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Urinalysis Lecture + Lab Spring 2023 > Body Fluid Lab Exam (Test #2) > Flashcards

Body Fluid Lab Exam (Test #2) Flashcards

1
Q

What are the three major types of body fluids?

A

CSF, synovial and serous

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2
Q

Cerebrospinal fluid is constantly produced where?

A

Brain choroid plexi (plexuses, capillary knots that protrude into brain ventricles)

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3
Q

The rate of filtration and active transport of cerebrospinal fluid is?

A

500 mL per Day

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4
Q

What is the blood-brain barrier?

A

It is the epithelial cell exterior of choroid plexus

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5
Q

Where does CSF flow?

A

Flows over and around the brain and spinal chord providing cushion for the two.

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6
Q

What are the three major functions of CSF?

A

Supply nutrients, remove waste & act as mechanical barrier and cushion brain and spinal cord.

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7
Q

How should CSF specimens be treated?

A

They should be treated with a lot of caution like they are infectious

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8
Q

Where does sterile puncture of spinal cord take place?

A

Between 3rd & 4th, or 4th & 5th lumbar vertebrae = “lumbar puncture”

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9
Q

What is a ventricular shunt?

A

A surgically placed tube to drain excess fluid from ventricles. Drainage usually collected in 1 container

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10
Q

Hospitals usually collect 3 tubes from a lumbar puncture sometimes 4. Where do the tubes go start from 1 to 4?

A

Tube 1 - Chemistry & serology - Contains skin plug but gets centrifuged
Tube 2- Micro - Less likely to have skin flora
Tube 3 - Hematology - Least likely to have skin cell contamination
Tube 4 - Reserved - In case a mistake or more tests are added. No fluids are trashed.

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11
Q

How are CSF tube tests treated?

A

Treated like they are STAT

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12
Q

How are all the tubes prepared for storage?

A

Chem & Serology (Tube 1) - Centrifuged and frozen
Micro Tube (2) - Leave at room temp. and set up test ASAP!
Hematology Tube (3) - Refrigerate tube or cell count must be done within 1 hour of collection (normal TAT is 1 hr for fluids).
Reserve (4) - Frozen

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13
Q

After testing on CSF tubes are done, do they get trashed?

A

No they do not. They are stored for future test addons

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14
Q

Describe a normal CSF in a tube.

A

Crystal clear and colorless

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15
Q

What could be reasons for a CSF tube to be milky or turbid?

A

Increased protein, lipids, or WBCs! Turbidity is a definite sign of infectious CSF!

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16
Q

A CSF tube may have hemolysis, what would a scientist need to do to the tube to be sure?

A

Centrifuge the CSF tube then place the tube in front of a paper white background. The supernatant should be colored compared to the white background!

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17
Q

A CSF tube has a clear pink or red xanthochromia. This suggests…?

A

OxyHgb due to blood degradation either >2 hrs but <2 days

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18
Q

A CSF tube has a orange xanthochromia. This suggest…?

A

Heavy hemolysis over 2 hours but under 2 days. It could also suggest carotenemia.

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19
Q

A CSF tube has a yellow xanthochromia. This suggest…?

A

OxyHgb broken down to unconjugated bilirubin from heavy, long-term (>days) hemolysis or kernicterus.

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20
Q

Kernicterus is…?

A

Infant brain damage due to increase unconjugated bilirubin

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21
Q

A CSF appearing oily is a sign of…?

A

Radiographic contrast media administration!

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22
Q

A CSF appearing bloody or hemolyzed is a sign of…?

A

Recent bleeding (very recent). Reasons of bleeding could be traumatic tap or cerebral hemorrhage.

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23
Q

A CSF appears blood/hemolyzed. How does an MLS differentiate between a traumatic tap or cerebral hemorrhage?

A

Centrifuge all the CSF tubes (1-4 or 1-3). A traumatic tap will progressively less blood in later tubes. Tube 1 will have the most with Tube 4 or 3 having small / trace amounts. The supernatant may have xanthochromic from serum protein contamination. There CSF sample may be clotted or have bloody streaks.

A cerebral hemorrhage or blood introduced into CSF from a pre-existing cause will have the same amount of blood in all tubes. Other signs are no blood clot and presence of siderophages / erythrophages. The supernatant can be clear if the sample is fresh but xanthochromic will be present if the specimen is old.

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24
Q

Bonus nugget of knowledge! A patient has tubercular meningitis their CSF sample may show…?

A

Weblike pellicle (scum) to form when refrigerated overnight.

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25
Q

What is the significance of a clear CSF?

A

A sign of good health in other words normal.

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26
Q

What is the significance of a milky or turbid CSF caused by WBCs and or RBCs?

A

Could be…
1. Meningitis
2. Traumatic tap (fresh fresh hemorrhage)
3. Microbial meningitis

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27
Q

What is the significance of a milky or turbid CSF caused by proteins?

A

Disorder of blood-brain barrier
e.g.
1. Increased IgG within CNS sign of MS (multiple sclerosis?)
2. Increased Blood-brain barrier permeability could suggest Guillain-Barre syndrome

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28
Q

What is the significance of a bloody CSF?

A

Hemorrhage

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29
Q

What is the significance of a xanthochromic CSF caused by Hgb?

A

Old hemorrhage or lysed cells from traumatic tap. Check date of collection to see if it is old or new.

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30
Q

What is the significance of a xanthochromic CSF caused by bilirubin?

A

RBC breakdown or elevated serum bilirubin

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31
Q

What is the significance of a xanthromic CSF caused by protein?

A

Disorder of blood-brain barrier
e.g.
1. Increased IgG within CNS sign of MS (multiple sclerosis?)
2. Increased Blood-brain barrier permeability could suggest Guillain-Barre syndrome

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32
Q

What is the significance of a clotted CSF caused by protein?

A

Disorder of blood-brain barrier
e.g.
1. Increased IgG within CNS sign of MS (multiple sclerosis?)
2. Increased Blood-brain barrier permeability could suggest Guillain-Barre syndrome
3. Traumatic tap

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33
Q

What is the significance of a clotted CSF caused by plasma clotting factors?

A

Traumatic tap

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34
Q

What is the normal range of an adult CSF’s WBCs/uL and RBCs / uL?

A

WBC - 0-5 WBCs / uL
RBC: 0 RBCs / uL

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35
Q

What is the typical time limit for CSF analysis?

A

Within 1 hour the reason is because it is a sensitive test. The specimen starts to degrade fast. 40% of WBCs disintegrate within first 2 hours of collection.

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36
Q

Cell count of CSF must be done STAT STAT for the reason…?

A

Danger of cell lysis. 40% of WBCs can disintegrate within first 2 hours following collection.

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37
Q

In differential count on CSF what stain is used?

A

Wright-stain and it is prepared from a cytocentrifuge.

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38
Q

What kind of centrifuge is used in slide preparation?

A

Cytocentrifuge

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39
Q

What is the cytocentrifuge principle?

A

Body fluid driven through a cuvette outlet under slow centrifugal force. The cells are deposited as a monolayer button on slide and excess fluid is absorbed by a filter card.

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40
Q

What are the advantages of using a cytocentrifuge for slide preparation?

A
  1. Minimal cell distortion
  2. Concentration of cells for counting.
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41
Q

What is the goal of differential count on CSF?

A

Count 100 cells, classify and report as percentages

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42
Q

What if you can’t count to 100 cells on a differential for CSF?

A

Use hemacytometer for count and report only numbers of cell types seen.

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43
Q

What is the purpose of 7% albumin added to specimen before cytocentrifugation?

A

To cushion cells

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44
Q

What is the ratio of 7% albumin to CSF specimen (in drops)

A

1 drop of 7% albumin to 5 drops of CSF specimen

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45
Q

True or false, cushioning cells with 7% in CSF, serous fluids, and synovial is acceptable.

A

False, 7% albumin is only for CSF and serous fluids not synovial fluids!

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46
Q

Significance of lymphocytes in small numbers in CSF (concentrated)

A

Normal

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47
Q

Significance of lymphocytes in large numbers in CSF (concentrated)

A

A sign of lymphocytosis suggesting possible viral, tubercular, fungal miningitides or multiple sclerosis (requires presences of other things to suggest M.S.

48
Q

For CSF to suggest multiple sclerosis what need to be there?

A

presents with leukopenia of <25 / uL and only lymphs. There can be plasma cells!

49
Q

Significance of neutrophils in very small numbers in a concentrated specimen?

A

Normal, granules may be less prominent

50
Q

Neutrophilia of the CSF suggests…?

A

Bacterial meningitis, early casees of viral, tubercular, or fungal meningitis, or cerebral hemorrhage (must observe cell disintegration)

51
Q

Neutrophilia with cell disintegration under the microscope in CSF suggests…?

A

Cerebral hemorrhage

52
Q

Monocytes in large numbers in CSF suggests…?

A

Monocytosis (chronic bacterial meningitis), viral, tubercular, fungal meningitis, and MS

53
Q

True or false, clumps of choroid plexus and/or ependymal cells (line brain ventricles) are normal.

A

True, the latter can be found especially after an invasive CNS procedure. If peripheral blood cells were found then the findings would be considered abnormal.

54
Q

What kind of cells are considered abnormal everywhere, including CSF?

A

Plasma & malignant cells. Malignant come from either primary brain tumors or metastatic tumors/leukemias.

55
Q

In a normal adult CSF what is the dominant WBC?

A

lymphocytes, think AL

56
Q

In a normal child CSF what is the dominant WBC?

A

Monocytes, think PM

57
Q

What is pleocytosis?

A

Elevated numbers of normal cells in concentrated CSF. Abnormal finding!

58
Q

Elevated levels of eosinophils in a concentrated CSF suggests…?

A

Parasitic infection, allergic reactions, or intracranial shunts. Their appearance will be the same as the ones in peripheral blood.

59
Q

Plasma cells seen in CSF suggests…?

A

MS, multiple sclerosis

60
Q

Elevated levels of macrophages in a concentrated CSF suggests?

A

Viral and bacterial meningitides. RBCs may be observed and come from a long term cause.

61
Q

Blasts or myeloblasts seen in CSF suggests…

A

Acute leukemia

62
Q

What are the characteristics of malignant cells?

A

Very large, usually in groups with fusing cell borders, aberrant polyploid nuclei, cytoplasmic blebbing.

63
Q

Significance of malignant cells in CSF?

A

Metastatic carcinoma or leukemia

64
Q

Budding yeast in CSF is suggestive of?

A

CNS yeast infection. Yeast stained with india ink with a clear surrounding (capsule) is suggestive of cryptococcus.

65
Q

Characteristics of ependymal and/or choroidal cells are?

A

Flattened 2-D sheets, clustered, distinct nuclei and cell membrane

66
Q

Presence of ependymal and/or choroidal cell significance is?

A

Signs of normal trauma or trauma from diagnostic procedures

67
Q

Presences of nRBCs significance is…?

A

Bone marrow contamination from tap. Its not significance.

68
Q

What would be the parameters of CSF for a patient with bacterial meningitis? WBC count, WBC type, protein levels, glucose levels.

A

Elevated WBCs, Neutrophils, markedly protein levels, and decrease glucose levels

69
Q

What would be the parameters of CSF for a patient with viral? WBC count, WBC type, protein levels, glucose levels.

A

Elevated WBC count, lymphocytes present, elevated protein levels, normal glucose

70
Q

What would be the parameters of CSF for a patient with tubercular? WBC count, WBC type, protein levels, glucose levels.

A

Elevated WBC count, lymphocytes and monocytes, markedly to moderately increased protein, and decrease glucose levels

71
Q

What would be the parameters of CSF for a patient with fungal? WBC count, WBC type, protein levels, glucose levels.

A

Elevated WBC count, lymphocytes and monocytes present, marked to moderate protein elevation, normal to decrease glucose

72
Q

Bacterial meningitis is ___A____. Viral meningitis is ____B_____ with supportive care.

A

A - fatal
B - self-limiting

73
Q

Characteristics of the body cavity lining cells a.k.a mesothelial cells

A
  1. Monolayer
  2. Distinct cytoplasmic & nuclear margins (fried egg appearance)
  3. May have vacoules
  4. Everywhere but CSF
74
Q

List characteristics of a malignant mesothelial cell.

A
  1. 3-D clumps
  2. Indistinct nuclear & cytoplasmic margins
    3.Bizzare, polyploid nuclei
  3. Increased number of mitotic forms
  4. Large nucleoli
  5. Blebbed cytoplasmic edges
75
Q

What are the two functions of synovial fluid?

A
  1. Supplies nutrients to cartilage
  2. Acts as lubricant
76
Q

How is synovial fluid made?

A

Produced by filtration of plasma across synovial membrane. Its combined with secretion of hyaluronate-lubricin complex from the same membrane.

77
Q

True or false, synovial fluid basically has the same chemical composition of plasma.

A

True

78
Q

What procedure is used to collect synovial fluid for the lab?

A

Arthrocentesis

79
Q

What are the four major categories of joint disease?

A
  1. Noninflammatory
  2. Inflammatory
  3. Septic
  4. Hemorrhagic
80
Q

Noninflammatory category can by caused by…

A

Degenerative joint disorders such as osteoarthritis

81
Q

Inflammatory category can be caused by…

A

Immunologic or crystal problems such as RA, SLE, gout, and pseudogout

82
Q

Septic category can be caused by

A

Microbial infection

83
Q

Hemorrhagic category can be caused by

A

Traumatic injury or coagulation deficiencies

84
Q

Normal synovial fluid characteristics are…

A
  1. Clear and pale yellow
  2. Egg white consistency (String test, a continuous string = healthy)
  3. Viscous
85
Q

Why is synovial fluid viscous?

A

The polymerization of hyaluronic acid, essential for proper joint lubrication

86
Q

Unhealthy joints signs are…

A

Decreased viscosity or runny synovial fluid because the hyaluronic acid cannot polymerize therefore it would fail to produce a continuous string.

87
Q

What are the three most common crystals causing arthritis?

A
  1. Monosodium urate (MSU) a.k.a. gout
  2. Ca pyrophosphate (CPPD) a.k.a pseudogout
  3. Cholesterol - chronic effusions such as RA)
88
Q

Describe monosodium urate under the microscope

A

Large needle shaped crystals that may be inside or outside cells.
Gout is needles in and out, -Dr. Hutson

89
Q

Describe Ca pyrophosphate (CPPD) under the microscope

A

Small rhombic-shaped or rod shaped crystals, inside cells.
Pseudogout in rods or rhombi

90
Q

Describe cholesterol crystals under the microscope

A

Large, flat, extracellular notched plates

91
Q

What instrument can be used to differentiate crystals under the microscope?

A

A red compensator!

92
Q

Using a red compensator monosodium urate (MSU) would have what kind of color to it?

A

Pale yellow when aligned parallel with axis.
“U has parallel lines that are yellow”

93
Q

How does a red compensator work?

A

Separates light beam into slow- and fast moving components. It retards red light making the background red instead of black.

94
Q

Using a red compensator what color would a Ca pyrophosphate (CPPD) have?

A

Blue!

95
Q

What is a signet ring?

A

Macrophage with a big vacoule that drank too much

96
Q

Which 2 joint disorder categories is a decreased glucose result found?

A

Inflammatory and septic

97
Q

In which joint disorder category does synovial fluid appear greenish?

A

Septic

98
Q

Which joint disorder category might the synovial fluid contain RF?

A

Inflammatory

99
Q

In which joint disorder category is there a marked increase in segs? (At >100k/uL)

A

Septic

100
Q

Which is the only joint disorder category that retains relatively good viscosity?

A

Noninflammatory

101
Q

What is the parietal membrane?

A

Membrane that lines the cavity wall

102
Q

What is the visceral membrane?

A

Membrane that covers organ inside the body cavity

103
Q

Where can serous fluid be found and what does it do?

A

Found between membranes (parietal and visceral membranes). It provides lubrication.

104
Q

What is an effusion?

A

any abnormal accumulation of serous fluid

105
Q

Transudate occurs because…?

A

Systemic disease outside a body cavity. Mechanical process due to altered colloidal oncotic pressure or fluid stasis resulting in elevated passive ultrafiltration of plasma across intact vascular walls.

106
Q

What are examples of transudate appearing in the body?

A

CHF due to fluid stasis, nephrotic syndrome, and alcoholic cirrhosis due to decrease total protein (T.P.)

107
Q

Exudate appears when?

A

When there is an inflammatory disease, infection or malignancy inside a body cavity.

108
Q

How does exudate form?

A

Active chemical process due to inflammation resulting in changes in membrane permeability. Sometimes even actual vascular wall damage. It causes both fluid secretion and excretion (pus) into body cavities.

109
Q

What are some situations exudate would occur?

A

Pneumonia, pleurisy, TB, and peritonitis

110
Q

Low glucose levels in pleural fluid suggests what?

A

TB, rheumatoid inflammation, and malignancy

111
Q

Low pH level in pleural in pleural fluid suggests…?

A

TB, malignancy, esophageal rupture.

112
Q

What procedure is used to collect pleural fluid?

A

Thoracentesis

113
Q

In peritoneal fluid elevated amylase suggests…?

A

Pancreatitis or GI perforation

114
Q

Elevated urea or creatinine in perittoneal fluid suggests…?

A

ruptured bladder

115
Q

Low glucose in peritoneal fluid suggests…?

A

Tubercular peritonitis, or malignancy

116
Q

Elevated alkaline phosphatase in peritoneal fluid suggests..?

A

Intestinal perforation

117
Q

Peritoneal fluid is collected via what procedure?

A

Paracentesis

Urinalysis Lecture + Lab Spring 2023 (5 decks)

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