The type of appearance that RBCs have in a hypotonic urine is a swollen appearance and the RBCs or red blood cells can even lose their normal biconcave shape and become almost spherical or even can resemble ghost cells.
When the RBCs or red blood cells resemble ghost cells the membrane will be visible but the hemoglobin will have been washed out.
This is a result of the water moving into the RBC or red blood cell from the hypotonic urine which causes it to swell.
In hypotonic urine the cells increase in size and also appear colorless.
And dysmorphic RBC can also arise from glomerular diseases and will also appear misshaped, fragmented and or have protrusions.
The ghost cells is a term that is used to describe RBCs which have lysed leaving behind their outer membrane.
Crenated red cells, traditionally considered an indication of glomerular bleeding, may be encountered in any concentrated urine specimen.
Acanthocytes, which are doughnut-shaped red cells with a central hole and membrane blebs attached peripherally, are more specific for an upper-tract bleeding source.
Gross hematuria refers to visible blood in urine, while microscopic hematuria indicates red blood cell (RBC) detection through urinalysis or urine microscopy without apparent visual blood.