Kridsada Sirisabhabhorn and Supaporn pumpa Clinical Microscopy & ParasitologyDivision, Department of Medical Technology Laboratory , ThammasatCharlermprakiethospital, Pathumtani, Thailand 12120

1. Kridsada Sirisabhabhorn and Supaporn Pumpa
Dysmorphic rbc (dRBC) is leaked morphologic of red blood cell which infiltrated
throughout from pathologic of glomerular in kidney. The variant types of dRBC morphology
are significant for indication of glomerular bleeding and grading of severe glomerular
disease. Thus, D1 cell is like a ring-like shape and severe cytoplasmic color loss with
membranous protrusions or blebs, D2 is like a doughnut-like shape and moderate
cytoplasmic color loss with membranous protrusions or blebs. and D3 cell is like a doughnut
shape and mild cytoplasmic color loss without membranous protrusions or blebs.(1) In the
present, various choices of automated analyzer technology could be support technician
such as reduce TAT (Turn Around Time) and reduce workload like as principle capture
image.(3) and flow cytometry. Nevertheless advances in skills and experience is still
important for classification of pathological urine element, especially dRBC that notified
glomerular disease exclude non-glomerular disease.
Objectives
1. To study performance of 2 individuals who are well trained and non
trained in order to screen abnormal cases and identify dRBC and urine
elements with clinical specific kidney diseases from iQ®200i microscopic
automated analyzer.
2. To demonstrate achievement of the well trained person to classify
morphology of dRBC.
Material & Method
Total 143 cases of urinalysis were 74 male and 59 female cases that
received from IPD patients of Thammasat Charlermprakite hospital,
Pathumtani, Thailand. All samples were analyzed by 2 technicians (well
trained and non-trained in dRBC identification) using iQ®200i. Over 3 ml
and uncentrifuge of midstream urine permitted for input to iQ®200i
system; combine chemistry and microscopic part. The technical
reclassified elements on desktop of iQ®200i, the principle of capture
image urine elements. Three major categories which are red blood cells,
white blood cells and squamous epithelial cells were recognized by
analyzer. On the contrary, minor categories depended on human
verification. During the experiment if previous specimen was high
concentration of cells later introduced to clean with cleanser and diluents
for eliminated carry over. dRBC in all cases were confirmed by
centrifugation at 400 x g for 5 min. and subjected to brightfield
microscopic examination. Finally, the results were analyzed by descriptive
statistic.
Results
Table 1 and Bar chart 1. shown that the efficiency skill in urine elements screening between
non-trained with well trained person. After urine elements were easily screened by iQ®200i,
there were abnormal 49 cases which needed confirmation by brightfield microscopic
examination as shown in table 2. The results were demonstrated that 10 cases of dRBC in
variant classification of dRBC as D1, D2 and D3 cell and mixed erythrocytes morphology
respectively as on table 3.
Classification
of personal skill
All cases (143)
Released
cases
% of all cases
Non-trained 57 39.86
Well trained 94 65.73
10 cases of dysmorphic red blood cell
Cell types no. of cases % of all cases
D1 0 0
D2 6 4.20
D2 +D1 1 0.70
D2 +D3 1 0.70
D3 2 1.400
10
20
30
40
50
60
70
80
90
100
Non‐trained Well trained
% screening cases achievement of total cases (143)
Non‐trained
Well trained
Discussion & Conclusion
Introduction
Abstract
Class of personal
skill
Appearance cases
of dRBC
After centrifugation
Non-trained
(cases)
Well trained
(cases)
dRBC found 4 10
dRBC not found 139 133
References 1. Nagahama, D.,Yoshiko, K., Morita, M.W.Y., Iwatani, Y. and Matsuo, S. 2005. A useful new classification of dysmorphic urinary erythrocytes. Clin Exp Nephrol 9:304–9.
2. Crop., M.J., de Rijke., Y.B., Verhagen., P.C.M.S., Cransberg, K.and Zietse, R. 2010. Diagnostic Value of Urinary Dysmorphic Erythrocytes in Clinical Practice. Nephron Clin Pract ;115:c203–c2.
3. Sarvary, E., Lee, D., Varadi, J. Varga, M., Gaal, I. and Chmel, R. et. al, 2010. The iQ200 Microscopic Analyzer is valuable tool for evaluation of urinary sediment at transplanted patients. Interventional Medicine & Applied
Science, Vol. 2 (1). 22–6.
This study demonstrated that experience from well trained person for diagnostic urine element is important in routine urinalysis. In the well trained personal
determined easy elements on monitor of iQ®200i who approved screening raise up to 25.87% of all cases more than non-trained personal. This experiment revealed that
there were 10 dRBC cases from 49 abnormal cases. Moreover, variant morphology of dRBC in this study were described as D2, D3 cell sand mixed type D2 with D1
cells and D2 with D3 cells. This study is preliminary survey in significant of well trained experience in iQ®200i usual which influence to diagnosis dRBC erythrocyte that
associated with glomerular disease. Most kinds of dRBC morphology were appeared as D2 cell [moderate glomerular damage] below as D3 cell [mild glomerular
damage]. Particularly, it is difficult for D3 cell investigation because it may be missed in diagnosis by less experience person. However,D3 cell is an early marker for
indication of glomerular disease.(2) This preliminary study will be create different experience field in usual automate analyzer effect to diagnosis abnormal urine elements.
The sensitivity, specificity and PPV in kidney disease should be further study. The benefit of this study is to enhance personal performance in order to identify dRBC and
increase quality in routine urinalysis.
Clinical Microscopy & Parasitology Division, Department of Medical Technology Laboratory ,
Thammasat Charlermprakiet hospital, Pathumtani, Thailand 12120
Key words : Dysmorphic rbc, iQ®200i, glomerular disease
Classification of dysmorphic erythrocyte (dRBC) plays a crucial role in indication of glomerular damage. Moreover, variant type of morphology dRBC is used to
demonstrate the severity of glomerular disease. Although, the iQ®200i microscopic capture image analyzer can be used to reduce laborious and time consuming, the well
trained of device usual is still improving for dRBC investigation. The aim of this study is to evaluate the efficiency of 2 individuals of well trained and non-trained using
with the iQ®200i for improving the dRBC diagnosis and rule out normal urine before dRBC confirmation by microscopic. One hundred and forty-three urine samples of
IPD patients in Thammasat Charlermprakiet hospital, Pathumtani, Thailand were collected and subjected to urinalysis by iQ®200i analyzer and 2 medical technologists.
Next, abnormal cases were centrifuged at 400x g 5 min and then the pellet was observed under bright-field microscope. The urinalysis results between 2 individuals were
compared by using descriptive statistic. The results were demonstrated that the well trained performed raise 25.87% of cases in urinary screening so that better than
non-trained skill. Especially, classification of dRBC were described as D2, D3 cell and mixed types of D2+D1 cells and D2+D3 cells as 4.2, 1.4, 0.7 and 0.7%,
respectively. The advantages of this study is to emphasize in dRBC diagnosis and activate personal skill for usual device. However, sensitivity, specificity and PPV of
predicted kidney disease should be further study.
The introduction of well trained experience with iQ®200i microscopic analyzer improved
dysmorphic erythrocyte diagnosis
Table 1.
Bar chart 1.
Table 2.
Table 3.
D2+D1 cells D2+D3 cells
Acknowledgements : We would like to thank for her kindness of Lecture Ornrudee Khantisitthiporn, Faculty of Allied Health Sciences, Thammasat University for approve literature and Mr.Palakorn Puttarak, Lab director of Medical Technology
Laboratory, Thammasat Charlermprakiet Hospital for support poster presentation.
D1 cell
D3 cell
D2 cell
Photo by Kridsada Sirisabhabhorn, MT.