ARDS = adult respiratory distress syndrome; BAL = bronchoalveolar
lavage; LE = Lupus Erythematosus.
INDEX TERMS: body fluids; cerebrospinal; serous; synovial.
Clin Lab Sci 2009;22(1):54
1. Describe the significance of eosinophils in urine.
2. Describe lupus erythematosus cells in serous and synovial
3. Describe the significant cellular findings in bronchial alveolar
lavage (BAL) specimens.
Cytocentrifuge slides can provide important information in
diagnosing various conditions.
Urine for eosinophils
Urine samples for eosinophils may be submitted when interstitial
nephritis secondary to antibiotic therapy is suspected. Slides to search
for eosinophils should be prepared by concentration of the sample by
either standard centrifugation or cytocentrifugation. Slides should be
stained with Wright stain and a thorough search made for eosinophils. A
finding of any eosinophils is significant.
Lupus Erythematosus (LE) cells
LE cells are neutrophils containing a smooth homogeneous nuclear
mass. The nucleus of the neutrophil will be displaced to the edge of the
cell wall by the large homogeneous mass. In patients who have systemic
lupus erythematosus, the characteristic LE cell may be seen in serous
and synovial fluids. All the factors necessary for formation of these
cells--incubation, trauma to the cells, and the LE factor--are present
in vivo in patients with systemic lupus erythematosus. The finding of
these cells can be of diagnostic significance in patients not previously
identified with this disease. See Figure 1.
Bronchoalveolar lavage (BAL)--the fluid that isn't a fluid
Bronchoalveolar lavage (BAL) is usually performed on hospitalized
patients who have non-resolving pneumonia in an attempt to identify
organisms that are not responding to antibiotic treatment or to detect
malignancy. The "fluid" is obtained by introducing warmed
saline into the lungs through a bronchoscope in 20 mL aliquots followed
by aspiration of the saline. A total of 100-120 mL of saline is
introduced and aspirated with a recovery of 40-60 mL. (3) The
"fluid" is sent to the laboratory for extensive microbiology
testing and cytology examination. Occasionally, cell counts and
differential counts are requested. Any laboratory performing these
procedures needs to be aware that organisms in these specimens are
airborne and caution should be taken when containers of fluid are mixed
and opened. Containers should be opened under a biological safety hood,
tests should be "set up" under the hood (i.e., hemacytometers
charged, cytofunnels filled, films prepared), and laboratory personnel
performing these procedures should wear a mask while performing cell
counts. There are no reference ranges for cell counts on these
"fluids" and they have no clinical significance. As in any
fluid, the types of cells present are significant. In BAL, the most
clinically meaningful information is supplied by the extensive
microbiological testing for bacteria and fungus that is the purpose for
performing the procedure. The presence of numerous neutrophils can
indicate infection or inflammation; numerous eosinophils can indicate
allergic reactions, parasitic infections, or eosinophilic pneumonia; and
excessive lymphocytes can indicate conditions including viral pneumonia,
connective tissue disorders, or lymphoma. (3) Macrophages containing tar
can be seen in samples from patients who smoke. Erythrophages may be
seen if there has been hemorrhage in the lungs more than 12 hours prior
to the procedure. Ciliated epithelial cells are columnar epithelial
cells found in the upper respiratory tract. They are elongated cells
with the nucleus on one end of the cell and cilia on the other.
[FIGURE 1 OMITTED]
[FIGURE 2 OMITTED]
See Figure 2. If seen on the hemacytometer when performing cell
counts on fresh specimens, these cells appear mobile as they are
propelled by their cilia. Type II pneumocytes, resembling
adenocarcinoma, can be seen in patients with adult respiratory distress
syndrome (ARDS). Type II pneumocytes are very large, dark-staining cells
in clumps containing large vacuoles that contain surfactant. Bacteria
engulfed by neutrophils may be seen in cases of bacterial infection.
Pneumocystis organisms, if present, will appear as amorphous material
that, upon careful examination, may contain the round cysts
characteristic of the organism. See Figure 3.
[FIGURE 3 OMITTED]
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(1.) Strasinger S, DiLorenzo M, editors. Urinalysis and body
fluids, 5th edition, Philadelphia: F.A. Davis; 2008.
(2.) Collins L. Body fluids in the hematology laboratory. In: Rodak
B, Fritsma G, Doig, K., editors. Hematology: clinical principles and
applications, 3rd edition. St. Louis: Elsevier; 2007.
(3.) Mego T. Body fluids. Presented at CLSA Annual Meeting,
Anchorage AK, April 2008. Available from
Accessed 2008 Sept 1.
(4.) Kjeldsberg C and Knight J, editors. Body fluids, 3rd edition.
Chicago: ASCP Press; 1993.
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Leilani Collins MS MT(ASCP)SH CLS(NCA) is associate professor,
Clinical Laboratory Science Program, University of Tennessee Health
Sciences Center, Memphis TN.
Address for correspondence: Leilani Collins MSMT(ASCP)SH CLS(NCA),
associate professor, Clinical Laboratory Science Program, University of
Tennessee Health Sciences Center, 930 Madison Avenue, Suite 670, Memphis
TN38163. (901) 448-6299. firstname.lastname@example.org.
Leilani Collins MS MT(ASCP)SH CLS(NCA) is the Focus: Body Fluids