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MLT Semester #1 > 1030 Unit 5 > Flashcards

1030 Unit 5 Flashcards

1
Q

What are the functions of CSF?

A

① supply nutrients to the nervous tissue
② removes metabolic waste
③ maintains intracranial pressure
④ cushions the brain and spinal cord

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2
Q

Describe the lining of the brain and spinal cord

A

-made up of 3 meninges
①dura mater→ hard layer that lines skull and spine column
② arachnoid filamentous inner membrane (spiderweb)
③ pia mater →gentle thin lining membrane on the brain and spinal cord

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3
Q

What produces CSF?

A

The choroid plexuses capillary network of filtration between the blood plasma and theCSF blood-brain barrier

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4
Q

Describe structure of the choroid Plexuses

A
  • 2 lumen ventricles and 3rd and 4th ventricles
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5
Q

Describe CSF volume characteristics

A
  • 20 ml produced every hour
    -Fluid goes to the subarachnoid space
  • normal value → 90-150 ml
    -neonates normal value → 10-60 ml
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6
Q

Describe blood brain Barrier

A

-tight fitting endothelial cells
-protects brain
- The values acts in a one-way response

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7
Q

What could disrupt the blood brain barrier?

A

-meningitis →
→infection
→ multiple sclerosis
-allows protein, guecose and leukocytes ( WBC) into the CSF

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8
Q

What is the location of the CSF collection?

A

Lumbar puncture between 3rd and 4th vertebra OR 5th and 6th vertebra

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9
Q

What should occur after the needle is in place in CSF collection?

A

-opening pressure is recorded in patient chart by the trained physician performing the lumber puncture
- elevated pressure requires the fluid to be removed slowly

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10
Q

Explain collection tubes for CSF collection

A

Specimens are collected sterilely in 4 tubes ‘
① chemistry and serology test - may be frozen
② microbiology - room temperature
③ cell count- hematology - may refrigerate up to 4 hours
④ might be used for microbiology or for extra test

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11
Q

When should CSF be tested?

A

STAT- drop what your doing and test immediately

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12
Q

Explain possible appearances of CSF that should be reported?

A
  • Colorless/clear
  • cloudy
  • turbid
  • milky
  • xanthochromic → pink, orange, yellow
  • bloody → red
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13
Q

What causes oily CSF?

A

_ Radiographic contrast media

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14
Q

What causes clotted CSF?

A
  • clotting factor
  • protein
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15
Q

What causes pellicle CSF?

A

-protein
- clotting factors

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16
Q

What is the normal appearance of CSF?

A

Clear/ colorless

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17
Q

What is xanthochromic?

A

An indication of Old blood, longer than traumatic tap
-caused by-
→hemoglobin
→ bilirubin
→ carotene
→ protein
→ melanin

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18
Q

How much fibrinogen is normally fInd in CSF?

A

None

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19
Q

What does red CSF indicate?

A

Traumatic tap

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20
Q

What does orange/yellow CSF indicate?

A

Old blood

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21
Q

What cells are Included in a call count?

A

-leukocytes (WBC)
-nucleated cells

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22
Q

What is the normal value for CSF for WBC?

A

-0-5 WBCs/ul
- children can be higher
- neonates → 30 mononuclear cells

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23
Q

What is the normal value for RBC in CSF?

A

-0
- most are due to traumatic tap

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24
Q

What is the traditional way to do a RBC count?

A
  • Neubauer chamber and equation
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25
Q

What is the equation for find the RBC cell count?

A

(# of cells counted x dilution)/(#of squares counted X volume of 1 square)

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26
Q

What should occur if a few number of cells are present?

A
  • Count all 9 squares
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27
Q

What would you do if you need WBCs to be more visible?

A
  • Add glacial acetic acid, it will lysis RBC
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28
Q

Describe bacterial meningitis

A

-↑ WBC count
-neutrophils present
-marked protein elevation
↓ glucose level
- lactate level >35 mg/dl
- positive gram stain and bacterial antigen tests
-PCR

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29
Q

What causes the PCR to be positive in bacterial meningitis?

A
  • Streptococcus pneumonia
  • streptococcus agalactiae
  • Neisseria meningitidis
  • haemophilus influenza
  • listeria monocytogenes
  • escherichia coil K1
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30
Q

Describe viral meningitis

A

↑ WBC count
-Lymphocytes present
-moderate protein elevation
- normal glucose
- normal lactate level

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31
Q

What causes the PCR to be positive in viral meningitis?

A

-Enterovirus
-herpes
- simplex virus
- parechovirus

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32
Q

Describe tubercular meningitis

A

↑ WBC count
Lymphocytes present
Monocytes present
↑moderate to marked protein
↓ glucose level
> 25 mg/dl lactate level
- pellicle formation

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33
Q

What causes the PCR to be positive in tubercular meningitis?

A
  • Mycobacterium tuberculosis
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34
Q

Describe fungal meningitis

A

↑ WBC count
-Lymphocytes present
-Monocytes present
↑ moderate to marked protein
-Normal OR ↓ glucose level
>25 mg/dl lactate level

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35
Q

Explain positive test for fungal meningitis occur?

A
  • Positive for India ink
    → cryptococcus neoforman
  • positive immunological test
    → eryptococcus neoforman
    -PCR positive for
    → cryptococous neoformans
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36
Q

What are the clinical significances of lymphocytes in CSF? What are the microscopic findings?

A

-normal
-Viral, tubercular, and fungal meningitis
- HIV /AIDS
- sclerosis
- degenerative disorders
- parasitic infections

MICRO → all stages of development can be found

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37
Q

What are the clinical significances of neutrophil sin CSF? What are the microscopic findings?

A
  • Bacterial meningitis
  • early cases of viral, fungal, and tubercular meningitis
  • cerebral hemorrhage
  • cerebral abscess
    -CNS infarction
  • injection of medications or radiographIC dye into the subarachnoid space
  • metastatic tumors
  • repeated lumbar punctures

MICRO for bacterial meningitis→ granules may be seen less prominent than in blood
MICRO for an others → cells disintergrate rapid

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38
Q

What are the clinical significances of monocytes in CSF? What are the microscopic findings?

A
  • Normal
    -rival, tubercular and fungal meningitis
  • multiple sclerosis

MICRO → found mixed w/ lymphocytes

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39
Q

What are the clinical significances of eosinophils in CSF? What are the microscopic findings?

A

-parasitic infections
-fungal infections
- coccidioïdal meningitis
- introducing medications and shunts in CNS

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40
Q

What are the clinical significances of macrophages in CSF? What are the microscopic findings?

A
  • RBCs in spinal fluid
  • contrast media

MICRO→ may contain phagocytized RBCs appearing as empty vacuoles or ghost calls, hemosiderin granules and hematoidin crystals

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41
Q

What are the clinical significances of blast cells in CSF? What are the microscopic findings?

A
  • Acute leukemia

MICRO → lymphoblasts, myeloblasts, or monoblasts

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42
Q

What are the clinical significances of lymphoma cells in CSF? What are the microscopic findings?

A

Disseminated lymphomas

MICRO →resemble lymphocytes with cleft nuclei

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43
Q

What are the clinical significances of plasma cells in CSF? What are the microscopic findings?

A
  • Multiple sclerosis
  • guillain-barre syndrome
    -sarcoidosis
    -parasitic infection
  • syphilistic meningitis
    -tuburculous meningitis
  • lymphocytes reactions

MICRO for multiple sclerosis→ traditional and classic forms seen
MICRO for lymphocytes→ reactive lymphocytes

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44
Q

What are the clinical significances of ependymal,chloroidal, and spindle-shaped cells in CSF? What are the microscopic findings?

A
  • diagnostic procedures

MICRO → seen in clusters with fusing of cell walls

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45
Q

What are the clinical significances of malignant cells in CSF? What are the microscopic findings?

A

-metastatic procedures
- primary central nervous system carcinoma

MICRO→ seen in clusters with fusing of cell borders and nuclei

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46
Q

What is pleocytosis?

A

Increase of normal cells→ abnormal

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47
Q

What leukocytes are classified as polynuclear?

A

Eosinophil
Basophil
Neutrophil

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48
Q

What leukocytes are classified as mononuclear?

A
  • Monocytes
    -lymphocytes
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49
Q

What should you do if a few number of cells are present in a cell count?

A
  • Count all 9 squares
    -sometimes, WBC may be less than RBC and you may count in different areas
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50
Q

What is a cytocentrifuge?

A

-Forces cells onto a slide in a monolayer
-filter paper absorbs moisture
- 0.1 ml CSF to 1 drop 30% albumin

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51
Q

0 number of WBCs counted in chamber, what would be the number of cells after cytocentrifuge?

A

0-40

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52
Q

1-5 number of WBCs counted in chamber, what would be the number of cells after cytocentrifuge?

A

20-100

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53
Q

6-10 number of WBCs counted in chamber, what would be the number of cells after cytocentrifuge?

A

60 - 150

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54
Q

11-20 number of WBCs counted in chamber, what would be the number of cells after cytocentrifuge?

A

150-250

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55
Q

21 number of WBCs counted in chamber, what would be the number of cells after cytocentrifuge?

A

251

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56
Q

What is normal to be seen in a differential count?

A

Lymphocytes
Monocytes

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57
Q

What is an easy way to differentiate between meningitis types:

A

↑ neutrophils= bacterial
↑ lymphocytes and monocytes= viral, tubercular, parasitic, and fungal

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58
Q

Explain what to expect when neutrophils are present?

A
  • Early onset of viral, fungal, tubercular, and parasitic
  • appearance
    → cytoplasm vacuolated
    → granules could be lost
    → may see phagocytized bacterial pyknotic = degenerated cells
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59
Q

Explain what to expect when eosinophils are present?

A
  • Parasitic infection
  • fungal infection
  • introduction of forgien material = allergic reaction
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60
Q

Explain what to expect when lymphocytes are present?

A
  • Normal to see in low numbers
    -viral, tubercular, fungal meningitis
    -reactive lymphocytes
    → dark blue cytoplasm
    → clumped chromatin
    → plasma cells
    -HIV infection (AIDS), multiple sclerosis and degenerative neurological disorders
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61
Q

Explain what to expect when monocytes/ macrophages are present?

A

-usually counted together
- monoytes=blood
- macrophages/histocytes= tissue
-viral, tubercular, or fungal meningitis

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62
Q

What is nonpathological significant in CSF?

A

Appearance of lining cells
-choroidal cells
-ependymal cells

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63
Q

What are pathological significance in CSF?

A

-any form of blasts ( 1st stage of a hemopoietic cell)
- lymphoma cells can also be seen
- malignant cells
→astrocytoma
→retinoblastoma
→medulloblastomas
(usually dark, ugly, and inclusters

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64
Q

What is the normal value of protein in CSF?

A

15 - 45 mg/dl

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65
Q

What proteins are present in CSF?

A
  • Albumin → predominant
    -transthyretin (prealbumin)→ second predominance
  • alpha globulin
    -beta globulin
    -separate carbohydrate-deficient transfersin fraction (“tau” → not in serum)
  • gamma globulin
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66
Q

What are the types alpha globulins present in CSF?

A
  • Haptoglobin
    -ceruloplasmin
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67
Q

What is the beta globulin present in CSF?

A

Transferrin

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68
Q

What are the gamma globulins present in CSF?

A

-IgG → predominant
-IgA

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69
Q

What proteins are not considered normal for CSF?

A

-IgM
-fibrinogen
-lipoprotein

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70
Q

What are causes for elevated protein found in CSF?

A
  • Damaged to blood-brain-barrier(most common)
    → meningitis
    → hemorrhage conditions
    → multiple sclerosis
  • immunoglobulin production within the CNS
    -decreased normal protein clearance from the fluid
    -neural tissue degeneration
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71
Q

What are principles for the two methods used for measuring protein in CSF?

A

-Turbidity production
→automated instrumentation in form ot nephelometry
-dye-binding ability

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72
Q

What does diagnosis of neurological disorders associated with abnormal CSF require?

A

Measurements of individual protein fractions

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73
Q

How do you determine if elevated IgG levels are due to blood brain barrier defect or being produced within the CNS?

A

-Comparisons must be made between serum and CSF levels of albumin
- methods include
→CSF/serum albumin index to evaluate the integrity of blood brain barrier
→ CSF IgG index to measure IgG synthesis within the CNS

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74
Q

How ao you determine the CSF/ serum albumin index?

A
  • calculated after determining concentration of CSF albumin in mg/dl AND serum concentration in g/dl
    -equation:
    (CSF albumin mg/dl)/( serum albumin g/dl)
  • an index value less than 9 represents an intact blood- brain barrier
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75
Q

How do you determine the IgG index

A
  • Comparison of CSF/serum albumin index with the CSF/serum IgG index
    -equation
    [CSF IgG (mg/dl)/serum IgG (g/dl)]/[CSF albumin (mg/dl)/ serum albumin (g/dl)]
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76
Q

What is myelin basic protein?

A

-Major component of the myelin nerve sheath surrounding axons of nerves in the nervous system
-presence in CSF indicates recent destruction of the myelin sheath that protects axons
- can be used to monitor the course of multiple sclerosis
-↑ in trauma, encephalitis, guillain-barre.

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77
Q

Describe dye binding ability

A
  • Oligoclonal bands (immunoglobins in CSF)
    . Electrophoresis
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78
Q

What is the normal value for glucose in CSF?

A

60-70% of the plasma glucose

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79
Q

When should CSF glucose be tested?

A

Should be compared to a serum glucose within 2 hours of the tap

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80
Q

What is elevated glucose in CSF related to?

A

A high serum glucose

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81
Q

Describe what decreased glucose in CSF is

A
  • Significant
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82
Q

↓ glucose +↑ WBC (neutrophils) =?

A

Bacterial meningitis

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83
Q

↓glucose + ↑ WBC (lymphocytes)=?

A

Tubercular meningitis

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84
Q

Normal glucose + WBC (lymphocytes)=?

A

Viral meningitis

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85
Q

What are the normal values for lactate in CSF:

A

10 - 24 mg/dl

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86
Q

What is the significance of increased concentration of lactate in CSF?

A

> 25 mg/dl → bacterial meningitis
-test used to monitor bad head injury

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87
Q

What is the significance of increased glucose in CSF?

A

None

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88
Q

What is the significance of decreased levels of lactate and glutamine in the CSF?

A

None

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89
Q

What is the significance of increased glutamine in CSF?

A

> 35 mg/dl → some disturbance of consciousness

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90
Q

What is the normal value of glutamine in CSF?

A

8-18 mg/dl

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91
Q

How does glucose “move”?

A

Selectively transported

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92
Q

What is elevated in liver disease?

A

Glutamine

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93
Q

What produces glutamine in CSF?

A

-Ammonia
- alpha- ketoglutarate

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94
Q

Describe the microbiology test of CSF

A
  • Aide in analyzing the CSF for organisms
  • can take 24 hours to 6 weeks depending on organisms
    -CSF culture confirms results.
  • preliminary test
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95
Q

Describe manual methods of microbiology test of CSF

A
  • Grams stain
  • acid fast stain
    -India ink → cryptococcal neoform (yeast)
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96
Q

Describe automated microbiology tests of CSF

A
  • Latex testing (on the way out)
  • molecular testing → (nucleic acid amplification) PCR
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97
Q

Describe latex agglutination test/ lateral flow assay of CSF

A
  • replaced India ink
  • antigen panel-
    → strep B, H. Flu, strep phuemonia, N. Meningitis A, B, C, Y & W135, E. Coli K1
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98
Q

Describe naegleria Fowleri

A
  • Parasite in water source
    -enters through the nose and migrates to the brain
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99
Q

What serology test for syphilis I

A

VDRL

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100
Q

Describe gram stain (in CSF)

A
  • Performed routinely when suspected meningitis
  • detects bacterial and fungal organisms
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101
Q

What speed and time is CSF centrifuged?

A

1500 g for 15 minutes

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102
Q

What could cause a false negative in a gram stain?

A

Hardest stain slide to read, causing errors in diagnosing

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103
Q

What could cause a false positive in gram stains?

A

If precipitated stain or debris is mistaken for micro-organisms

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104
Q

What test is performed it someone is suspected of having meningitis tubercular

A

Acid fast or fluorescents antibody stains

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105
Q

What is the most common reason for false positives in immunologic assays (of CSF)?

A

Rheumatoid factor

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106
Q

Describe lateral flow assay (IFA) of CSF testing

A
  • Rapid
  • detects cryptococcal neoforms
  • high sensitivity and specificity
    -utilizes a reagent strip coated with monoclonal antibodies that react with the cryptococcal polysaccharide capsule
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107
Q

Where is CSF is produced mainly in?

A

Choroid plexuses

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108
Q

What is the primary purpose for performing CSF protein electrophoresis?

A

To detect oligoclonal bands-represents inflammation within the CNS

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109
Q

Describe oligoclonal bands

A

-Located in gamma region of the protein electrophoresis
-indicates immunoglobulin production

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110
Q

What is done to ensure the oligoclonal bands are present as a results of neurological inflammation?

A

Simultaneously serum electrophoresis must be performed

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111
Q

What disorders may produce banding in serum of electrophoresis of CSF

A

-leukemia
-lymphoma
-viral infection

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112
Q

What is a valuable tool for diagnosing multiple sclerosis?

A

2 or more oligoclonal bands in CSF that are not present in serum, particularly accompanied by increased IgG index

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113
Q

What are neurological disorders that have banding in CSF but not the Serum

A

-Multiple Sclerosis
-encephalitis
-neurosyphilis
-Guillian-Barre syndrome
-neoplastic disorders

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114
Q

What happens to oligoclonal banding when Multiple sclerosis is in remission

A

Remains but may disappear with other disorders

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115
Q

What is the confirmatory test for diagnosing Meningitis?

A

CSF culture

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116
Q

What does CSF flow through?

A

Subarachoidnoid space

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117
Q

What are the substances in CSF controlled by?

A

Blood brain barrier

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118
Q

What department is the CSF tube labeled 3 routinely sent to?

A

Hematology

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119
Q

What CSF tube should be kept at room temperature?

A

Tube 2

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120
Q

What are characteristics for a traumatic tap?

A

-even distribution of blood in all tubes
-xanthochromic supernatant

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121
Q

What are characteristics of intercranial hemorrhage?

A

-concentration of blood in tube 1 is greater than in tube 3
-specimen contains clots

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122
Q

What causes xanthrochtomia

A

-immature liver function
-RBC degradation
-elevated CSF

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123
Q

What does a web like pellicle in refrigerated CSF specimen indicate?

A

Tubercular meningitis

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124
Q

What is the CSF WBC count diluted with?

A

Acetic acid

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125
Q

A total CSF cell count on a clear fluid should be what?

A

Count undiluted

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126
Q

What is the purpose of adding albumin to CSF before cytocentrafugation?

A

-increase the cell yield
-decrease cellular distortion

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127
Q

What is the primary concern when pleocytosis of neutrophils and lymphocytes is present in the CSF fluid

A

Meningitis

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128
Q

Neutrophils with pyknotic nuclei may be mistaken for what?

A

Nucleated RBC

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129
Q

The presence of what is increased in a parasitic infection ?

A

Eosinophils

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130
Q

When do macrophages appear in the CSF?

A
  • After hemorrhage
    -after repeated spinal taps
  • after diagnostic procedures
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131
Q

When are nucleated RBCs seen in CSF?

A

Bone marrow contamination

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132
Q

What could be seen after a CNS diagnostic procedure?

A
  • Chorodial calls
    -ependymal cells
  • spindle. Shaped cells
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133
Q

What are hemosiderin granules and hematoidin crystals are seen in?

A

Macrophages

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134
Q

What are myeloblasts in the CSF considered?

A

As a complication of acute leukemia

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135
Q

What are cells that resemble large and small lymphocytes with cleaved nuclei?

A

Lymphoma cells

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136
Q

How can CSF be differentiated from serum?

A

-tau transferrinz

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137
Q

How is the integrity of the blood brain barrier is measured using what?

A

CSF/semm albumin index

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138
Q

What condition is suggested by the following results:CSF glucose of 15 mg/dl, WBC count of 5000, 90% neutrophils and protein of 80 mg/dl?

A

Tubercular meningitis

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139
Q

If a patient had a normal glucose of 120 mg/dl, what would a normal CSF glucose be?

A

80 mg/dl

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140
Q

What will CSF lactate be more consistently decreased in?

A

Viral meningitis

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141
Q

Measurement of what can be replaced by CSF glutamine analysis in children with reye syndrome?

A
  • Ammonia
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142
Q

What is the most sensitive and specific method to detect the causative organism in meningitis?

A

PCR assay

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143
Q

What is the test of choice to detect neurosyphilies?

A

-RPR

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144
Q

What are the 4 components of semen?

A

①testes and epididymis
②seminal vessels
③prostate
④bulbourethral gland
-normal semen specimen must have all types

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145
Q

Describe testes and epididymis pertaining to semen

A
  • Spermatozoa produce in seminferous tubules and mature in epididymis
  • 5% of semen volume
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146
Q

Describe seminal vesicles

A

-majority of fluid of semen, 60%
- contain fructose - causes sperm motility

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147
Q

Describe prostate characteristics

A

-acidic fluid (acid phosphates, citric acid)
-20 -3090 of volume of semen
- responsible of coagulation and liquefaction

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148
Q

Describe bulbourethral glands

A
  • 5% of volume of semen
    -alkaline fluid
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149
Q

What are reasons for testing sperm

A

① fertility
② post vasectomy monitoring

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150
Q

What occurs when first portion of ejaculate is missing?

A
  • Sperm count will be decreased
  • sperm count pH is falsely increased
    -specimen will not liquefy
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151
Q

What occurs when the last portion of ejaculate is missing?

A
  • Semen volume is decreased
  • sperm count is falsely increased
    -pH is falsely decreased
  • specimen will not clot
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152
Q

What are requirements for sperm collection?

A

-abstinence for atleast 2 days but not more than 7 days
-WHO → 3 specimens between 7 days and 3 weeks
- give clear instructions should be given
- delivery within 1 hour of collection at room temperature
- positive indication
- collection should not have any nonspermicidal, condoms or lubrication

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153
Q

Explain appearance in macroscopic semen analysis

A
  • test within 1 hour of collection
  • appearance
    → normal is gray-white, translucent
    → white is ↑ WBC
    →red is RBC
    →yellow is urine (toxic to sperm)
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154
Q

Explain liquefaction in macroscopic semen analysis

A
  • Fresh → clotted
  • liquefy in 30 to 60 minutes
  • if clotting continues after 60 minutes, there is decreased prostatic enzymes
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155
Q

What is the normal volume of semen?

A
  • 2-5 ml
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156
Q

How is the viscosity reported when testing sperm?

A

-0 → watery
-4 → gel like

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157
Q

What is the pH of semen?

A

-7.2 - 8.0
-increased → infection
- decreased → obstruction

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158
Q

What factors can affect the sperm?

A
  • Quantity (normal →20 - 250 M/mL, border line→ 10-20 M/mL)
  • morphology of the head and tail
  • speed- motility
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159
Q

Explain counting on neubauer chamber

A
  • 1-20 dilution
    -dilution fluid → bicarbonate and formalin
  • countin 4 corners plus the center
  • side must match within 10%
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160
Q

What are the microscopic automated instruments for sperm?

A
  • Sperm class analyzer
    -CEROS CASA system
    -automated sperm quality analyzer
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161
Q

Explain motility of sperm

A

-sperm with forward, progressive movements
-evaluate undiluted on glass slide with Cover slip
-estimate percentage with progressive forward motion in 20 HP fields or 200 sperm per slide and count percentages of different categories
- 4 indicating rapid, straight line movement
-0 indicating no movement
-normal → minimum motility with a rating of 2,0 after 1 hour is considered normal

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162
Q

Describe sperm viability test

A

-Mix with eosin-nigrosine stain
- stain dead sperm
- count number of dead per 100 sperm

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163
Q

Explain seminal fluidfructuse test

A
  • Energy for sperm
    -normal→ equal or greater than 13 umole/ejaculate
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164
Q

Explain anti-sperm antibodies test

A
  • Antibodies can be produced by male and female
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165
Q

Explain post-vasectomy semen analysis

A
  • Monthly testing beginning at 2 months
  • continues until no viable sperm are seen on a wet preparation
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166
Q

Explain microbial testing of semen

A
  • Detects…
  • Chlamydia
  • mycoplasma
    -ureaplasma
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167
Q

What does chemical testing determine levels of (in sperm)?

A
  • Alpha- glucosidase
    -free L-carnitine
  • glycerophophocholine
    -zinc
    -citric and
    -Glutamyl transpeptidase
  • prostatic acid phosphates
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168
Q

Where does the maturation of spermatozoa take place?

A

Epididymis

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169
Q

What are the enzymes for coagulation and liquefaction of semen produced by?

A

Prostate gland

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170
Q

What is the major component of seminal fluid?

A

Fructose

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171
Q

Failure of laboratory personnel to document the time a semen specimen is collected primarily affects the interpretation of what?

A

Viscosity

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172
Q

A semen specimen delivered to laboratory in a condom has a normal sperm count and markedly decreased sperm motility. What does this indicate?

A

-Antispermacide in the condom

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173
Q

What could an increased semen pH be caused by?

A

Prostatic infection

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174
Q

Why would proteolytic enzymes be added to semen specimens?

A

Decrease viscosity

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175
Q

What is the normal sperm Concentration?

A

More than 20 million/mL

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176
Q

What is the primary reason to dilute a semen speciemen before performing a sperm count?

A

Immobilize sperm

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177
Q

What is the purpose of the acromsomal cap?

A

To penetrate the ovum

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178
Q

What part of the sperm contains a mitochondrial sheath?

A

Midpiece

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179
Q

What part of the sperm does not assist in motility?

A

Head

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180
Q

What is the normal sperm morphology when using the WHO criteria?

A

> 30% normal forms

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181
Q

What round cells are need for concern and may be included in sperm counts and morphology analysis?

A
  • Leukocytes
  • spermatids
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182
Q

After an abnormal sperm motility test with a normal sperm count, what additional test might be ordered?

A

Eosino-nigrosin stain

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183
Q

What is the follow up testing for a low sperm concentration?

A
  • Seminal fluid fructose
184
Q

Describe the immunobead test for antisperm antibodies

A
  • Detects presence of male antibodies
  • determines presence of IgG, IgM, and IgA antibodies
    -determines location of antisperm antibodies
185
Q

What disorder is detected by measurement of alpha-glucosidase?

A

Disorder of the epididymis

186
Q

Describe synovial fluid

A
  • Joint fluid of movable joint
  • knee, elbow, hip, and shoulder
  • ultrafiltrate of plasma(non selective filtration)
  • smooth articulate cartilage and cavity with fluid
187
Q

What is the normal volume of synovial fluid?

A

<3.5 mL

188
Q

Describe appearance of synovial fluid

A
  • Colorless to pale yellow
  • clear
    -viscosity → high, able to form string
189
Q

What is a normal leukocytes count in synovial fluid?

A

< 200 cells/micro-L

190
Q

What is a normal neutrophil concentration in synovial fluid?

A

< 25% of the differential

191
Q

What is normal glucose:plasma difference in synonial fluid?

A

< 10 mg/dL lower than the blood glucose level

192
Q

Describe normal total protein of synovial fluid

A

<3 g/dL

193
Q

What is the normal lactate in synovial fluid?

A

< 25.0 mg/dL

194
Q

Describe the 2 types of synoviocytes in the membrane lining

A

-type A→ macrophages-phagocytosis ( similar to monocytes)
-type B→ fibroblasts- produce hyaleronic acid, fibronectin, and collagen

195
Q

What are the functions of synovial fluid?

A

①reduce friction
②lubricate the joint
③nutrients to cartilage
④reduces shock during injury/activities

196
Q

What is arthritis?

A

Damage to membrane creates pain and stiffness

197
Q

What are the 4 classification of arthritis?

A

①noninflammatory
②inflammatory
③ septic
④ hemorrhagic

198
Q

What health concerns are associated with the noninflammatory category of arthritis?

A

Degenerative, osteoarthistis

199
Q

What health concerns are associated with the inflammatory category of arthritis?

A
  • Immunologic
  • lupus erythematosus (LE)
  • rheumatoid arthritis (RA)
    -Lyme disease crystal induced
  • gout
    -pseudogout
200
Q

What health concerns are associated with the septic category of arthritis?

A

Microbial infection

201
Q

What health concerns are associated with the hemorrhage category of arthritis?

A

-trauma
-tumors
- coagulation deficiencies

202
Q

Describe appearance of synovial fluid in the non inflammatory category

A

-clear yellow fluid
-good viscosity

203
Q

Describe the WBCs count, neutrophil concentration and glucose of synovial fluid in the noninflammatory category?

A

WBCs = < 1000 microliters
Neutrophils <30%
Similar to blood glucose

204
Q

Describe the appearance of synovial fluid in the inflammatory category

A

Immunologic origin
-cloudy yellow
-poor viscosity

Crystal induced origin
-cloudy or milky
-low viscosity

205
Q

Describe WBC count, neutrophils and glucose in synovial fluid of the inflammatory cAtegory

A

Immunologic origin
-WBCs 2,000-75,000 microliters
-neutrophils >50%
-decreased blood glucose
-possibly autoantibodies present

Crystal induced origin
-WBCs up to 100,000 microliters
-neutrophils <70%
-decreased glucose levels
-crystals present

206
Q

What is the appearance of synovial fluid in the septic category

A

-Cloudy yellow-green fluid
-variable viscosity

207
Q

Describe the WBCs count, neutrophil concentration and glucose found in synovial fluid that is in the septic category

A

-WBCs = 50,000-100,000 microliter
-Neutrophils > 75%
-Decreased glucose level
-positive culture and gran stain

208
Q

Describe the appearance of synovial fluid in the hemorrhagic category

A

-Cloudy, red fluid
-low viscosity

209
Q

Describe the WBC count, neutrophil concentration and glucose in synovial fluid in the hemorrhagic category

A

-WBC equal to blood
-neutrophils equal to blood
-normal glucose

210
Q

What type of tube would be used to collect synovial fluid when a gram stain and culture is being performed?

A

Sterile sodium heparin or sodium polyanehtol sulfonate

211
Q

What type of tube would be used to collect synovial fluid when a cell count is being performed?

A

Sodium heparin or liquid ethylenediametetraacetic acid (EDTA)

212
Q

What type of tube would be used to collect synovial fluid when glucose analysis is being performed?

A

Sodium fluoride or no anticoagulanted

213
Q

What type of tube would be used to collect synovial fluid when all other tests are being performed?

A

Nonanticoagulanted

214
Q

What cell count is performed most frequently on synovial fluid?

A

Total leukocyte count

215
Q

Describe manual cell counts for synovial fluid?

A
  • Specimen thoroughly mixed
    -use neubauer counting chamber
    -clear fluids can be counted undiluted
    -turbid and bloody need to be diluted
216
Q

What should differential counts should be performed on (synovial fluid)?

A

Centrifuged preparations or thinly smeared slides.

217
Q

What are the primary cells seen in normal synovial fluid?

A

-monocytes
-macrophages
- synovial tissue cells
-<25% neutrophils
-< 15% lymphocytes

218
Q

What does elevated neutrophils indicate?

A

Septic condition

219
Q

What does an elevated cell count w/ a predominance of lymphocytes indicate?

A

Nonspecific inflammation

220
Q

What are abnormal cells in synovial fluid?

A

-eosinophils
- LE
- Reiter cells
- RA cells (ragocytes)

221
Q

When is lipid droplets present in synovial fluid?

A

Crush injuries

222
Q

When are hemosiderin granules seen in synovial fluid?

A
  • seen in cases of pigmented villonodular synovitis
223
Q

What is the most frequently ordered chemistry test for synonal fluid?

A

Glucose determination because markedly ↓ glucose indicates inflammatory or septic disorders

224
Q

What is synovial fluid an ultrafiltrate of?

A

Plasma

225
Q

What are the types of chemistry tests for synovial fluid?

A
  • Glucose
  • total protein
  • lactate
    -uric acid
  • enzymes
226
Q

What disorder has elevated uric acid levels?

A

Gout

227
Q

What does elevated lactate levels in synovial fluid indicate?

A

Septic arthritis caused by gram-positive cocci and gram-negative bacilli

228
Q

Why are enzymes tested in synovial fluid?

A

Monitor severity and prognosis of RA

229
Q

What are the 2 most important tests performed on synovial fluid? And why?

A
  • Cultures
  • gram stains
  • infection may occur as secondary complication of inflammation caused by trauma or through dissemination of systemic infection
  • both must be performed
230
Q

What are the most common organisms that infect the synovial fluid?

A

-staphylococcus
-streptococcus
-haemophilus species
-N. Gonorrhoere

231
Q

What is the molecular method for detection of microorganisms of synovial fluid?

A

PCR

232
Q

Why are serological tests for synovial fluid important?

A
  • Because of immune systems association with inflammation process
  • important in diagnosing joint disorders
233
Q

How is synovial fluid collected?

A

Need aspiration → arthrocentesis

234
Q

What is the normal volume of synovial fluid in a knee joint? Volume in an inflamed thee?

A

-normal → < 3.5 mL
-inflamed→ up to 25 mL

235
Q

Describe General tube collection for synovial fluid

A

-EDTA→ hematology
-green (heparin) → crystal exam, chemistry test
-SPS (yellow)for culture in microbiology or a still tube

236
Q

What is added to synovial fluid to reduce viscosity when conducting a cell count?

A
  • hyaluronidase
237
Q

What should be the dilution solution for a cell count on synovial fluid?

A

Saline

238
Q

What should not be used to dilute synovial fluid? Why?

A

-Water or acetic acid
- can cause mucin clot formation and cell clumping

239
Q

What are the guidelines for a cell count test?

A
  • <200 nucleated cells → count all 9
  • > 200 → count 4 corners
  • > 400 - count 5 center boxes
  • normal WBC =< 200 cells/microliter
240
Q

What are the causes of crystal formation?

A

-metabolic disorders
-decreased renal excretion

241
Q

What are primary crystals of synovial fluid?

A
  • Monosodium urate (MSU)
  • calcium pyrophosphate dihydrate CPPD
242
Q

Describe monosodium urate (MSU)

A
  • AKA uric acid
  • gout
243
Q

What are the causes of gout?

A

-↑Uric acid from impaired metabolism of purines
-↑ consumption of high-purine foods, alcohol, and fructose
- chemotherapy
- decrease of renal excretion of uric acid

244
Q

Describe pyrophosphate dihydrate CPPD

A

-indicates pseudogout
- associated w/ degenerative arthritis, disorders causing elevated calcium levels

245
Q

What are other crystals that are not considered primary in synovial fluid?

A

-Hydroxyapatite
- cholesterol
- corticosteroids
- calcium oxalate
- apatite (calcium phosphate)

246
Q

Describe hydroxyapatite in synovial fluid

A

Cartilage degeneration, only seen with election microscopy

247
Q

Describe cholesterol in synovial fluid

A
  • Systemic autoimmune diseases (LE, RA) appear similar to urine cholesterol arsenals
    -notched corners
248
Q

Describe corticoidsteroids in synovial fluid

A

-injections
- flat, variable plates

249
Q

Describe calcium oxalate in synovial fluid

A

Seen in Renal analysis patients

250
Q

Describe apatite in synovial slid

A

-AKA calcium phosphate
- small particles
- requires election microscope
-indicates osteoarthritis

251
Q

What is the primary function of synoviocytes?

A

Provide nutrients for the joints

252
Q

What test in not frequently done on synovial fluid?

A

Uric acid

253
Q

What is the procedure name for collection of synovial fluid?

A

Arthrocentesis

254
Q

Before testing, what should very viscous synovial fluid be treated with?

A

Hyalurónidase

255
Q

What color would synovial fluid be with a bacterial infection?

A

Green tinged

256
Q

Which would be affected most if synovial fluid
was refrigerated before testing?

A

Crystal examination

257
Q

What category of arthritis has the highest WBC count?

A

Septic arthritis

258
Q

What category of arthritis has the lowest percentage of neutrophils?

A

Noninflammatory arthritis

259
Q

How should synovial fluid crystal examination should be examined?

A

Wet preparation

260
Q

It crystals shaped like needles are aligned perpendicular to the slow vibration of compensated polarized light, what color are they?

A

Blue

261
Q

What is always need for a culture of synovial grid?

A

Chocolate agar
(to detect neisseira gonorrhoeae)

262
Q

Describe serous membranes cavity

A
  • Closed cavity
    → pleural-thoracic area-lung
    → pericardial - heart
    → peritoneal - peritoneal cavity liver, stomach intestine bladder, and ovaries
263
Q

Describe the 2 membranes of the serous membrane

A
  • Parietal membrane → line the cavity
    -visceral membrane →membrane around the organs
264
Q

What is serous fluid?

A
  • fluid in between the membranes
  • lubricate - prevent friction
    -small amounts are present - production = reabsorption are constant rate
265
Q

What is serous fluid an ultrafiltrate of?

A

Plasma

266
Q

Describe hydrostatic pressure in reference to serous fluid

A
  • Parietal and visceral capillaries enter through the membrane
    -↑ oncotic pressure allowing fluid back into the capillaries
267
Q

Describe oncotic pressure

A

-AKA colloidal pressure
- normal conditions serum protein are the same in the capillaries

268
Q

What is effusion?

A

Build up or accumulation of serous fluid

269
Q

What are causes of effusion?

A

-increased capillary hydrostatic pressure
- decreased oncotic pressure
- increased capillary permeability
- lymphatic obstruction

270
Q

What are examples of increased capillary hydrostatic pressure?

A
  • Congestive heart failure
  • salt and fluid retention
271
Q

What are examples of decreased oncotic pressure?

A
  • Nephrotic syndrome
  • hepatic cirrhosis
    -malnutrition
    -protein-losing enteropathy
272
Q

What are examples of increased capillary permanently?

A
  • Microbial infections
  • membrane inflammation
    -malignancy
273
Q

What are examples of lymphatic obstruction?

A

-malignant tumor, lymphomas
- infection and inflammation
-thoracic duct injury

274
Q

What are 2 forms of effusion?

A
  • Translate
    -exudate
275
Q

Describe transudate effusion

A

Systemic disorder disrupting the balance of fluid filtration and reabsorption
→ change in hydrostatic pressure

276
Q

Describe exudate effusion

A

-Conditions that involve the membranes,
-infections and malignancies

277
Q

What tests are performed to differentiate between effusion fluid?

A

-total protein
- lactic dehydrogenase (LDH)
- cell count
- differentiate from blood ratio for total protea
And LDH

278
Q

What is the appearance of translate and exudate?

A

Transudate → clear, pale yellow
Exudate → cloudy, color varies

279
Q

What is the WBC count for transudate and exudate?

A

Transudate → <1000 microliters (pleural, pericardial)
→ <500 microliters (peritoneal)
Exudate→ >1000 microliter

280
Q

Does transudate and exudate spontaneously clot?

A

Transudate→ no
Exudate → possible

281
Q

What is the fluid total protein of transudate and exudate?

A

Transudate→ 30g/L or less
Exudate → >30 g/L

282
Q

What is the fluid:semi total protein ratio of Transudate and exudate?

A

Transudate → <0.5
Exudates→ >0.5

283
Q

What is the fluid: serum LD ratio of Transudate and exudate?

A

Transudate→ <0.6
Exudate → >0.6

284
Q

What is the fluid LD of Transudate and exudate?

A

Transudate→<0.67 x ULN serum
Exudate→ > 0.67 x ULN serum

285
Q

What is the pleural fluid cholesterol of Transudate and exudate?

A

Transudate→ < 45-60 mg/dL
Exudates→ > 45-60 mg/dL

286
Q

What is the pleural fluid: serum cholesterol ratio of Transudate and exudate?

A

Transudate → <0.3
Exudate→ >0.3

287
Q

What is the pleural fluid: bilirubin ratio of Transudate and exudate?

A

Transudate→ <0.6
Exudate→ >0.6

288
Q

What is the serum-ascites albumin gradient of Transudate and exudate?

A

Transudate→ >1.1
Exudate → <1.1

289
Q

What is the glucose of Transudate and exudate?

A

Transudate→ equal to serum
Exudate → less than or equal to serum

290
Q

What is the specific gravity of Transudate and exudate?

A

Transudate → <1.015
Exudate → >1.015

291
Q

What is the procedure called when collecting pleural fluid?

A

Thoracentesis

292
Q

What is the procedure called when collecting pericardial and peritoneal fluid?

A

Paracentesis

293
Q

Cell count for serous fluid is collected in what tube?

A

EDTA

294
Q

What is the normal appearance of pleural fluid?

A

-pale yellow/clear

295
Q

What are abnormal appearances of pleural fluid?

A

-turbid→ WBCs - inflammation infection
-blood → hemothorax -traumatic injury, malignancy
-milky → chylous material

296
Q

How is hemothorax and hemorrhage determined?

A
  • Run a hematocrit
  • > 50%- due to injury.
    -a membrane disease would have a low hemato at
297
Q

Describe chemistry test of pleural fluid

A
  • Cholesterol serum to pleural
    → >60 mg/dL
    → serum/pleural ratio >0.3

-bilirubin serum to pleural
→serum/ pleural ratio > 0.6

  • glucose
    → helpful in RA
298
Q

Describe hematology test of serous fluid

A
  • Primary cells
    → macrophages
    → neutrophils
    → lymphocytes
    → eosinophil
    → mesothelial
    → plasma
    → malignant

-64 -80% macrophages
-18-30% lymphocytes
-1-2 % neutrophils

299
Q

What does ↑ neutrophils in pleura’s fluid indicate?

A

-infection
-pancreatitis
-pulmonary infarct. (b)

300
Q

What kind of monocytes are in pleural fluid

A

Macrophages and histocytes

301
Q

What does lymphocytes indicate if present in the pleural fluid?

A
  • Tuberculosis
  • viral infection
  • malignancy
  • autoimmune disease
302
Q

What does the presence of eosinophils in the pleural fluid indicate?

A
  • > 10% trauma to pleural cavity
  • allergic reactions
    -parasites
303
Q

What does the presents of lining cells in pleural third mean?

A
  • Mesothelial
    -reactive → clusters, varying amounts of cytoplasm
    -eccentric nuclei and multinucleated
    -may look like malignant cells
304
Q

What are the most common chemistry tests for pleural fluid

A

-glucose
- pH
-total protein
-Adenosine deaminase
-Triglycerides
-amylase

305
Q

What does↓ glucose indicate in pleural fluid?

A

-tuberculosis
- rheumatoid inflammation
- malignant effusion
-esophageal rupture

306
Q

What does abnormal pH for pleural fluid?

A
  • <7.3 → need of chest tube = pneumonia
  • <6.0 → esophageal rupture
307
Q

What are abnormal adenosine deaminase (ADA) levels and what does this indicate?

A
  • > 40 U/L
    -tuberculosis
    -malignancy
308
Q

What does abnormal levels of amylase indicate In pleural fluid?

A
  • Pancreatitis
  • esophageal rapture
309
Q

What organisms are the primary cause of pleural effusion infection?

A

_Staphylococcus aureus
- enterobacterales
- anaerobics
- M. Tuberculosis

310
Q

What are microbiology tests performed on pleural fluid?

A
  • Culture with gram stain
    -AFB culture with stain
  • new→ PCR
311
Q

What are serological tests of pleural fluid?

A

-CEA → carcinoembryonic antigen
-CA-125→ metastatic uterine cancer
-breast cancer markers
→ CA-15.3
→CA-549
- lung. Cancer
→CYFRA 21-1

312
Q

What is pericardial fluid a result of?

A
  • Change in membrane due to infection (pericarditis), malignancy, and trauma
313
Q

What does translate in pericardial cause?

A
  • Uremia
    -hypothyroidism
  • autoimmune diseases
314
Q

What is the normal appearance of pericardial fluid?

A

Pale yellow/clear

315
Q

What are abnormal appearances of pericardial fluid?

A

-red → puncture, anticoagulants
- milky → chylous
- WBC > 1000 = bacterial endocarditis

316
Q

What lab tests are performed on pericardial fluid?

A
  • Cell counts
  • chemistry → lactic dehydrogenase ,(LD)
  • markers levels for tumor
  • cultures → routine bacterial, fungal, acid fast bacteria
317
Q

What is the accumulation of fluid in peritoneal membrane?

A

Ascites

318
Q

What causes build up of peritoneal fluid?

A

-hepatic disorder (cirrhosis)
-bacterial infection in intestine (peritonitis)

319
Q

What is a peritoneal lavage?

A
  • Diagnostic procedure to determineintra-abdominal bleed
    -normal saline injected into cavity und with drawn and perform cell count
320
Q

What is test is preferred over total protein and LD ratio when testing peritoneal fluid?

A

Serum- ascites albumin gradient (SAAG)

321
Q

Describe Serum- ascites albumin gradient (SAAG)

A
  • Serum and fluid albumin levels are measured ‘
  • fluid level is subtracted from serum level
  • difference > than 1.1 is a transudate (hepatic origin)

Serum albumin - fluid albumin= hepatic transudate

3.8- 1.2 = 2.6

322
Q

What is the normal appearance of peritoneal fluid?

A

Pale yellow/clear

323
Q

What are abnormal appearances of peritoneal fluid?-

A

_Tubid → bacterial infection
- green/dark brown→ bile

324
Q

Describe chemistry testing of peritoneal fluid

A
  • Glucose
    → below plasma levels = peritonitis and malignany
  • ↑ amylase → pancreatitis and gastrointestinal perforation

-↑ alkaline phosphatase: intestinal perforation

-↑BUN, creatinine→ ruptured bladder and accidental perforation

325
Q

Describe microbiology and serology testing of peritoneal

A
  • Gram stains and aerobic and anaerobic cultures
    -anaerobic cultures → inoculate blood culture bottle a bed side
  • acid fast smear
  • adenosine deaminase and culture for TB
    -tumor markers
    →CEA
    →CA 125
326
Q

Presence of CA 125 antigen with a negative CEA suggests what?

A
  • The source is from ovaries, fallopian tubes, and endometrium
327
Q

What does the presence of CEA antigen suggests?

A

Source is gastrointestinal

328
Q

What is the primary purpose of serous fluid?

A

Lubricate serous membrane

329
Q

The membrane that lines the wall of a cavity is called what?

A

Parietal

330
Q

During normal production of serous fluid, what happens to slight excess?

A

Absorbed by lymphatic system

331
Q

What is the production of serous fluid is controlled by?

A
  • Capillary oncotic pressure
  • capillary hydrostatic pressure
  • capillary permeability
332
Q

What is an Increase in the amount of serous fluid is called?

A

Effusion

333
Q

What is caused by increased hydrostatic pressure?

A

Exudate

334
Q

What is caused by increased capillary permeability?

A

Transudate

335
Q

What is caused by decreased oncotic pressure?

A

Transudate

336
Q

What is caused by congestive heart failure?

A

Transudate

337
Q

What is malignancy related in serous fluid?

A

Exudate

338
Q

What is TB related in serous fluid?

A

Exudate

339
Q

What is endocarditis related in serous fluid?

A

Exudate

340
Q

What has a clear appearance: Transudate and exudate?

A

Transudate

341
Q

Why are fluid:serum protein and lactic dehydrogenase ratios are performed in serous fluid?

A

To classify Transudate and exudate

342
Q

What requires additional testing: Transudate or exudate?

A

Exudate

343
Q

What is an additional test performed on pleural fluid to classify if a fluid is Transudate or exudate?

A

Fluid: cholesterol ratio

344
Q

What is a differential observation of pleural fluid associated with tuberculosis?

A

Decreased mesothelial cells

345
Q

What are characteristics of malignant cells?

A

-Cytoplasmic molding
-mucin-containing vacuoles
-increased nucleus: cytoplasm ratio

346
Q

Plasma cells seen in pleural fluid indicates what?

A

TB

347
Q

What is a significant cell found in pericardial or pleural fluid that should be referred to cytology?

A

Mesothelioma cells

348
Q

What is a test performed primarily on peritoneal lavage fluid?

A

RBC count

349
Q

What is the recommended test for determining whether peritoneal fluid is Transudate or exudate?

A

Serum ascites albumin gradient

350
Q

What test is performed to differentiate between bacterial peritonitis and cirrhosis?

A

Absolute neutrophil count

351
Q

Describe bronchoalveola R lavage (BAL)

A
  • method for examining cellular, immunologic and microbiological information from the lower respiratory tract
    -helpful for immunocompromised patients and patients with airway/breathing problems
352
Q

Describe BAL collection procedure

A

-bronchoscopy
-fiber optic into middle of lobe(upper or lower)
-documentation of what are examined
-sterile saline is slowly administered into scope and mixed then aspirated the contents for examination and culture

353
Q

Describe saline amount for broncoscopy?

A
  • amount instilled is 100-300 ml in 20-50 ml aliquots
354
Q

Explain samples for the broncoscopy?

A

-first sample should be discarded
-an optimum sample is >30% of recovery (50-70%)
- <25% = chronic obstructive lung disease

355
Q

Describe specimen handling of broncoscopy

A

-must be transports in within 39 minutes of collection
-should stay at room temperature
-cell count should be performed with in 1 hour of collection but stable for 3
-will look for WBC count
-can filter specimen to remove mucus, phlegm and dust

356
Q

What are the diagnostic test for broncho specimen

A
  1. Cell count
  2. Microbiology
  3. Cytopathology
357
Q

What colors can be reported for broncho specimens

A

-colorless
-milky white
-light brown beige
-gray-beige
-red

358
Q

Describe abnormal colors of broncho specimen

A

Red—> diffuse hemorrhage or difficulty in collection

Orange-red —> old hemorrhage (may want to do iron stain)

Milky-light beige —> accumulation of phospholipids-protein due to surfactants

359
Q

If a bronco wash has a creamy layer in top, what is that?

A

Lipids—> centrifuge

360
Q

Describe cell counts of broncho wash

A

-count WBC and RBC on hemocytometer
-may need dilution
-gold standard is the chamber

361
Q

What is a BMP LeukoCheck system?

A

-ammonium oxalate
-lysis RBC which allows for dilution and a clear solution to count WBC

362
Q

Explain how to count WBC using a chamber

A

Count both side all 9 squares-a total of 18

363
Q

Explain cell distribution over the hemocytometer for cell counts in a broncho wash

A

-WBC difference should not be >15 cells
-RBC differences should not be >30
-the cells should agree within 10% on each side

364
Q

What should be notated if there is clumping?

A

Cell count may be inaccurate due to clumps of cells

365
Q

What are the cell that are present in BAL?

A

-macrophages
-lymphocytes (CD4/CD8 ratio)
-neutrophils
-eosinophils
-ciliated columnar bronchial epithelial cells
-squamous, epithelial cells

366
Q

Describe the macrophages found in BAL

A

-phagocytize (hemosiderin)
-normal range 56-80%

367
Q

Describe lymphocytes found in BAL

A

-normal range —> 1-5%
- increased in lung disease, drug reactions, pulmonary lymphoma, and non bacterial infection
- >25% lymphocytes-granulomatous lung disease
- >50% lymphocytes - hypersensitivity pneomonitis

368
Q

Describe neutrophils present in BAL

A

-Primary cell seen
-normal is <3%
-elevated in smokers, toxin exposure, bronchopneumonia and diffuse alveolar damage
- >50% acute lung injury, aspiration pneumonia or infection

369
Q

Describe eosinophils present in BAL

A

-usually <1-2% of total cells
-seen in asthma, drug induced lung, infection (parasite, mycobacteria or fungal)
- >25% -eosinophilic lung disease

370
Q

Describe erythrocytes present in BAL

A

-Indicates acute alveolar hemorrhage or from procedure
-phagocytized RBC - suggest a alveolar hemorrhage in last 48 hours
Hemosiderin macrophages indicate older than 48 hours

371
Q

Describe epithelial cells present in BAL

A

-Ciliated columnar cells are prominent
-normal range —> 4-17%

372
Q

What conditions are present with a low CD4/CD8 ratio?

A

-hypersensitivity pneumonia
-silicosis
-drug-induced disease
-HIV infection

373
Q

What are conditions of normal CD4/CD8 ratio?

A

-TB
-malignancies

374
Q

What are conditions that have a high CD4/CD8?

A

-sarcoidosis
-connective tissue disorder

375
Q

What is a quick test that can identify pathogens of a BAL?

A

PCR

376
Q

Explain what is being looked for in cytology of a BAL

A

-sulfur granules (actinomyces)
-hemosiderin-laden macrophages
-langerhans cells
-cytomegalic cells
-fat droplets (red O)
-periodic -acid Schiff (PAS) for fungus
-dust particles in pneumoconiosis or asbestos exposure

377
Q

What stain is used in cytology for the diagnosis of lipid-laden alveolar macrophages?

A

-Sudan III stain

378
Q

Describe amniotic fluid

A
  • cytogenetic
    -is the product of fetal metabolism-waste
    -tells about the metabolism process and fetal maturation
  • in on the amnion or the amniotic sac
379
Q

What are the functions of amniotic fluid?

A

-exchange of water and chemical between the fetus and the maternal circulation
-cushions for the fetus
-fetal movement
-regulates temperature around fetus
-permits proper lung development

380
Q

Explain the volume of amniotic fluid

A

-regulates balance between production of fetal urine, lung fluid, absorption of fetal swallowing and intramembranous flow
-fluid increases through the fetus development
- 12 weeks = 60 ml
- 3rd trimester = 800-1200 ml —> secretes lung liquid in lung growth

381
Q

What is indicated with >1200 ml of amniotic fluid?

A

Polyhydramnios

382
Q

What is indicated when Amniotic fluid is < 800 ml?

A

Oligohydramnios

383
Q

Describe polyhydramnios

A

-failure to swallow will results in increase fluid (fetal distress)
-secondary —> fetal anomalies, cardiac issues, congenital infection or chromosome abnormalities

384
Q

Describe oligohydramnios

A

-increased fetal swallowing, urinary tract deformities, membrane leakage
-associated with congenital malformations, premature rapture of amniotic membrane and umbilical cord compression

385
Q

Explain amniotic fluid composition

A

-placenta is the source
- made of water and solutes
-composition is of maternal plasma + small amounts of slough fetal cells

386
Q

What is the biochemical composition of amniotic fluid?

A

-bilirubin
-lipids
-enzymes
- electrolytes
- urea
-creatinine
-uric acid
-proteins and hormones

387
Q

What are the abnormal proteins in amniotic fluid due to Neural tube defect ?

A

-alpha-fetoprotein
-acetylcholinesterase

388
Q

How does creatinine help in amniotic fluid?

A
  • determine fetal age
    —> before 36 weeks = 1.5-2.0 mg/dL
    —> over 36 = >2.0 mg/dL
389
Q

What should be done to determine premature membrane rupture or accidental puncture of maternal bladder from amniocentesis?

A

-measure creatinine and urea will be lower in amniotic fluid than urine
-creatinine and urea will be lower in amniotic fluid than urine
- amniotic fluid has <3.5 mg/dL creatinine and < 30 mg/dL urea
- urine could have up to 10 mg/dL for creatinine and 300 mg/dL for urea

390
Q

Describe fern test

A

-Amniotic fluid specimen air dries on glass slide
-examine microscopically for fern like amniotic fluid crystals

391
Q

Describe bilirubin scan in amniotic fluid

A
  • delta A450>0.025
    -hemolytic disease of the fetus and newborn
392
Q

Describe Lecithin-sphingomyelin ratio of amniotic fluid

A
  • > /=2.0
  • fetal lung maturity
393
Q

Describe foam stability index of amniotic fluid

A

> /= 47
- fetal lung maturity

394
Q

When should a amniocentesis be performed?

A

-if serum AFP is abnormal or positive
-after observation of ultrasound, fetal body measurements may not agree with gestational age
-genetics

395
Q

What are tests performed for genetics of amniotic fluid?

A

-karyotyping
-fluorescence in situ hybridization (FISH)
-fluorescent mapping special karyotyping (SKY)
-DNA testing

396
Q

Describe collection of amniotic fluid

A

-transabdominal
-amniocentesis
-maximum of 30 mL collected in sterile syringes
-discard first 2-3 mL for contamination

397
Q

Describe handling and processing of amniotic fluid

A

-perform immediately
-may need ice or be refrigerated
-always protect specimen from light due to possible bilirubin

398
Q

What is the normal appearance of amniotic fluid?

A

Colorless with slight to moderate turbidity due to cells

399
Q

What are abnormal appearances of amniotic fluid

A

Blood streaked —> traumatic tap, abdominal trauma, intra-amniotic hemorrhage

Bilirubin: bright yellow

Meconium (first bowel movement)—> dark green

Fetal death —> dark red brown

400
Q

Development of what has decreased HDFN?

A

Anti-Rh

401
Q

Explain fetal distress hemolytic disease of the fetus (newborn) (HDFN)

A

-Fetal cells with antigen enter maternal circulation and cause production of maternal antibodies
-maternal antibodies cross the placenta and destroy fetal cells with the corresponding antigen

402
Q

Explain steps of antibodies crossing the placenta

A
  1. Exposed in 1st pregnancy
  2. Mother makes antibodies
  3. 2nd pregnancy the antibodies cross the placenta and bind to fetal RBC = result destroys the cells
  4. Cause unconjugated bilirubin in amniotic fluid
  5. Bilirubin is measurable using a spectrophotometer
403
Q

What does the amount of unconjugated bilirubin present correlate with?

A

Amount of RBC destruction

404
Q

Describe tests for fetal distress

A

-spectrophotometric analysis of fluid optical density (OD) measured in intervals between 365 and 550 nm is plotted on graph paper
-bilirubin causes OD rise at max absorbance level of 450
-difference is plotted on an Liley graph. Queenan curve

405
Q

What is DeltaA450

A

Difference between baseline and 450 nm peak of bilirubin

406
Q

What test is performed to differentiate between fetal and maternal blood?

A

Kleihauer-Berle

407
Q

Describe Liley graph

A

-plots DeltaA450 against gestational age
-consists of 3 zones based on severity

408
Q

Describe zone I of the Liley graph

A

Mildly affected fetus

409
Q

Describe zone II of the Liley graph

A

Requires careful monitoring

410
Q

Describe zone III of the Liley graph.

A

Severity affected fetus, may require induction of labor or intrauterine exchange transfusion

411
Q

What is the most common birth defect

A

Neural tube defect

412
Q

What are tests that are done for neural tube defect?

A

-maternal serum alpha- fetoprotien (MSAFP)
-ultrasound
-amniocentesis

413
Q

What does elevated AFP in maternal serum and amniotic fluid indicate what?

A

Possible anencephaly or spina bifida

414
Q

When are Increaesed levels of AFP found?

A

When skin fails to close over neural tissue

415
Q

Explain what MoM for Neural tube defect testing?

A
  • multiple of medians
    -median is laboratory reference level for a given week of gestation
    -more than two times the MoM is abnormal
416
Q

What test is more specific for neural disorders?

A

Fluid amniotic acetylcholinesterase

417
Q

What are surfactants of fetal lung maturity?

A

-mature lungs and allows the aveoli to remain open during inhalation and exhalation
-keeps the aveoli from collapsing, decreasing the surface tension
-allows the lungs to inflate easily
-lab tests determine fetal lung maturity

418
Q

What is a primary component of lung surfactants?

A

Lecithin

419
Q

What does sphingomyelin do

A

Serves as a control for the rise of lecithin

420
Q

When is preterm deliveries considered safe?

A

L/S ratio 2.0 or higher

421
Q

What is considered the reference method for testing for fetal Lung maturity

A
422
Q

What are fetal lung maturity tests?

A

-lecithin-sphingomyelin ratio
-phosphatidyl glycerol
-foam stability index
-lamellar bodies
-LBC

423
Q

Explain lamellar bodies

A

-storage form of surfactant
-90% phospholipid
-10% protein

424
Q

What are lamellar bodies secreted by?

A

Type II Pneumocytes of fetal lung

425
Q

Explain the lamellar body count

A

_same size as platelets (1.7-7.3 fl.)
-can be counted on a hematology analyzer (optic or independence
->50,000 microliters = Mature
-<15,000 microliters = immature

426
Q

What are advantages of lamellar body count on hem analyzer

A

-rapid TAT
-low cost
-wide availability
-simple
-small amount of specimen needed
-great clinical performance

427
Q

Give characteristics of fecal specimen

A

-100-200 g of feces is excreted in 24 hours
-intestine is primary site for final breakdown and reabsorption of protein, carbohydrates and fats

428
Q

What aids the small intestine in break down and reabsorption of feces

A

Pancreatic enzymes
—> trypsin
—>chymotrypsin
—> amino peptidase
—> lioases

Liver produces bile salts that help breakdown fats

429
Q

Describe what happens to the fluids in the digestion

A

. They are reabsorbed
- only 500–1500 ml wil make it to large intestine
-150 g mL will be excreted

430
Q

Explain diarrhea

A

> 200 g stool weight per day with increased liquid and more than 3 movements

431
Q

What are 4 classification factors for feces

A
  1. Illness duration
  2. Mechanism
    3.severity
  3. Stool characteristics
432
Q

What are 2 types of water diarrhea

A

1-Secretory
2-osmotic types (fecal electrolytes)

433
Q

What are test performed for diarrhea?

A

-fecal electrolytes
-osmolarity
-pH
- <5.6 indicates sugar malabsorption

434
Q

Explain secretory diarrhea

A

-caused by increased water and electrolytes
-no reabsorption in the large intestine

435
Q

Explain osmotic diarrhea

A

-caused by poor absorption
-incomplete digestion of food increased in large intestine
-disaccharide deficiency
-malabsorption
-poorly absorbed sugars
-laxatives
-magnesium antiacids
-antibiotics

436
Q

Explain steatoeehea

A

-increased data in stool >6 g/day
-Stained with Sudan or Red O stain
-lack of bile salts or pancreatic enzymes

437
Q

Brown color of feces

A

Stercobilinogen—> urobilin

438
Q

What does pale feces indicate

A

Blockage of the bile duct

439
Q

What did bright red and dark red color of feces indicates?

A

Bright red —> lower GI bleed
Dark red—> upper GI bleed

440
Q

Why are microscopic examinations performed on feces?

A

-To detect leukocytes associated with microbial diarrhea
- to look for muscle fibers and fats

441
Q

What is most commonly found in microscopic exams of feces

A

Neutrophil (worn out)
-can be seen with gram or Wright stain and or wet mount

442
Q

Who can muscle fibers be seen in fecal matter?

A

-patients with biliary obstruction, malabsorption and gastrocolic fistulas

443
Q

Explain qualitative fecal fats test

A

-screen for fats
-two part test
—>neutral fat and split fat
—> large red-orange droplets =/> 60 per hpf indicative of steatorrhea

444
Q

Explain neutral test

A

-1 part stool, 2 parts water
-mix emulsified stool with 95% ethyl alcohol on slide
-add two drops of Sudan III

445
Q

Explain split fat test

A

-mix specimen with acetic acid and heat
-greater the size of the droplets, the more positive the test
-cholesterol forms after heating and cooling

446
Q

What does an increase split fat indicate?

A

Malabsorption

447
Q

What does a normal split and increase neutral indicate?

A

Maldigestionn

448
Q

What is the most frequent test performed on stool?

A

Occult blood
-explains unexplained anemia

449
Q

What are the most specific and sensitive test for screening for blood in feces

A

-guaiac (most frequent)
-immunochemical
-fluorometric porphyrins quantification

450
Q

What is a false positive of guaiac

A

-myoglobin/hemoglobin
-food
-medicine

451
Q

What is a false negative of guiaic?

A

Didn’t test areas with blood present

452
Q

What could be a false positive for porphyrins based

A

Due to red meat

453
Q

Describe quantitative fecal fat test

A

Use to confirm steatorrhea
- collect for 3 days
-gold standard - van de kamer titration

454
Q

What is a Reiter cell

A

Macrophage ingested neutrophil

455
Q

What is a ragocytes?

A

Neutrohils with dark granuales

456
Q

What is ATP test

A

Used on vomitus or stool from neonate to distinguish fetal and maternal hemoglobin

457
Q

What does a high semen pH indicate?

A

Prostatic infection

MLT Semester #1 (15 decks)

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