Body Fluid Lab Exam (Test #2) Flashcards
What are the three major types of body fluids?
CSF, synovial and serous
Cerebrospinal fluid is constantly produced where?
Brain choroid plexi (plexuses, capillary knots that protrude into brain ventricles)
The rate of filtration and active transport of cerebrospinal fluid is?
500 mL per Day
What is the blood-brain barrier?
It is the epithelial cell exterior of choroid plexus
Where does CSF flow?
Flows over and around the brain and spinal chord providing cushion for the two.
What are the three major functions of CSF?
Supply nutrients, remove waste & act as mechanical barrier and cushion brain and spinal cord.
How should CSF specimens be treated?
They should be treated with a lot of caution like they are infectious
Where does sterile puncture of spinal cord take place?
Between 3rd & 4th, or 4th & 5th lumbar vertebrae = “lumbar puncture”
What is a ventricular shunt?
A surgically placed tube to drain excess fluid from ventricles. Drainage usually collected in 1 container
Hospitals usually collect 3 tubes from a lumbar puncture sometimes 4. Where do the tubes go start from 1 to 4?
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.
How are CSF tube tests treated?
Treated like they are STAT
How are all the tubes prepared for storage?
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
After testing on CSF tubes are done, do they get trashed?
No they do not. They are stored for future test addons
Describe a normal CSF in a tube.
Crystal clear and colorless
What could be reasons for a CSF tube to be milky or turbid?
Increased protein, lipids, or WBCs! Turbidity is a definite sign of infectious CSF!
A CSF tube may have hemolysis, what would a scientist need to do to the tube to be sure?
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!
A CSF tube has a clear pink or red xanthochromia. This suggests…?
OxyHgb due to blood degradation either >2 hrs but <2 days
A CSF tube has a orange xanthochromia. This suggest…?
Heavy hemolysis over 2 hours but under 2 days. It could also suggest carotenemia.
A CSF tube has a yellow xanthochromia. This suggest…?
OxyHgb broken down to unconjugated bilirubin from heavy, long-term (>days) hemolysis or kernicterus.
Kernicterus is…?
Infant brain damage due to increase unconjugated bilirubin
A CSF appearing oily is a sign of…?
Radiographic contrast media administration!
A CSF appearing bloody or hemolyzed is a sign of…?
Recent bleeding (very recent). Reasons of bleeding could be traumatic tap or cerebral hemorrhage.
A CSF appears blood/hemolyzed. How does an MLS differentiate between a traumatic tap or cerebral hemorrhage?
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.
Bonus nugget of knowledge! A patient has tubercular meningitis their CSF sample may show…?
Weblike pellicle (scum) to form when refrigerated overnight.
What is the significance of a clear CSF?
A sign of good health in other words normal.
What is the significance of a milky or turbid CSF caused by WBCs and or RBCs?
Could be…
1. Meningitis
2. Traumatic tap (fresh fresh hemorrhage)
3. Microbial meningitis
What is the significance of a milky or turbid CSF caused by proteins?
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
What is the significance of a bloody CSF?
Hemorrhage
What is the significance of a xanthochromic CSF caused by Hgb?
Old hemorrhage or lysed cells from traumatic tap. Check date of collection to see if it is old or new.
What is the significance of a xanthochromic CSF caused by bilirubin?
RBC breakdown or elevated serum bilirubin
What is the significance of a xanthromic CSF caused by protein?
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
What is the significance of a clotted CSF caused by protein?
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
What is the significance of a clotted CSF caused by plasma clotting factors?
Traumatic tap
What is the normal range of an adult CSF’s WBCs/uL and RBCs / uL?
WBC - 0-5 WBCs / uL
RBC: 0 RBCs / uL
What is the typical time limit for CSF analysis?
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.
Cell count of CSF must be done STAT STAT for the reason…?
Danger of cell lysis. 40% of WBCs can disintegrate within first 2 hours following collection.
In differential count on CSF what stain is used?
Wright-stain and it is prepared from a cytocentrifuge.
What kind of centrifuge is used in slide preparation?
Cytocentrifuge
What is the cytocentrifuge principle?
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.
What are the advantages of using a cytocentrifuge for slide preparation?
- Minimal cell distortion
- Concentration of cells for counting.
What is the goal of differential count on CSF?
Count 100 cells, classify and report as percentages
What if you can’t count to 100 cells on a differential for CSF?
Use hemacytometer for count and report only numbers of cell types seen.
What is the purpose of 7% albumin added to specimen before cytocentrifugation?
To cushion cells
What is the ratio of 7% albumin to CSF specimen (in drops)
1 drop of 7% albumin to 5 drops of CSF specimen
True or false, cushioning cells with 7% in CSF, serous fluids, and synovial is acceptable.
False, 7% albumin is only for CSF and serous fluids not synovial fluids!
Significance of lymphocytes in small numbers in CSF (concentrated)
Normal
Significance of lymphocytes in large numbers in CSF (concentrated)
A sign of lymphocytosis suggesting possible viral, tubercular, fungal miningitides or multiple sclerosis (requires presences of other things to suggest M.S.
For CSF to suggest multiple sclerosis what need to be there?
presents with leukopenia of <25 / uL and only lymphs. There can be plasma cells!
Significance of neutrophils in very small numbers in a concentrated specimen?
Normal, granules may be less prominent
Neutrophilia of the CSF suggests…?
Bacterial meningitis, early casees of viral, tubercular, or fungal meningitis, or cerebral hemorrhage (must observe cell disintegration)
Neutrophilia with cell disintegration under the microscope in CSF suggests…?
Cerebral hemorrhage
Monocytes in large numbers in CSF suggests…?
Monocytosis (chronic bacterial meningitis), viral, tubercular, fungal meningitis, and MS
True or false, clumps of choroid plexus and/or ependymal cells (line brain ventricles) are normal.
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.
What kind of cells are considered abnormal everywhere, including CSF?
Plasma & malignant cells. Malignant come from either primary brain tumors or metastatic tumors/leukemias.
In a normal adult CSF what is the dominant WBC?
lymphocytes, think AL
In a normal child CSF what is the dominant WBC?
Monocytes, think PM
What is pleocytosis?
Elevated numbers of normal cells in concentrated CSF. Abnormal finding!
Elevated levels of eosinophils in a concentrated CSF suggests…?
Parasitic infection, allergic reactions, or intracranial shunts. Their appearance will be the same as the ones in peripheral blood.
Plasma cells seen in CSF suggests…?
MS, multiple sclerosis
Elevated levels of macrophages in a concentrated CSF suggests?
Viral and bacterial meningitides. RBCs may be observed and come from a long term cause.
Blasts or myeloblasts seen in CSF suggests…
Acute leukemia
What are the characteristics of malignant cells?
Very large, usually in groups with fusing cell borders, aberrant polyploid nuclei, cytoplasmic blebbing.
Significance of malignant cells in CSF?
Metastatic carcinoma or leukemia
Budding yeast in CSF is suggestive of?
CNS yeast infection. Yeast stained with india ink with a clear surrounding (capsule) is suggestive of cryptococcus.
Characteristics of ependymal and/or choroidal cells are?
Flattened 2-D sheets, clustered, distinct nuclei and cell membrane
Presence of ependymal and/or choroidal cell significance is?
Signs of normal trauma or trauma from diagnostic procedures
Presences of nRBCs significance is…?
Bone marrow contamination from tap. Its not significance.
What would be the parameters of CSF for a patient with bacterial meningitis? WBC count, WBC type, protein levels, glucose levels.
Elevated WBCs, Neutrophils, markedly protein levels, and decrease glucose levels
What would be the parameters of CSF for a patient with viral? WBC count, WBC type, protein levels, glucose levels.
Elevated WBC count, lymphocytes present, elevated protein levels, normal glucose
What would be the parameters of CSF for a patient with tubercular? WBC count, WBC type, protein levels, glucose levels.
Elevated WBC count, lymphocytes and monocytes, markedly to moderately increased protein, and decrease glucose levels
What would be the parameters of CSF for a patient with fungal? WBC count, WBC type, protein levels, glucose levels.
Elevated WBC count, lymphocytes and monocytes present, marked to moderate protein elevation, normal to decrease glucose
Bacterial meningitis is ___A____. Viral meningitis is ____B_____ with supportive care.
A - fatal
B - self-limiting
Characteristics of the body cavity lining cells a.k.a mesothelial cells
- Monolayer
- Distinct cytoplasmic & nuclear margins (fried egg appearance)
- May have vacoules
- Everywhere but CSF
List characteristics of a malignant mesothelial cell.
- 3-D clumps
- Indistinct nuclear & cytoplasmic margins
3.Bizzare, polyploid nuclei - Increased number of mitotic forms
- Large nucleoli
- Blebbed cytoplasmic edges
What are the two functions of synovial fluid?
- Supplies nutrients to cartilage
- Acts as lubricant
How is synovial fluid made?
Produced by filtration of plasma across synovial membrane. Its combined with secretion of hyaluronate-lubricin complex from the same membrane.
True or false, synovial fluid basically has the same chemical composition of plasma.
True
What procedure is used to collect synovial fluid for the lab?
Arthrocentesis
What are the four major categories of joint disease?
- Noninflammatory
- Inflammatory
- Septic
- Hemorrhagic
Noninflammatory category can by caused by…
Degenerative joint disorders such as osteoarthritis
Inflammatory category can be caused by…
Immunologic or crystal problems such as RA, SLE, gout, and pseudogout
Septic category can be caused by
Microbial infection
Hemorrhagic category can be caused by
Traumatic injury or coagulation deficiencies
Normal synovial fluid characteristics are…
- Clear and pale yellow
- Egg white consistency (String test, a continuous string = healthy)
- Viscous
Why is synovial fluid viscous?
The polymerization of hyaluronic acid, essential for proper joint lubrication
Unhealthy joints signs are…
Decreased viscosity or runny synovial fluid because the hyaluronic acid cannot polymerize therefore it would fail to produce a continuous string.
What are the three most common crystals causing arthritis?
- Monosodium urate (MSU) a.k.a. gout
- Ca pyrophosphate (CPPD) a.k.a pseudogout
- Cholesterol - chronic effusions such as RA)
Describe monosodium urate under the microscope
Large needle shaped crystals that may be inside or outside cells.
Gout is needles in and out, -Dr. Hutson
Describe Ca pyrophosphate (CPPD) under the microscope
Small rhombic-shaped or rod shaped crystals, inside cells.
Pseudogout in rods or rhombi
Describe cholesterol crystals under the microscope
Large, flat, extracellular notched plates
What instrument can be used to differentiate crystals under the microscope?
A red compensator!
Using a red compensator monosodium urate (MSU) would have what kind of color to it?
Pale yellow when aligned parallel with axis.
“U has parallel lines that are yellow”
How does a red compensator work?
Separates light beam into slow- and fast moving components. It retards red light making the background red instead of black.
Using a red compensator what color would a Ca pyrophosphate (CPPD) have?
Blue!
What is a signet ring?
Macrophage with a big vacoule that drank too much
Which 2 joint disorder categories is a decreased glucose result found?
Inflammatory and septic
In which joint disorder category does synovial fluid appear greenish?
Septic
Which joint disorder category might the synovial fluid contain RF?
Inflammatory
In which joint disorder category is there a marked increase in segs? (At >100k/uL)
Septic
Which is the only joint disorder category that retains relatively good viscosity?
Noninflammatory
What is the parietal membrane?
Membrane that lines the cavity wall
What is the visceral membrane?
Membrane that covers organ inside the body cavity
Where can serous fluid be found and what does it do?
Found between membranes (parietal and visceral membranes). It provides lubrication.
What is an effusion?
any abnormal accumulation of serous fluid
Transudate occurs because…?
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.
What are examples of transudate appearing in the body?
CHF due to fluid stasis, nephrotic syndrome, and alcoholic cirrhosis due to decrease total protein (T.P.)
Exudate appears when?
When there is an inflammatory disease, infection or malignancy inside a body cavity.
How does exudate form?
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.
What are some situations exudate would occur?
Pneumonia, pleurisy, TB, and peritonitis
Low glucose levels in pleural fluid suggests what?
TB, rheumatoid inflammation, and malignancy
Low pH level in pleural in pleural fluid suggests…?
TB, malignancy, esophageal rupture.
What procedure is used to collect pleural fluid?
Thoracentesis
In peritoneal fluid elevated amylase suggests…?
Pancreatitis or GI perforation
Elevated urea or creatinine in perittoneal fluid suggests…?
ruptured bladder
Low glucose in peritoneal fluid suggests…?
Tubercular peritonitis, or malignancy
Elevated alkaline phosphatase in peritoneal fluid suggests..?
Intestinal perforation
Peritoneal fluid is collected via what procedure?
Paracentesis
