2015 CAP-CMP参考答案.pptVIP

2015年 CAP能力验证CM_参考答案 Case History (1) This urine sample is from a 77-year-old woman. Laboratory data include: specific gravity = 1.017; pH = 6.4; glucose, protein, ketones, nitrite, and leukocyte esterase = negative; blood = positive. Identify the arrowed object(s) on each image(CMP04-07) (Urine Sediment Photographs, UNSTAINED, 100X) Note CMP-10:The arrowed cell is a degenerated/degenerating neutrophil, Degenerated neutrophils are round to oval cells ranging from 10 to 15 μm, and their N:C ratio is 1:3 or less. The major distinguishing feature is that the nucleus shows karyorrhexis and/or pyknosis. These changes are appreciated when a cell with neutrophilic granules (pale pink cytoplasm with fine lilac granules) contains a single, dark, round to oval nucleus (pyknosis) as shown in the arrowed cell, or multiple, unconnected nuclear lobes (karyorrhexis). The chromatin is dense and homogeneous without visible parachromatin or nucleoli. The nuclear lobes may fragment into numerous small particles of varying size that can resemble microorganisms such as bacteria or fungi. Also, the nuclear outlines may become indistinct and blurred. As the cellular degeneration continues, the cytoplasm will become hypogranulated, then agranular, and the cytoplasmic borders may become frayed and indistinct. Sometimes, the cells will contain scattered larger azurophilic or dark blue granules (toxic granulation). Vacuolation is frequent. These cells can be seen both in normal individuals and in patients with a variety of medical conditions, including infections, inflammatory disorders, and malignancies. It is nondiagnostic and nonspecific. Other cells that may resemble degenerated neutrophils are nucleated red cells in the blood and orthochromic normoblasts in the bone marrow. These cell types have pinkish orange, agranular cytoplasm and a single, often eccentric nucleus with dense chromatin and very little to no parachromatin. Case History (3) This urine sample is f