Case Study- Serous Body Fluids

Question 1

Ascites fluid was obta i ned on a patient who had a fever and painful abdominal distention. The fluid a ppea red cloudy and amber. The cell cou nt was RBCs 20,000/L and WBCs 5,000/L. The d ifferential was neutrophils 70%, lymphocytes 25%, monocytes 5%, and an occasional mesoth elial cel l. Figure 13 - 21 represents the smear from this specimen .

1. From which body cavity was this fluid obtained?
2. Classify this effusion as transudate or exudate. Explain the basis for the classification.
3. Which microorganism is most likely present in this fluid?
4. What tests should be done to determine whether there has been an intestinal perforation?

Answer 1

1. From which body cavity was this fluid obtained?
   =>Peritoneum or abdomen
2. Classify this effusion as transudate or exudate. Explain the basis for the classification.
   => Exudate based on cell count.
3. Which microorganism is most likely present in this fluid?
   => Escherichia coli
4. What tests should be done to determine whether there has been an intestinal perforation?
   => Alkaline phosphatase

Question 2

Case 13·2 A pleural fluid was obta i ned on a patient in the emergency department. lt a ppeared milky and shimmery. The cell
count showed no RBCs and WBCs 50/L with nearly 1 00% lymphocytes. The cell count was d ifficult to perform beca use of other objects present on the hemocytometer. Figure 13-22 shows these objects.

1. What are the obj ects that made the WBC count difficult to
   perform?
2. Explain the correlation between the macroscopic appearance of this fluid and the microscopic findings.
3. What tests can be performed to determine whether this
   effusion is due to trauma or is a chronic condition?

Answer 2

1. What are the obj ects that made the WBC count difficult to perform?
   => Cholesterol crystals
2. Explain the correlation between the macroscopic appearance of this fluid and the microscopic findings.
   => A milky appearance occurs when many WBCs are present. However, in this case the WBC count is low. Another cause for milky pleural fluid is cholesterol. The crystalline form of cholesterol contributes to the shimmery appearance of the fluid as the crystals reflect light when floating in the specimen.
3. What tests can be performed to determine whether this effusion is due to trauma or is a chronic condition?
   => Tests such as color & clarity, cell counts, and glucose can be used to differentiate between transudates and exudates.