The cytoplasm of a lymphocyte is clear sky
blue, scanty, with few unevenly distributed,
azurophilic granules with a halo around them. The
nucleus is generally round or oval or slightly in-
dented, and the chromatin is lumpy and con-
densed at the periphery.
The largest of the normal white blood cells is
the monocyte. Its color resembles that of a lymph-
ocyte, but its cytoplasm is a muddy gray-blue. The
nucleus is lobulated, deeply indented or
horseshoe-shaped, and has a relatively fine
chromatin structure. Occasionally the cytoplasm
is more abundant than in the lymphocyte.
The cytoplasm of a neutrophil has numerous
fine lilac-colored granules, which sometimes are
hardly visible. The nucleus is dark purple or red-
dish purple, and it maybe oval, horseshoe-or S-
shaped, or segmented (lobulated). The neutrophil
is further subclassified according to age as:
Metamyelocyte (also called juvenile).
This is the youngest neutrophil generally
reported. The nucleus is fat, indented, and
is usually bean shaped or cashew nut
Band (sometimes called stab). This is the
older or intermediate neutrophil. The
nucleus has started to elongate and has
curved itself into a horseshoe-or S-shape.
As the band ages, it progresses to:
Segmented. The nucleus is separated into
two, three, four, or five segments or lobes.
Hypersegmented. The nucleus is divided
into six or more segments or lobes.
The physical and chemical properties of nor-
mal urine are markedly constant; any abnor-
malities are easily detected. The use of simple tests
provides the physician with helpful information
concerning the diagnosis and management of
This section will deal with the routine and
microscopic examination of urine specimens,
some of the principles involved, and some of the
simpler interpretations of the findings.
Urine specimens for routine examinations
must be collected in aseptically clean containers.
Unless circumstances warrant, catheterization
should be avoided because it may cause urinary
tract infections. Specimens of female patients are
likely to be contaminated with albumin and blood
from menstrual discharge, or with albumin and
pus from vaginal discharge. For bacteriologic
studies, care must be taken to ensure that the ex-
ternal genitalia have been thoroughly cleansed
with soap and water. The patient must then void
the initial stream of urine into the toilet or a
suitable container and the remainder directly in-
to a sterile container. All urine specimens should
be examined when freshly voided or should be
refrigerated to prevent decomposition of urinary
constituents and to limit bacterial growth.
This is a sample of urine voided without regard
to the time of day or fasting state. This sample
is satisfactory for most routine urinalyses. It is
the least valid specimen, since tests results may
reflect a particular meal or fluid intake.
First Morning Specimen
This is the first specimen of urine voided upon
rising. It is the best sample for routine urinalysis
because it is usually concentrated and more likely
to reveal abnormalities. If positive results are ob-
tained from the first morning specimen, the
physician may order a 24-hour specimen for quan-
Twenty-four Hour Specimen
This specimen measures the exact output of
a specific substance over a 24-hour period. To col-
lect this specimen:
Have the patient empty his or her bladder
at 0800. Discard this urine.
Collect all urine voided during the next 24
At 0800 the following day (end of 24-hour
period), instruct the patient to empty his
or her bladder.. Add this urine to the pooled
Specimen must be refrigerated during
Preservatives will be added to the first
specimen voided, according to the types of
tests being ordered.