures
With increased bacteria
Likely infection -/ UTI
@ 7 WBC identifiable, ones at arrows are best examples. Others possible, but need to change focus for better evaluation. 3-5 RBCs.

3. Microscopic Sediment – White Blood Cells
Increased numbers. (pyuria / leukocyturia)
Quantitating WBC in urine
Ave. number seen in hpf
This example WBC/hpf

4. Microscopic Sediment – White Blood Cells
Detection
High dry objective (10x ocular + 40x objective = 400x total mag.)
Fine adjustment
Description
Grayish-blue / yellowish-green in color – depending on microscope
@ microns in diameter, but affected by specific gravity of urine
Fine cytoplasmic granulation, rough surface, may have irregular edges.
Usually polynuclear, but may be mononuclear, but often hard to see detail.

5. Microscopic Sediment – White Blood Cells
WBCs -larger than RBCs
WBCs - smaller than renal epithelial cells.
WBCs – usually neutrophils
WBCs – may be in clumps

6. Microscopic Sediment – White Blood Cells
Neutrophil is predominant
Identify under high power
Glitter cells
Hypotonic urine
Brownian movement
Swell; granules sparkle
Pale blue if stained
Nonpathologic

7. Microscopic Sediment – White Blood Cells
Eosinophils
Hansel stain preferred over Wrights to demonstrate presence of eosinophils in urine.
Increases seen in variety of conditions,
Drug-induced interstitial nephritis
Renal transplant rejection / acute graft rejection
most allergic reactions schistosomiasis, & acute allergic interstitial nephritis

8. Microscopic Sediment – White Blood Cells
Mononuclear cells – more rarely encountered than segmented neutrophils
Lymphocytes
Monocytes
Macrophages
Histiocytes
Differentiate from renal tubular epithelial (RTE) cells
Lymphocytes may resemble RBCs; seen in early transplant rejection
May need to refer to cytodiagnostic testing

9. Microscopic Sediment – White Blood Cells
Lymphocytes
Occasionally seen in normal sediment
Increased numbers reported in acute allergic interstitial nephritis, graft rejection, etc.
Requires special staining (PAP) to verify identity

10. Microscopic Sediment – White Blood Cells
Monocytes
Also can be found in conditions listed for lymphocytes
Also requires special staining to verify identity
Macrophages
Usually of normal size with inclusions in cytoplasm.
Occasionally enlarged with one or more smaller cells engulfed.
Seen in acute inflammatory processes
***When filled with fat droplets would be called oval fat bodies.

11. Microscopic Sediment – White Blood Cells
Review of identification
Grayish-blue microns in diameter
Polynuclear neutrophils most seen
Fine cytoplasmic granulation, rough surface, may have irregular edges.
Few lymphs seen as well, but hard to ID
Enhancement techniques
Stains
Sternheimer- Malbin for general
Hansel for eosinophils
Toluidine blue
PAP
Microscopy
Light microscope
Phase contrast
Review of WBC identification
Using regular light microscopy the white blood cells in the urine sediment usually appear dull gray / Grayish-blue or maybe yellowish in color.
As was for the RBCs, the exact coloring of the cells in the unstained sediment varies slightly depending on the characteristics, and filters in the microscope you are using.
They microns in diameter – but size is affected by the specific gravity of the urine
Polynuclear neutrophils or segs, are the WBC most often seen in the urine sediment. They have fine cytoplasmic granulation and – if urine is water-like - the granules will shiver back and forth and in the past they would have been identified as glitter cells
A Few lymphocytes may be seen in the urine sediment as well, but harder to specifically identify.
Enhancement techniques used to aid in the ID of wbcs in urine include the use of stains, such as
Sternheimer- Malbin for general analysis; and
Hansel stain - which is specific for identification of eosinophils.
Other stains sometimes used include Toluidine blue & PAP
We generally use the Light microscope for routine evaluation but may find the phase contrast microscope to also be useful . Proceed to the next slide for more information – picture on next slide

12. Microscopic Sediment – White Blood Cells
Phase contrast

13. Microscopic Sediment – White Blood Cells
WBC / leukocytes
This slide has higher level of magnification than normally used in routine examination.

14. Microscopic Sediment – White Blood Cells
WBCs, RBCs, cell debris, bacteria

15. References Dr Andre Audet, Leukocytes & Glitter Cells
Lillian Mundt & Kristy Shanahan, Graff’s Textbook of Urinalysis and Body Fluids, 2nd Ed.
Susan Strassinger & Marjorie Di Lorenzo, Urinalysis and Body Fluids, 5th Ed.
Mery Haber, MD, A Primer of Microscopic Urinalysis, 2nd Ed.
Zenggang Pan, MD, PhD., Dept of Pathology, U of Alabama at Birmingham
Shih-Yung Medical Instruments Co., Ltd
Dr Andre Audet, Leukocytes & Glitter Cells
Department of the Army, Landstuhl Regional Medical Center
I have used many references and sources in the development of the slides in these units.
I want to provide appropriate credit to all of those who have made their work available for use in the educational setting.
This listing is just the beginning and I will continue adding to it as we go along. CRg
This concludes the session on wbcs in the urine sediment.