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Mercy CLS 7/8: Coagulation/Body Fluids > Body fluids—Chemistry, serous, synovial > Flashcards

Body fluids—Chemistry, serous, synovial Flashcards

1
Q

most common chemical tests performed on CSF

A
  • glucose
  • protein
  • IgG
  • CSF electrophoresis
  • myelin basic proteins
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2
Q

CSF protein RR

A

15-45 mg/dL
0.6% concentration of serum

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3
Q

—– protein identifies fluid as CSF

A

TAU

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4
Q

major Ig in CSF

A

IgG

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5
Q

3 proteins absent from CSF

A

IgM
fibrinogen
beta lipoprotein

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6
Q

causes of ↓ CSF protein

A
  • leakage/trauma
  • water intoxication
  • rapid CSF production
  • recent puncture
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7
Q

causes of ↑ CSF protein

A
  • damage or inflammation of meninges
  • infection
  • trauma
  • neoplasms
  • cerebral infarction
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8
Q

CSF protein >500 mg/dL

A

bacterial meningitis

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9
Q

volume CSF taken depends on…

A

patient volume
opening pressure

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10
Q

CJD testing CSF sample handling

A

-80° freezer

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11
Q

primary and secondary CSF proteins

A

albumin
prealbumin

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12
Q

major CSF beta globulin

A

transferrin

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13
Q

TAU

A

carbohydrate-deficient transferrin
seen in CSF, not in blood
used to identify CSF

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14
Q

higher CSF protein values found in…

A

infants
people over 40

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15
Q

2 major techniques for measuring CSF protein

A

turbidity production
dye-binding ability

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16
Q

CSF/serum albumin index is used for…

A

BBB integrity
<9: intact BBB

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17
Q

CSF/serum albumin index

A

CSF albumin (mg/dL)/serum albumin (g/dL)

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18
Q

2 causes of elevated IgG in CSF

A
  • increased production (MS)
  • leakage (damaged BBB)
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19
Q

IgG index RR

A

0.25-0.85

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20
Q

IgG index

A

(CSF IgG)(serum albumin)/(serum IgG)(CSF albumin)

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21
Q

↑ IgG index

A

local production of IgG
MS

BBB is not damaged

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22
Q

↓ IgG index

A

strokes
tumors
meningitis

BBB is damaged

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23
Q

IgG index values >—— indicate IgG production within the CNS

A

0.70

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24
Q

bands in the gamma region of CSF electrophoresis

derived from clones of immunocompetent cells

A

oligoclonal bands

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25
Q

oligoclonal bands in CSF
no bands in serum

A

MS

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26
Q

oligoclonal bands in CSF and serum

A
  • leukemia/lymphoma
  • HIV
  • viral infection
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27
Q

represent inflammation in the CNS

A

oligoclonal bands

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28
Q

Presence in CSF indicates recent demyelination

A

myelin basic proteins (MBPs)

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29
Q

used to monitor MS course/tx

A

MBP

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30
Q

↑ gamma globulins in CSF due to Bence Jones proteins crossing BBB

A

MM

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31
Q

CSF glucose RR

A

60-70% plasma glucose

around 40-70 mg/dL

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32
Q

CSF glucose procedure

A

draw plasma glucose 2 hours prior for comparison

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33
Q

pellicle

A

a delicate cobweb clot in CSF seen in tubercular meningitis

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34
Q

Decreased CSF glucose values are caused primarily by…

A
  • alterations in the mechanisms of glucose transport across thee BBB
  • increased use of glucose by the brain cells
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35
Q

normal CSF WBCs

A

0-5/uL

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36
Q

CSF lactic acid RR

A

10-24 mg/dL

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37
Q

pellicle formation due to…

A

marked increase of proteins

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38
Q

use of CSF lactic acid

A
  • Diagnosis and management of meningitis
  • Monitor head injuries
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39
Q

CSF ——— will fall rapidly when meningitis tx is successful

A

lactic acid

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40
Q

false increase of CSF lactic acid

A

hemorrhagic specimens or traumatic tap

RBCs have lactate

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41
Q
  • markedly ↓ CSF glucose
  • lactate >35
  • WBC >50
  • ↑ % neuts
A

bacterial meningitis

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42
Q
  • normal CSF glucose
  • normal lactate
  • WBC >50
  • ↑ % lymphs
A

viral meningitis

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43
Q
  • ↓ CSF glucose
  • lactate >25
  • WBC >50
  • ↑ % lymphs
A

tubercular meningitis

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44
Q
  • normal CSF glucose
  • lactate >25
  • WBC >50
  • ↑ % lymphs
A

fungal meningitis

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45
Q

if CSF has <50 WBCs…

A

think about degenerative neurologic disorders

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46
Q

CSF glutamine RR

A

8-18 mg/dL

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47
Q

function of glutamine

A

produced by brain cells from ammonia + 𝛼-ketoglutarate

serves to remove toxic ammonia from CNS

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48
Q

glutamine preferred over ammonia because…

A

ammonia is volatile

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49
Q

CSF glutamine > —— correlates with coma

A

35

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50
Q

causes of ↑ CSF glutamine

A
  • Reye’s syndrome
  • liver disease
  • disturbance of consciousness
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51
Q

3 serous cavities of body

A
  • pleural
  • pericardial
  • peritoneal
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52
Q

2 serous membranes

A

parietal
visceral

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53
Q

fluid buildup in serous cavities

A

effusion

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54
Q

main causes of effusions

A
  • CHF increasing BP
  • hypoproteinemia decreasing oncotic pressure
  • inflammation increasing capillary permeability
  • infection
  • malignancy
  • lymphatic obstruction
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55
Q

2 types of effusions

A

transudate
exudate

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56
Q

fluid accumulation due to a systemic disease affecting filtration/reabsorption balance

A

transudate

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57
Q

fluid accumulation due to disorders involving the membrane surfaces

A

exudate

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58
Q

characteristics of transudates

A

Transudates
- transparent
- fluid:serum protein <0.5
- WBC <1000
- no spontaneous clotting
- serum-ascites albumin gradient >1.1

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59
Q

characteristics of exudates

A

Exudates
- cloudy
- fluid:serum protein >0.5
- WBC >1000
- spontaneous clotting possible
- serum-ascites albumin gradient <1.1

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60
Q

(transudates/exudates) usually require less testing

A

transudates

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61
Q

3 types of needle aspirations of serous fluid

A
  • thoracentesis
  • pericardiocentesis
  • paracentesis
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62
Q

types of tubes of serous fluid drawn

A
  • EDTA: hematology
  • sterile heparinized/SPS: micro, cytology
  • clotted/heparin: chemistry, serology
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63
Q

——— fluid specimens for pH are STAT and should be maintained anaerobically

A

serous

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64
Q

the ——– cavity is not a true cavity but becomes one when a disease state is present

A

pleural

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65
Q

causes of PE transudates

A
  • CHF
  • nephrotic syndrome
  • cirrhosis
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66
Q

causes of PE exudates

A
  • infection
  • pulmonary infarction
  • pancreatitis
  • SLE
  • RA
  • cancer
  • trauma
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67
Q

2 types of milky PE and their causes

A
  • chylous: triglycerides; thoracic duct leaking; stain with sudan III
  • psudeochylous: cholesterol; chronic inflammatory condition
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68
Q

how to differentiate 2 causes of bloody PE

A
  • Hemothorax (trauma): Hct >50% or >blood Hct
  • Hemorrhagic effusion (membrane damage): Hct <50% or similar to blood Hct
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69
Q

brown PE

A

rupture of amoebic liver abscess

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70
Q

black PE

A

aspergillus

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71
Q

viscous PE

A

malignant mesothelioma (↑ hyaluronic acid)

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72
Q

↓ glucose in PE

A
  • RA
  • purulent infection
73
Q

↑ lactate in PE

A

bacterial infection

74
Q

↓ pH in PE

A
  • pneumonia not responding to antibiotics
  • esophageal rupture (pH <6.0)
75
Q

↑ ADA in PE

A
  • tuberculosis
  • malignancy
76
Q

↑ amylase in PE

A
  • pancreatitis
  • esophageal rupture
  • malignancy
77
Q

pH of PE <7.0 indicates…

A

need for chest tubes

78
Q

Carcinoembryonic antigen

A

GI malignancy

79
Q

CA125

A

uterine and ovarian malignancy

80
Q

causes of pericardial transudates

A
  • autoimmune disorders
  • uremia
  • hypothyroidism
81
Q

causes of pericardial exudates

A
  • infection
  • MI
  • cancer
  • trauma
82
Q

amount of pericardial serous fluid

A

10-50 mL

83
Q

causes of bloody pericardial fluid

A
  • accidental puncture
  • misuse of anticoags
84
Q

suspected when cardiac tamponade (compression) is heard by physician

A

pericardial effusion

85
Q

WBC >1000 and high % neuts in pericardial fluid

A

bacterial endocarditis

86
Q

acid fast stain and adenosine deaminase

A

tubercular effusion

87
Q

peritoneal effusion

A

ascites

88
Q

causes of peritoneal transudates

A
  • CHF
  • nephrotic syndrome
  • cirrhosis
89
Q

causes of peritoneal exudates

A
  • peritonitis (infection)
  • neoplasms
  • pancreatitis
  • trauma
90
Q

recommended over fluid:serum protein and LD ratios to detect peritoneal transudates of hepatic origin

A

serum-ascites albumin gradient (SAAG)

91
Q

SAAG >1.1

A

peritoneal transudate of hepatic origin

92
Q

SAAG <1.1

A

exudative peritoneal effusions

93
Q

normal saline introduced into peritoneal cavity

detect abdominal injuries

A

peritoneal lavage

94
Q

SAAG =

A

serum albumin - fluid albumin

95
Q

RBC count >——— from peritoneal lavage indicates blunt trauma

A

100,000

96
Q

eos in peritoneal lavage

A

allergic reactions to equipment
air in the cavity

97
Q

normal WBC in peritoneal fluid

A

<500

98
Q

green peritoneal fluid

A

bile, gallbladder, pancreatic disorders

99
Q

↑ BUN/creatinine in peritoneal fluid

A

ruptured or punctured bladder

100
Q

↑ ALP in peritoneal fluid

A

intestinal perforation

101
Q

movable joints

A

diarthroses/synovial

102
Q

functions of synovial fluid

A
  • prevents friction
  • absorbs shock of joint compression
  • provides nutrients to cartilage
103
Q

excluded from synovial fluid

A

HMW proteins

104
Q

cells that secrete synovial fluid

A

synoviocytes

105
Q

contribute to viscosity of synovial fluid

A

polymerization of hyaluronic acid
some protein

106
Q

4 classifications of arthritis

A
  1. Noninflammatory: degenerative, osteoarthritis
  2. Inflammatory: immunologic, lupus erythematosus (LE), rheumatoid arthritis (RA), Lyme disease, crystal-induced (gout and pseudogout)
  3. Septic: microbial infection
  4. Hemorrhagic: trauma, tumors, coagulation deficiencies
107
Q

normal viscosity of synovial fluid

A

able to form a 4-6 cm string

108
Q

normal synovial fluid WBC

A

<200

109
Q

normal synovial fluid neuts

A

<25%

110
Q

normal synovial fluid glucose

A

<10 mg/dL lower than BG

111
Q

normal synovial fluid total protein

A

<3 g/dL

112
Q

needle aspiration of synovial fluid

A

arthrocentesis

113
Q

normal amount of knee synovial fluid collected

A

3.5 mL

114
Q

tubes collected for synovial fluid

A
  • sterile heparinized/SPS: micro
  • liquid EDTA (no powdered): hematology
  • heparinized/clotted: other tests
  • sodium fluoride: glucose (ideally)
115
Q

test synovial fluid STAT to avoid…

A

cellular lysis
changes in crystals

116
Q

used to assess hyaluronate polymerization in synovial fluid

A

Ropes/mucin clot test

add 2-5% acetic acid
normal fluid forms a solid clot

117
Q

Ropes test results

A
  • good - solid clot
  • fair - soft clot
  • low - friable clot
  • poor - no clot
118
Q

can ID fluid as synovial

A

add acetic acid
normally forms a clot

119
Q

main crystals found in synovial fluid

A
  • monosodium urate (MSU) in gout
  • calcium pyrophosphate dihydrate (CPPD) in pseudogout
120
Q

causes of MSU crystals in synovial fluid

A
  • impaired purine metabolism
  • high purine foods
  • leukemia chemo
  • decreased renal excretion of uric acid
121
Q

causes of CPPD in synovial fluid

A
  • degenerative arthritis
  • elevated Ca++
122
Q

crystals from calcified cartilage degeneration

A

hydroxyapatite
calcium phosphate

123
Q

crystals from RA, SLE

A

cholesterol

124
Q

crystals following knee injections

A

corticosteroid

125
Q

crystals in renal dialysis pts

A

CaOx

126
Q

artifacts that may be found in synovial fluid

A
  • starch
  • powdered anticoags
  • dust
  • scratches
  • polyethylene fragments from artificial joints
127
Q

where can crystals be found in synovial fluid?

A

extracellular, intracellular, or both

128
Q

ability to refract light in 2 directions

A

birefringent

129
Q

magnified birefringent images appear bright or colored against black background

A

polarizing microscopy

130
Q

MSU crystal characteristics

A
  • needle shaped
  • intracellular and extracellular
  • negative birefringence
  • slow vibration: yellow; more intense than CPPD
  • fast vibration: blue; more intense than CPPD
131
Q

CPPD crystal characteristics

A
  • rod, needle or rhombic shaped
  • intracellular and extracellular
  • positive birefringence
  • slow vibration: blue; less intense than MSU
  • fast vibration: yellow; less intense than MSU
132
Q

used to observe birefringence of crystals

separates light ray into fast and slow moving vibrations

A

red compensator crystal

133
Q

the compensator aligns crystals with the —— vibration

A

slow

134
Q

cholesterol crystals characteristics

A
  • notched rhombic plates
  • extracellular
  • negative birefringence unless stacked
135
Q

corticosteroid crystal characteristics

A
  • flat, variably shaped plates
  • primarily intracellular
136
Q

MSU molecules run ——– to the long axis, aligned with slow vibration; fast light is impeded, producing a ——— color (negative birefringence)

A

parallel
yellow

137
Q

CPPD molecules run ——— to long axis and impede the slow light producing a ——– color (positive birefringence)

A

perpendicular
blue

138
Q

why is chemical testing not considered clinically important on synovial fliud?

A

ultrafiltrate of plasma – approximately the same chemically

139
Q

↑ lactic acid in synovial fluid

A

septic arthritis caused by GPC and GNR

140
Q

↓ lactic acid in synovial fluid

A

arthritis caused by Ngon

141
Q

synovial fluid lactic acid >—— mmol/L (—- mg/dL) indicate an immediate tx onset

A

9
81

142
Q

used to monitor severity and prognosis of RA

A

enzymes in synovial fluid

143
Q

used to monitor extent of joint inflammation

A

CRP and fibrinogen in synovial fluid

144
Q

Borrelia Ab in synovial fluid

A

Lyme

145
Q

ultrafiltrate of serum

A

no additional material from membrane cells

serous fluid

146
Q

serous fluid production through ——– membrane

reabsorption into lymphatic system through ———– membrane

A

parietal
visceral

147
Q
A
148
Q

blood sample should be drawn at the same time as ——- fluid

A

serous

149
Q

most significant test on pleural fluid

A

diff

150
Q

normal cells in pleural fluid

A
  • lymphs
  • mesothelial cells
151
Q

large
round with round nucleii
blue cytoplasm, dark chromatin
may resemble lymphs, plasmas and malignants

A

mesothelials

152
Q

mesothelials can become…

A

macros

153
Q

eos in pleural fluid

A
  • trauma (air or blood in cavity)
  • allergic reaction
  • parasitic infection
154
Q

characteristics of reactive mesothelials

A
  • clusters
  • varying amounts of cytoplasm
  • eccentric nuclei
  • prominent nucleoli
  • can be giant and multinucleated
155
Q

characteristics of malignant cells that differentiate them from mesothelials

A
  • nuclear irregularities
  • vacuoles in cytoplasm, nucleus
  • hyperchromatic nucleoli
  • clumps with cytoplasmic molding
  • high N:C ratio
156
Q

important exam for pericardial fluid

A

cytologic exam for malignant cells

157
Q

frequently encountered malignant cells in pericardial fluid

A
  • metastatic lung carcinoma
  • breast carcinoma
158
Q

most common cause of ascitic transudate

A

hepatic disorders

159
Q

origins of peritonitis

A
  • perforation of intestine
  • ruptured appendix
160
Q

special macrophages that may be found in peritoneal fluid

A

lipophages

161
Q

contain concentric striations of collagen-like material

A

psammoma bodies

162
Q

↑ Ca++ in fluid
seen in benign conditions, and ovarian and thyroid cancer

A

psammoma bodies

163
Q

used to thin synovial fluid for analyzer

A

hyaluronidase

164
Q

no additives in synovial fluid for…

A

crystal analysis

165
Q

never used as diluent for synovial fluid

used instead

A

acetic acid (clots)

saline

166
Q

when to dilute synovial fluid for cell count

A

when it is not transparent

167
Q

normal WBC in synvoial fluid

A

<200

168
Q

normal cells in synovial fluid

A
  • monos/macros
  • synovial lining cells (same as mesothelials)
169
Q

indicates septic arthritis

A

↑ neuts in synovial fluid
often pyknotic

170
Q

indicates non-septic inflammation in joints

A

↑ lymphs in synovial fluid

171
Q

neutrophils in synovial fluid with cytoplasmic blue granules filled with RF immune complexes

A

ragocytes

found in RA

172
Q

macrophages in synovial fluid with ingested neutrophil

A

Reiter cells

Reiter syndrome, nonspecific inflammation

173
Q

3 signs of Reiter syndrome

A
  • red eyes
  • urinary tract problems
  • arthritic (overactive macros)
174
Q

very dark pink cells in synovial fluid

A

chondrocytes

175
Q

many chondrocytes

A

osteoarthritis

176
Q

neutrophil in synovial fluid with ingested “round body”

A

LE cell

found in SLE, RA

177
Q

how to count cells on amniotic fluid

A

count all nucleated cells (WBCs + SECs)

178
Q

normal cell to see in amniotic fluid

A

SEC

Mercy CLS 7/8: Coagulation/Body Fluids (9 decks)

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