Body Fluids Flashcards
Where is cerebrospinal fluid located?
Brain and spinal cord
Where is pleural fluid found?
Lungs
Where is pericardial fluid found?
Heart
Where is peritoneal fluid found?
Abdominal organs
Where is synovial fluid found?
Joints
Normal volume of CSF in an adult
90-150 mL in adults
What is the name given to the change in color of a supernatant, caused by the breakdown of hemoglobin?
Xanthochromia
CSF for neonates
- WBC count
- Lymphs vs. monos
- WBC count: 0-274 cells/cumm
- Monos > Lymphs
CSF for adults
- WBC count
- Lymphs vs. monos
- WBC count: 0-5 cells/cumm
- 70% lymphs vs. 30% monos
An increased cell count, particularly an increase in WBC count, in a bodily fluid, such as CSF
Pleocytosis
Bacterial meningitis leads to an increase in ____
Neutrophils
Viral meningitis leads to an increase in ____
Lymphocytes
Acute leukemias lead to an increase in ____
Blasts
Lymphomas lead to an increase in ____
Lymphoma cells
Cerebral hemorrhage (including strokes) lead to an increase in ____
Segs, monos, and macrophages
Correcting for a traumatic tap (formula 1)
True WBCCSF = subtract 1 WBC per 500 RBCs counted
Correcting for a traumatic tap (formula 2)
WBCcsf count - [WBCblood x (RBCCSF/RBCblood)}
Cytospin preps are made on all ____ specimens regardless of ____ ____
CSF; cell count
How do you make a cytopsin slide?
Add one drop of 22% albumin and 5 drops of fluid to make the cytospin prep
What type of serous body fluid accumulates due to a pathologic state such as infection or malignancy?
Exudate
Abnormal collection of fluid in a cavity?
Effusion
Accumulation due to a systemic disease state
Transudates
Causes of transudates
Congestive heart failure, ↓ plasma COP, hypoproteinemia of the nephrotic syndrome, liver failure
Accumulation due to a primary pathologic state
Exudate
Examples of exudates
Bacterial infections, viral infections, neoplasms, trauma, noninfectious inflammatory conductions (RA), collagen vascular disease (SLE)
Serous fluids are ultrafiltrates of what?
Plasma
Systemic causes of effusions and the underlying mechanism
- ↑ capillary HP - ↓ plasma COP
Local causes of effusions and the underlying mechanism
- ↑ capillary permeability - ↓ lymphatic resorption
Transudate
- Appearance
- Specific gravity
- Total protein
- LDH
- LDH activity ratio (BF: Serum)
- Cell count
- Spontaneous clotting
- Appearance: Clear
- Specific gravity: < 1.015
- Total protein: < 3.0 g/dL
- LDH: < 200 IU
- LDH activity ratio (BF: Serum): < 0.6
- Cell count: < 1000/uL
- Spontaneous clotting: No
Exudate
- Appearance
- Specific gravity
- Total protein
- LDH
- LDH activity ratio (BF: Serum)
- Cell count
- Spontaneous clotting
- Appearance: Cloudy
- Specific gravity: > 1.015
- Total protein: > 3.0 g/dL
- LDH: > 200 IU
- LDH activity ratio (BF: Serum): > 0.6
- Cell count: > 1000/uL
- Spontaneous clotting: Possible
Chylous effusion
Triglycerides > 110 mg/dL
If chylomicrons are present that = ____ If cholesterol crystals are present = ____
Chylous effusion; pseudochylous effusion
Chylous effusions are obstructions of the ____ ____ from lymphoma, neoplasm, or surgery
Lymphatic system
Pseudochylous effusions are ____ conditions such as RA and often have higher concentration of ____ than serum
Inflammatory; cholesterol
Normal cells in serous fluids
- Lymphs
- Mono-histiocytes (macrophages)
- Siderophages
- Erythrophages
- Signet Ring cells/Lipophages
- Mesothelial cells
Serous fluid is straw colored to yellow to clear, what does that mean?
Normal
Serous fluid is cloudy to hazy, what does that mean?
Infectious process
Serous fluid is bloody, what does that mean?
Malignancy or trauma
Serous fluid is milky, what does that mean?
Chyle (lipids)
Macrophages containing siderotic (iron) granules
Siderophages
Macrophages that have phagocytized RBCs
Erythrophage
Macrophages that have phagocytized large amounts of lipids
Signet ring cells
These cells are neutrophils that have phagocytized a naked nucleus showing a homogenous, smooth chromatin pattern
LE cells
Five clues to identifying malignant cells
- Form clusters
- Nuclear membrane is irregular or jagged
- Contain prominent, frequently multiple nucleoli w/ irregular membranes
- Chromatin is unevenly distributed
- N/C ratio is higher than normal
Normal cells found in synovial fluid
- Monos/macrophages (60%)
- Lymphs (30%)
- Neutrophils (10%)
- LE cells
- Cartilaginous cells
- Malignant cells
- Synoviocytes
**Purpose of hyaluronidase when analyzing synovial fluid
Synovial fluid is viscous, containing hyaluronic acid, adding hyaluronidase fixes that**
What are the groups of the synovial fluid classification?
- Normal
- Group 1 (Noninflammatory)
- Group 2 (Inflammatory)
- Group 3 (Septic)
- Group 4 (Hemorrhagic)
How do you perform a bronchoalveolar lavage?
Warm saline is introduced into the lungs and then withdrawn
What is the purpose of a BAL?
To determine the types of organisms and cells in areas of lung inaccessible by other means
BAL cell findings
- Histiocytes
May have carbonaceous material from smokers (black, brown, ro blue-black)
BAL cell findings
- Pneumocystic jiroveci
Common in specimens from HIV patients (may look like amorphous material)
Normal cells found in BAL
- Neutrophils
- Macrophages
- Pneumocytes (alveolar)
- Ciliated epithelial cells
- Histocytes
- Pneumocystis jiroveci
What do ciliated epithelial cells in a BAL indicate?
Indicates that sample was collected from upper respiratory tract instead of the lung
Normal cells found in CSF
Lymphs
- Neutrophils should be absent or rare regardless of age
Lymphs are found in all body fluids except for ____
BAL
Neutrophils are abnormal in all body fluids except for ____
BAL
Monocytes are normal in all body fluids except for ____
NONE!! Normal in ALL!!
Leukemia/Lymphoma cells are most common in what?
ALL and some AML
Rice bodies are found where and are made of what?
In synovial fluids; composed of collagen covered by fibrinous tissue
Monosodium Urate is seen in ____
Gout
Calcium pyrophosphate crystals are seen in ____
Pseudo-gout
How do MSU crystals look on a polarizer?
Bright needles strongly birefringent
How do CPP crystlas look on a polarizer?
Rhomboidal and weakly birefringent
How do MSU crystals look using a red compensator?
MSU crystals appear yellow when parallel to the axis and blue when perpendicular
How do CPP crystlas look using a red compensator?
CPP crystals appear blue when parallel to the axis and yellow when perpendicular
If the opening pressure is low in collection of spinal fluid, it leads to…
- Reduced volume
- Blocks the above puncture site
If the opening pressure is high in collection of spinal fluid, it leads to…
- High volume
- CNS hemorrhage
- Malignancy
- Hydrocephalus
- Meningitis
Describe how to differentiate a traumatic tap from a hemorrhage
- Amount of blood decreases b/w each successive tube
- Clotting
- Clear supernatant
Describe how to differentiate a hemorrhage from a traumatic tap
- Tubes are equally bloody
- Clotting is rare
- Pink, orange, or yellow supernatant
Significance of increased lymphs in body fluids
- Viral infections
- Mycobacterial, syphilitc, and leptospiral meningitis
- MS
- Guillian-Barre (autoimmune)
- Polyarteritis (autoimmune)
Found in tissues from hemoglobin and is chemically similar to bilirubin
Hematoidin
Rare finding the CSF; drug used for prophylaxis and treatment of meningeal leukemias; crystallized in a liposome which is destroyed by staining
Cytarabine crystals
Benign cells
- Size
- Staining
- Mitotic figures
- Nuclei shape
- Nucleoli
- Clumping
- Size: occasionally large; low N/C ratio
- Staining: light to dark
- Mitotic figures: Rare
- Nuclei shape: round to oval; nuclei uniform size w/ various amts of cytoplasm
- Nucleoli: Small if present
- Clumping: may have “windows”
Malignant cells
- Size
- Staining
- Mitotic figures
- Nuclei shape
- Nucleoli
- Clumping
- Size: Very large; high N/C ratio
- Staining: very basophilic
- Mitotic figures: Several
- Nuclei shape: irregular or even bizarre nuclear shape; disintegrated at edges; various sizes and shapes of nuclei
- Nucleoli: Large and prominent
- Clumping: no “windows”
Advantages of cytocentrifuge preparations for body fluids
- Concentrates cells when only a few WBC present
- Provides small area to search for tumor cells or indication of infection
- Provides permanent slide for file
Disadvantages of cytocentrifuge preparations for body fluids
- Requires special equipment - Cell integrity often compromised
