13 - CSF And BCF Flashcards
Causes of the accumulation of fluids is different cavities - Non-inflammatory causes
1️⃣ increase of hydrostatic pressure of the blood due to:
🔺 right sided heart failure
🔺liver hypertension, failure, cirrhosis 🔺blockage of a blood vessel
🔺renal fibrosis
2️⃣ decrease of plasma colloid oncotic pressure (⬇️ albumin)
🔺 type and quantity of protein intake
🔺gastric, pancreatic (EPI), intestinal digestion (specific intestinal diseases), 🔺malabsorption
🔺synthesis (liver failure),
🔺utilisation (growth, pregnancy, work, exercise, tumour)
🔺loss (renal - glomerulonephropathy, intestinal - PLE)
3️⃣impeded lymphatic flow (backward stasis)protein into interstitium
4️⃣ hormonal effects (aldosterone, AHD - primary or secondary case increased circulatory
volume)
Causes of the accumulation of fluids is different cavities -inflammatory causes
1️⃣bacterial toxins (endotoxins, exotoxins)
2️⃣viral effects (immune complexes)
3️⃣parasitic toxins
4️⃣inflammatory mediators (histamine etc., immune complexes)
Types of BSF fluids
transudate (hydro-) exudate (pyo-) modified transudate blood chylus (lymph)
Lymph
Can look like milk, NGs dominate -> inflammation
Blood; what to do, how do we know its blood?
Need to act quick! Look for origin(surgery)
Thrombocytes present=fresh bleeding (diss. Within 2-3h)
Hematocrit: blood ok means it havent reacted yet, while incr. Hematocrit in fluid = fresh bleeding
Sampling of BCF
1️⃣ taken in sterile environments,
2️⃣using syringe, iv. catheters, or vacuum bottles,
3️⃣ into glass tube (in order to evaluate coagulation ability) and Na(K)2EDTA containing tubes.
4️⃣ 3 may be needed: biochemical and cytological analysis, microbiology examination (in this case special tubes are provided)
Course of sample preparation of BCF
1️⃣ gross examination
2️⃣ Rivalta-test
3️⃣ total and nucleated cell count (by using automatic cell counters or
haemocytometer)
4️⃣ centrifuging by cytospin
5️⃣ separating upper layer: biochemical analysis
6️⃣ separation of sediment for cytological analysis - smear is made
How do we figure out origin of sample?
1️⃣ exudate or transudate? Eg. Rivalta
2️⃣A EXUDATE - NGs dominate, septic or non-septic? Cytology:
- septic(mostly bacteria) phagocytesed bacteria, if bacteria outside og cell=contamination
- non-septic: karyopicnosis
2️⃣B TRANSUDATE - mesoth cells, lymphocytes, tissue cells, tumor cells, ng(non dominant) - neoplastic or reactive? Further tests
- neoplastic: modified transudate
- reactive: modified transudate and/or transudate (might be tumor but not shedding cells, well encapsulated.)
🍏Parameters determined from body cavity fluids - how do we evaluate BCF
1️⃣ outlook physical parameters (colour, odour, consistency) 2️⃣ Rivalta-test 3️⃣ coagulation ability 4️⃣ specific gravity 5️⃣ pH 6️⃣ red blood cell count 7️⃣ nucleated cell count 8️⃣ total protein concentration 9️⃣ albumin/globulin ratio 1️⃣0️⃣ creatinine, urea concentration 1️⃣1️⃣ alpha-amylase, lipase activity 1️⃣2️⃣ LDH activity 1️⃣3️⃣ triglycerol, cholesterol concentration 1️⃣4️⃣ cytological analysis
How to make smear from different BCF
Few cells ex CSF, bronchoalveolar lavage)
🔺 use upper layer to re-suspend sediment and use to make smear
Many cells
🔺 sediment directly onto slide to make smear
🔺if too many RBC use sample from buffy coat layer instead
🍏Rivalta test
1️⃣ 1/2 drops of non-centrifuged sample(BCF) into 3% (only fibr, glob not alb)acetic acid solution in Na-EDTA tube, dont hit side of tube!
2️⃣ coagulation - there is exudate
🔺 weak acid will coagulate fibrinogen/globulin
3️⃣ no coag - transudate
🔺 weak acid cannot coag albumin(only strong)
3️⃣ loads of globulins: honey like sample in FIP. The sample drop will not dissolce in acetic acid, but remain as drop formed. ((best fip test!) globulins coag on surface of dense surface of drop)
transudate: 1️⃣color 2️⃣odour 3️⃣consistency 4️⃣rivalta 5️⃣coagulation ability 6️⃣SG 7️⃣pH 8️⃣nucl. Cell count 9️⃣TP
1️⃣bloody (heart failure, stasis of vessels) watery or yellowish (liver failure) 2️⃣no smell 3️⃣watery 4️⃣ neg rivalta 5️⃣ no coag 6️⃣ hypothenuric (<1017) 7️⃣ slightly alkaline or 7 8️⃣ <1-10 9️⃣ <25
modified transudate 1️⃣color 2️⃣odour 3️⃣consistency 4️⃣rivalta 5️⃣coagulation ability 6️⃣SG 7️⃣pH 8️⃣nucl. Cell count 9️⃣TP
1️⃣bloody, opaque, grey-white, reddish, yellowish, sometimes transparent sometimes 2️⃣watery sometimes 3️⃣slightly viscous 4️⃣ +/- rivalta 5️⃣ +/- coag 6️⃣ 1017-1025 7️⃣ slightly alkaline, acidic or 7 8️⃣ 10-50 9️⃣ 25-35
What causes coagulation
Fresh blood, innflammation
exudate 1️⃣color 2️⃣odour 3️⃣consistency 4️⃣rivalta 5️⃣coagulation ability 6️⃣SG 7️⃣pH 8️⃣nucl. Cell count 9️⃣TP
1️⃣generally opaque, bloody, grey- white, yellow-white, light brown 2️⃣often penetrating 3️⃣often viscous !4️⃣ +/++/+++ rivalta !5️⃣ + coag 6️⃣ >1025 7️⃣ acidic !8️⃣ >50 9️⃣ >35
