Determine DLC Count your own bloed Find out abnormal constituents of urine Sample 1
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Practical Haematology & Urinalysis: Three-Part Answer
PART 1 — DLC (Differential Leukocyte Count)
The DLC expresses each type of white blood cell as a percentage of 100 WBCs counted on a peripheral blood smear (stained with Leishman's or Wright's stain).
Method (Count Your Own Blood Smear)
- Prepare a thin peripheral blood smear; stain with Leishman's stain.
- Under oil immersion (×100), identify and classify 100 consecutive WBCs using a systematic battlement track.
- Record each cell type with a tally counter.
Normal DLC Values (Peripheral Blood)
| Cell Type | % (Adults) | Absolute Count (×10⁹/L) | Appearance |
|---|---|---|---|
| Neutrophils | 50–70% | 1.8–7.5 | Multi-lobed (2–5 lobes), pink granules |
| Lymphocytes | 20–40% | 1.0–4.8 | Round nucleus, scanty blue cytoplasm |
| Monocytes | 2–10% | 0.2–1.0 | Kidney/horse-shoe nucleus, grey cytoplasm |
| Eosinophils | 1–6% | 0.04–0.5 | Bi-lobed, large red-orange granules |
| Basophils | 0–1% | 0.0–0.1 | Bi-lobed, dark purple granules (obscure nucleus) |
Mnemonic: "Never Let Monkeys Eat Bananas" — Neutrophils, Lymphocytes, Monocytes, Eosinophils, Basophils
Clinical Significance of Shifts
| Finding | Causes |
|---|---|
| ↑ Neutrophils (Neutrophilia) | Bacterial infection, MI, burns, steroids, CML |
| ↑ Lymphocytes (Lymphocytosis) | Viral infections (EBV, CMV), CLL, whooping cough |
| ↑ Eosinophils (Eosinophilia) | Allergies, parasitic infections, asthma, drug reactions |
| ↑ Monocytes (Monocytosis) | TB, SLE, monocytic leukemia, chronic infections |
| ↑ Basophils (Basophilia) | CML, allergic reactions, hypothyroidism |
| Left shift (band forms >6%) | Severe bacterial infection, sepsis |
PART 2 — Normal Blood Constituents ("Your Own Blood")
Blood is approximately 8% of body weight. It consists of:
Plasma (~55% of blood volume)
| Constituent | Normal Range |
|---|---|
| Total protein | 6.0–8.0 g/dL (albumin 3.5–5.0; globulins 2.3–3.5) |
| Glucose (fasting) | 70–110 mg/dL (3.9–6.1 mmol/L) |
| Urea (BUN) | 7–20 mg/dL |
| Creatinine | 0.6–1.2 mg/dL |
| Sodium (Na⁺) | 136–145 mEq/L |
| Potassium (K⁺) | 3.5–5.0 mEq/L |
| Calcium | 8.5–10.5 mg/dL |
| pH | 7.35–7.45 |
| pO₂ | 80–100 mmHg |
| pCO₂ | 35–45 mmHg |
Cellular Elements (~45% = haematocrit)
| Component | Normal Value |
|---|---|
| RBC (men) | 4.5–5.5 ×10¹²/L |
| RBC (women) | 4.0–5.0 ×10¹²/L |
| Haemoglobin (men) | 13.5–17.5 g/dL |
| Haemoglobin (women) | 12.0–16.0 g/dL |
| Haematocrit (men) | 40–52% |
| Haematocrit (women) | 36–48% |
| MCV | 80–100 fL |
| MCH | 27–32 pg |
| MCHC | 32–36 g/dL |
| Total WBC | 4.0–11.0 ×10⁹/L |
| Platelets | 150–400 ×10⁹/L |
PART 3 — Abnormal Constituents of Urine (Sample 1 / Routine Urinalysis)
Normal urine contains water, urea, creatinine, ammonia, uric acid, sodium, potassium, chloride, and some phosphates. The following are abnormal (pathological) constituents:
A. Abnormal Chemical Constituents
| Abnormal Constituent | Condition | Significance |
|---|---|---|
| Glucose (Glucosuria) | Diabetes mellitus, renal glycosuria | Renal threshold exceeded (>180 mg/dL blood glucose) |
| Protein (Proteinuria) | Nephrotic syndrome, glomerulonephritis, UTI | >150 mg/day is pathological |
| Ketone bodies (Ketonuria) | DKA, starvation, high-fat diet | β-hydroxybutyrate, acetoacetate, acetone |
| Bilirubin (Bilirubinuria) | Obstructive jaundice, hepatitis | Conjugated bilirubin only crosses into urine |
| Urobilinogen ↑ | Haemolytic jaundice, hepatic failure | Normal trace; absent in complete biliary obstruction |
| Blood (Haematuria) | UTI, stones, malignancy, glomerulonephritis | Gross or microscopic |
| Haemoglobin (Haemoglobinuria) | Intravascular haemolysis (malaria, PNH, burns) | No RBCs seen on microscopy |
| Myoglobin (Myoglobinuria) | Rhabdomyolysis, crush injury | Dipstick positive, no RBCs |
| Pus / Pus cells (Pyuria) | UTI, pyelonephritis | >5 WBCs/HPF |
| Casts | Glomerulonephritis, nephrotic syndrome | RBC casts = glomerular origin |
| Bile salts | Obstructive jaundice | Hay's test positive (lowers surface tension) |
| Amino acids | Inborn errors of metabolism (PKU, cystinuria) | Overflow or renal aminoaciduria |
| Crystals (abnormal) | Cystine, uric acid, calcium oxalate | Excess or abnormal crystal types |
B. Physical Indicators of Abnormality
| Parameter | Normal | Abnormal Finding |
|---|---|---|
| Colour | Pale to amber yellow | Red (blood), dark brown (bilirubin), cloudy (infection) |
| Odour | Inoffensive aromatic | Sweet/fruity (ketones), fishy (trimethylaminuria), foul (infection) |
| Specific Gravity | 1.003–1.030 | <1.003 = diabetes insipidus; fixed 1.010 = renal failure |
| pH | 4.5–8.0 | Persistent alkaline → UTI with urease organisms |
C. Microscopic Abnormalities (Urine Sample 1 — Sediment)
| Finding | Clinical Significance |
|---|---|
| RBC casts | Glomerulonephritis (hallmark) |
| WBC casts | Pyelonephritis, interstitial nephritis |
| Granular casts | Non-specific tubular damage |
| Waxy casts | Chronic renal failure |
| Hyaline casts | Mild proteinuria, dehydration (borderline normal) |
| Fatty casts / Oval fat bodies | Nephrotic syndrome |
| Bacteria | UTI (>10⁵ organisms/mL = significant bacteriuria) |
| Trichomonas vaginalis | STI |
| Cystine crystals (hexagonal) | Cystinuria |
Sources: Henry's Clinical Diagnosis and Management by Laboratory Methods (Differential Leukocyte Count chapter); Campbell Walsh Wein Urology (Urinalysis section) — supplemented with standard haematology and biochemistry reference ranges.
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