Urine erythrocytes, which are red blood cells that appear in the urine. Increased urine red blood cells are caused by bleeding from the urinary system (kidneys, bladder or ureters) and blood entering the urine. This type of urine specimen is also known as hematuria and is classified as either visual or microscopic hematuria. Naked-eye hematuria is urine that can be seen as blood-colored with the naked eye. When there are >3 per high-powered field of view, but the urine does not have a blood-colored appearance, it is called microscopic hematuria. Therefore, fleshly hematuria bleeds more and is more serious than microscopic hematuria.
Normal range: <3 per high magnification field of view. Also: urine occult blood will reflect positive (+) when urine red blood cells are >10.
Clinical significance: common causes of hematuria are acute glomerulonephritis, chronic nephritis (such symptoms require prompt medical attention to avoid delay and development of uremia!) , acute pyelonephritis, urinary stones. Tuberculosis, tumor, trauma, etc. If there is simply a large amount of hematuria then stones are the most likely.
1.Aberrant red blood cell criteria
Birech report aberrant erythrocytes classification erythrocytes of various sizes and morphological abnormalities are categorized into the following 7 types:
(1) yeast-like erythrocytes: in the outer membrane of the erythrocytes there are small vesicles protruding or the cells are mold spore-like changes.
(2) fried bread roll-like erythrocytes: the erythrocyte membrane is clearly inside and outside the two circles, surrounded by hypertrophy, shaped like a fried bread roll.
(3) Ancient money-like erythrocytes: resembling ancient Chinese coins.
(4) Membrane defective red blood cells: the red blood cell membrane is incomplete, and part of the hemoglobin (Hb) is lost.
(5) Large erythrocytes: the cell body is enlarged, the center is light, and there is no sense of double disc depression.
(6) Small erythrocytes: small cytosol, thickened outer membrane, refractive enhancement.
(7) Bracelet-like erythrocytes: the cell body is larger, and the inner and outer membranes are obviously changed.
Regarding the classification of aberrant erythrocytes.
(1) Bagel-like erythrocytes.
(2) Ancient money-like erythrocytes.
(3) Granular and bead-like erythrocyte membranes.
(4) The size of the red blood cells varies from 1 to 2 times larger than normal to 1/2 as small and lighter in color.
(5) Fragmented erythrocytes.
(6) Budding erythrocytes.
(7) Spiny red blood cells.
(8) Other shapes, such as cell membrane rupture into various shapes, horseshoe-shaped, crescent-shaped, etc. Others, such as red blood cells are serrated, solid type, uniform in size are called uniform type.
2, homogeneous red blood cell standards
Red blood cells are uniform in size, uniform in variation, within two phases, most of them are normal and mulberry-like red blood cells, and some of them can appear as shadow red blood cells. This type mostly belongs to non-glomerular hematuria.
3.Mixed red blood cell standard
According to the different proportion of deformed and homogeneous red blood cells, there are two types of mixed red blood cell hematuria (deformed red blood cells >50%) and homogeneous red blood cell hematuria (homogeneous red blood cells >50%).
4.Determination limit
Aberrant red blood cells accounting for 80% or more is glomerular hematuria; aberrant red blood cells <20%, homogeneous red blood cells >80% or more is non-glomerular hematuria; aberrant red blood cells >20%, <80%, is mixed hematuria.
5. Morphological changes of aberrant red blood cells and glomerular hematuria
There are 7 to 8 kinds of morphological changes of aberrant red blood cells. In glomerular hematuria, most of them are aberrant red blood cells, accounting for more than 80%; in non-glomerular hematuria, most of them are homogeneous red blood cells, accounting for more than 80%; as well as mixed type with mainly aberrant red blood cells (>50%) and mixed type with mainly homogeneous red blood cells (>50%). The results of the above 3 types of aberrant erythrocytes, homogeneous erythrocytes and mixed erythrocytes are all convergent, and there is no reversibility, although it is more objective to observe with clinical symptoms.
The formation of aberrant erythrocytes: It is generally believed that the erythrocytes are damaged when passing through the glomerular basement membrane and deformed by extrusion when leaking out through the glomerular capillary wall, and are also related to urinary osmolarity, pH and other factors. Therefore, in addition to the graphical changes in the appearance of erythrocytes from the kidney, there were also significant differences in the size of their volume. Microscopic observation and examination of changes in the morphology of urinary erythrocytes are of value and clinical significance for the diagnosis of hematuria caused by glomerular diseases and for differential diagnosis. The presence of spiny and target-shaped red blood cells has more clinical diagnostic value.