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NDT Advance Access originally published online on March 8, 2005
Nephrology Dialysis Transplantation 2005 20(4):840-841; doi:10.1093/ndt/gfh529
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© The Author [2005]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oupjournals.org

Images in Nephrology
(Section Editor: G. H. Neild)

Anisocytes and poikilocytes in the urine

Giovanni B. Fogazzi, Mariadele Cantù and Giuseppe Garigali

Research Laboratory on Urine, UO Nefrologia e Dialisi, Ospedale Maggiore, IRCCS, Milano, Italy

Correspondence and offprint requests to: G. B. Fogazzi, UO di Nefrologia e Dialisi, Ospedale Maggiore, IRCCS, Via Commenda 15, 20122 Milano, Italy. Email: fogazzi{at}policlinico.mi.it

Keywords: haematuria; anisocytes; poikilocytes; urinary erythrocyte morphology; urine sediment

Two main types of erythrocytes can be found in the urine, i.e. dysmorphic erythrocytes, which are a marker of glomerular bleeding, and isomorphic erythrocytes, which are a marker of urological disorders [1,2]. In addition, in patients with sickle cell disease, sickled erythrocytes can occasionally be seen [3].

Herein we describe another type of urinary red cells, to our knowledge never described before, which we found in a 39-year-old patient suffering from bilateral hydronephrosis caused by endometriosis and severe iron deficiency anaemia, haemoglobin 9.0 g/dl (n.v. 14–18), serum iron 30 mcg/dl (n.v. 59–158), and percent saturation of transferrin 6.7% (n.v. 30–50).

The new type of urinary erythrocyte was found during an episode of gross haematuria after bilateral pyelostomy. The urine sediment contained too many isomorphic red cells to count. Intermingled with them were several erythrocytes of abnormal size and shape (Figure 1A), which were identical to the red cells found in peripheral blood (Figure 1B). The blood smear was prepared after a negative search for haemoglobin S and the finding at automatic complete blood cell count of a + anisocytosis (=variations in cell size), a +++ poikilocytosis (= variations in cell shape) and a +++ microcytosis (= small cells).



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  		Fig. 1. (A) Isomorphic (crenated and non-crenated) urinary erythrocytes intermingled with erythrocytes of irregular size and shape, most of which are indicated by the arrows (phase contrast microscopy, original magnification 400x). (B) Unstained peripheral blood film showing anisocytes and poikilocytes identical to those seen in the urine (arrows) (bright field microscopy, original magnification 400x).

 
Thus, the abnormal urinary erythrocytes were simply derived from the abnormal circulating erythrocytes which are known to haematologists as anisocytes and poikilocytes, and are a feature of various types of anaemia including that caused by iron deficiency anaemia [4].

Conflict of interest statement. None declared.

References

  1. Fairley KF, Birch DF. Haematuria: a simple method for identifying glomerular bleeding. Kidney Int 1982; 21: 105–108[Web of Science][Medline]
  2. Fasset RG, Horgan BA, Matthew TH. Detection of glomerular bleeding by phase-contrast microscopy. Lancet 1982; i: 1432–1434[CrossRef]
  3. Fogazzi GB, Leong S-O, Cameron JS. Don't forget sickled cells in the urine when investigating a patient for haematuria. Nephrol Dial Transplant 1996; 11: 723–725[Abstract/Free Full Text]
  4. Tichelli A, Gratwohl A, Speck B. Iron deficiency anemia: diagnosis and therapy. Schweiz Med Wocheschr 1992; 12: 461–65

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This Article
Right arrow Extract Freely available
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Right arrow All Versions of this Article:
20/4/840    most recent
gfh529v1
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