Body Fluids: CSF,Pleural,Ascites,Synovial Flashcards
CSF: Pink Xanthochromia indicates what?
Free hemoglobin
-Subarachnoid hemorrhage
CSF: Yellow Xanthochromia indicates what?
Bilirubin derived from Hg metabolism
Following a CNS bleed, when is yellow xanthochromia seen?
12 hours
-Peaks at 72 hours
Disappears in 2-4 weeks
What two findings provide evidence of a truly bloody spinal tap?
- Erythrophagocytosis
- Hemosierin laden macrophages
What is the normal CSF protein level?
15-45 mg/dL
When the blood brain barrier is intact, what is the CSF:Serum Albumin ratio?
<1:230
What is the Light Criteria (Transudative Vs Exudative Pleural Effusion)?
Transudative Vs Exudative Pleural Effusion:
- Pleural fluid: Serum protein ratio >0.5
- Pleural fluid: Serum LD ratio >0.6
- Pleural fluid >2/3 of the upper limit of normal for serum LD
*Presence of any criterion = Exudate
What usually causes Transudative pleural effusion? (3)
- Congestive Heart Failure
- Cirrhosis
- Nephrotic syndrome
What causes Exudative pleural effusions?
Essentially everything EXCEPT:
- CHF
- Cirrhosis
- Nephrotic syndrome
Chylous effusions (chylothorax) are caused by what?
Lymphatic (thoracic duct) obstruction
Pseudochylous effusions are caused be what?
Gradual accumulation of lipids from cellular breakdown:
- TB
- Rheumatoid
- Myxedema
Chylous Vs. Pseudochylous Effusions:
-Triglycerides
Triglycerides:
- Chylous - >110 mg/dL
- Psuedochylous - <50 mg/dL
Chylous Vs. Pseudochylous Effusions:
-Chylomicrons (by electrophoresis)
Chylomicrons (by electrophoresis):
- Chylous - PRESENT
- Psuedochylous - Absent
What is true regarding Pleural Effusions caused by CHF?
- Treated effect
- Location/Size
- Transudate may be “converted” to Exudate following treatment
- Larger, or confined to RIGHT Hemithorax
What is elevated in TB associated pleural effusions?
Adenosine Deaminase (ADA)
What % of PEs are asociated with pleural effusions?
50%
In what conditions are Mesothelial cells conspicuously decreased or absent in pleural fluid microscopy? (3)
- Rheumatoid pleuritis
- TB pleuritis
- Postpleurodesis pleuritis
What cells may be found in pleural fluid if there has been prior instrumentation or introduction of air into the pleural space?
Eosinophils
What is the most useful index for distinguishing portal HTN related ascites from others?
Serum Ascites Albumin gradient
-Difference between the albumin measured in serum and that mesured in ascites fluid
In portal HTN, what is the serum Ascites Albumin concentration?
> 1.1 g/dL
What is the synovial fluid chemistry pattern in Septic Arthritis?
- Glucose
- pH
- Lactate
*Similar findings seen in what conditions?
- Glucose - Low
- pH - Low (Acidic)
- Lactate - High
*RA and Gout
What crystals are found in Gout?
Monosodium Urate crystals
Gout (monosodium urate) crystal morphology. (3)
- Needle shaped Rods
- 2-20 um in length
- Negative Birefringence (Strong)
What does Negative Birefringence mean?
*GOUT
Crystal appears Yellow when Parallel to compensator
-Blue when perpendicular
What crystals are seen in Pseudogout?
Calcium Pyrophosphate crystals
Calcium Pyrophosphate Deposition Disease (Pseudogout) crystal morphology. (3)
- Rods/Rhomboids
- 2-20 um
- Positive Birefringence (Weak)
What does Positive Birefringence mean?
*Pseudogout
Crystal appears Blue when Parallel to compensator
-Yellow when perpendicular
