20. Body Fluids Flashcards
1
Q
Body Fluids
A
- taken from sterile compartment
- Inflammation or infection can change or increase the fluid
- Laboratory is responsible for identification and enumeration of cellular elements for aid in diagnosis
2
Q
Types of Body Fluid
A
- Serous or body cavity fluids (pleural, pericardial, peritoneal)
- Cerebrospinal fluid (CSF)
- Joint (synovial) fluids
3
Q
Serous Fluids
A
- Serve as lubricant between membranes of an organ and the sac which surrounds it (Pleural, Pericardial, Peritoneal).
- Effusion = Accumulation of excess fluid
- Increase in fluid production (effusion) can be caused by: Trauma, Infection, Malignancy
4
Q
Transudate vs Exudate
A
Transudate
- Caused by systemic disease: Congestive heart failure
- Pale yellow; clear
- WBC < 1000 cells/μL
Exudate
- Secondary to malignancy, infection, LE
- Cloudy, turbid, bloody
- WBC > 1000 cells/μL
5
Q
Gross Examination of Serous Fluids
A
- Normal: clear/ straw
- Infectious process: cloudy/hazy
- Trauma/malignancy: may be bloody
- Effused chyle in thoracic cavity: milky fluid. (Chyle is a mixture of lymph and fat globules)
6
Q
Fluid Differential and Cell count
A
- Cell count: hemocytometer (Reds and whites)
- Normal cell Differential: lymphocytes, macrophages, mesothelial cells
7
Q
Mesothelial Cells
A
- Sloughed from the membranes
- “Fried egg” appearance or eggs in a nest
- Oval nucleus, smooth nuclear borders
- Variable size/ consistent appearance
- Villus edge so cytoplasm can appear jagged
- May be multinucleated
- can see Windowing (to differentiate from tumor cells)
8
Q
Signet Ring
A
- macrophage ingested lipids or other fluid pushes nucleus to cell periphery
9
Q
Tumor cells
A
- mitotic figures
- 3D appearance
- Mesothelioma cells in pleural fluid
10
Q
Cerebrospinal Fluid
A
- Seventy percent produced by choroid plexuses in the cerebral ventricles: Active secretion, Ultrafiltration
- Thirty percent formed by ependymal lining of the ventricles
- Collection involves 4 tubes: Traumatic tap vs. subdural hematoma
11
Q
CSF appearance and Cell Count
A
Color:
- Colorless (NORMAL)
- Xanthochromic - hgb, bilirubin
- Bloody - RBCs
- Greenish - purulent
Turbidity:
- Clear
- Cloudy - WBCs, microorganisms, protein
- Clot - increased fibrinogen
Normal WBC: 0-5 WBC/uL
Normal RBC: 0-5 RBC/uL
12
Q
CSF Differential
A
- Normal: Lymphocytes in adults, Monocytes in newborns
- Bacterial meningitis: WBC in thousands, Predominantly neutrophils
- Viral meningitis: WBC in hundreds, Predominantly lymphocytes
- Eosinophils and basophils: allergic reaction, reaction to foreign material (ex. shunt)
- Nucleated RBC: bone marrow contamination
- Ependymal and choroid plexus cells: lining cells of CNS
- Cartilage cells (red-burgundy cytoplasm): indicate punctured vertebral body
- Siderophages: indicates pathologic hemorrhage
- CNS involvement from ALL or AML: Leukemia patients should always be scanned carefully for blast cells
- Metastases: Most common primary tumors are breast, lung, GI, and melanoma
- Tumor cells - high N:C ratio, clump together, multinucleated, increased mitosis
13
Q
Synovial Fluid
A
- Lubricating fluid in the cavity surrounding joints
- Increased viscosity due to hyaluronic acid: Addition of hyluronidase helps to liquify fluid (not to be used if crystal analysis is performed)
14
Q
Synovial Fluid Differential
A
Normal cells: Lymphocytes, Macrophages, Synovial cells
Abnormal Cells
- LE cells: Neutrophils that have engulfed a nucleus of a lymphocyte that has been altered by antinuclear antibody
- Tumor cells
- Neutrophils
- Crystals: intracellular, extracellular, requires polarizing microscope. Cholesterol crystals (intracellular) are large and flat. Monosodium urate crystals are needle-like (gout).
15
Q
Synovial Cells (Synoviocytes)
A
- Similar to mesothelial cells, just in synovial fluid
- Usually not as numerous
