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CLS 304 > Chapter 14 Synovial Fluid > Flashcards

Chapter 14 Synovial Fluid Flashcards

1
Q

Fluid within joint cavities. Examined to distinguish between septic, aseptic, or degenerative changes in joints commonly seen in arthritis, gout and autoimmune diseases

A

Synovial fluid

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2
Q

Label the missing terms

A
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3
Q

Functions of synovial fluid (3)

A
  • Provides lubrication in joints
  • provides nutrients to articulate cartilage
  • reduces shock of joint compression during strenuous activities
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4
Q

Formation of synovial fluid (3)

A
  • Ultrafiltrate of plasma across synovial membrane
  • synoviocytes line membrane and secrete hyaluronate, the major contributor to viscosity and synthesizes collagenases for phagocytic activity
  • normal amount in knee cavity <3.5 mL and does not clot
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5
Q

Needle aspiration for collection

A

Arthrocentesis

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6
Q

Fluid amount if inflamed

A

> 25 mL

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7
Q

Normal fluid vs. Diseased fluid

A

Normal does not clot, diseased clots

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8
Q

Normal knee fluid amount

A

3.5 mL

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9
Q

Collect in what tube for microbiology

A

Sterile heparinized

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10
Q

Collect in what tube for hematology

A

Liquid EDTA

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11
Q

Collect in what tube for glucose

A

Sodium fluoride

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12
Q

Test ASAP to avoid

A

Cellular lysis and changes in crystals

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13
Q

3 tubes used for collect: tube 1

A

No anticoagulant tube for chemical and immunologic studies

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14
Q

3 tubes used for collect: tube 2

A

Anticoagulant tube for microscopic studies

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15
Q

3 tubes used for collect: tube 3

A

Sterile anticoagulant tube for microbiological studies

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16
Q

What are the tests performed (6)

A
  • Appearance and viscosity
  • WBC and differential count
  • crystal analysis: compensated polarizing microscopy
  • microbiology: gram stain and culture
  • chemistry: glucose, protein, uric acid
  • serology: antigen-antibody, inflammation markers
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17
Q

Group?

  • degenerative joint disorders
  • osteoarthritis
  • traumatic arthritis
A

Noninflammatory

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18
Q

Group?

-Immunologie disorders, rheumatoid arthritis, lupus, Lyme arthritis, crystal induced gout and pseudogout

A

Inflammatory

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19
Q

Group?

- microbial infection

A

Septic/infections

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20
Q

Group?

  • traumatic injury, tumors, hemophilia, other coagulation disorders, anticoagulant overdose
  • Joint prosthesis
A

Hemorrhagic

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21
Q

Finding for normal fluid

A

Colorless to pale yellow <3.5 mL

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22
Q

Finding for WBCs and cell debris. Rice bodies (collagen particles)

A

Turbidity

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23
Q

Finding for inflammation

A

Yellow

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24
Q

Finding for crystals

A

Milky

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25
Finding for hemorrhage arthritis vs traumatic aspiration
Bloody
26
Finding for bacterial infection
Greenish
27
Finding for normal 4-6 cm string formation. Absent suggest bacterial infection
Viscosity (presence of hyaluronic acid)
28
Finding for normal: solid clot formation with acetic acid (ropes test)
Mucin clot for hyaluronate polymerization
29
Arthritis decreases
Polymerization
30
Normal amount of RBCs
<2000 per microliter
31
Traumatic tap or hemorrhage effusions cause
Increased RBCs
32
Normal amount of WBCs
<200 per microliter
33
Bacterial arthritis can cause
Increased WBCs
34
Used to concentrate cells and preserve morphology
Cytocentrifugation
35
More than 80% neutrophils associated with
Bacterial arthritis and urate gout
36
Normal amount of monocytes/macrophages, lymphocytes, and neutrophils
60% monocytes/macrophages, 30% lymphocytes, 10% neutrophils
37
Most common types of crystals present (5)
- Monosodium urate (gout) - calcium pyrophosphate (pseudogout seen in degenerative arthiritis) - cholesterol (chronic arthritic inflammation) - steroid injections - calcium based
38
Monosodium urate (MSU) crystals
39
Calcium pyrophosphate dihydrate (CPPD) crystals
40
Wet prep or Wright stained examination for crystals
Light microscopy
41
Examination for crystals: Ability to refract light rays: fixed light above, rotating filter (polarizer) below. Both filters allow light to pass in only 1 direction No light can pass = dark field Birefringent material is seen as bright particle or crystal
Polarizing microscopy for birefringence
42
Examination for crystals: | ID crystal based on the velocity of light rays passing through the crystal’s grain (axis): positive or negative
Quartz red line compensator
43
Characteristics of monosodium urate crystals (4)
- Intra-or extracellular - long, thin, and needle-like, pointed ends - single or in bundles - strongly birefringent, brilliant with polarized light
44
MSU Quartz red line compensator: parallel to the axis compensater=
Yellow color
45
MSU Quartz red like compensator: perpendicular to axis compensator=
Blue color
46
Runs parallel to the long axis, aligned with slow vibration; fast light is impeded, producing a yellow color (negative bifringence)
MSU molecules
47
Run perpendicular to long axis and impede the slow light producing a blue color (positive bifringence)
CPPD
48
MSU crystal with a plain light microscope
49
MSU crystal with polarized light
50
MSU crystal with quartz compensator
51
Characteristics of calcium pyrophosphate (CPP) (3)
- Intra- or extracellular - short, rectangular - weakly birefringent - may be difficult to see
52
CPP quartz red line compensator: parallel to the axis compensator=
Blue color
53
CPP Quartz red line compensator: perpendicular to axis compensatory =
Yellow color
54
CPP crystal with a plain light
55
CPP crystal with polarized light
56
CPP crystal with quartz compensator
57
- notched-plate shape - birefringent - seen in chronically inflamed joints- RA
Cholesterol crystals
58
- Distinguish from pathogenic crystals | - Maltese cross
Starch particles
59
Cholesterol crystals in joint fluid
60
- observe intracellularly on electron microscope | - tiny, needle-like crystals
Hydroxyapatite crystals
61
- Seen for months after steroid infections - no clinical significance - Look like MSU or CPP but yield conflicting results based on their birefringence
Corticosteroids
62
Normal glucose amount
Not less than 10 mg/dL of plasma glucose
63
Most frequent chemistry test
Glucose
64
A result of variety of joint diseases; only indicates inflammatory process
Increased total protein
65
Same levels as plasma; increased levels in fluid may cause monosodium rate (MSU) crystals
Uric acid
66
Increased from anaerobic glycolysis in the synovium; clinical value not yet established
Lactate
67
What test? - infections caused by inflammation, trauma, and systemic infections - gram stain and cultures are routinely performed
Microbiology tests
68
Infections agents seen on gram stain and culture
Bacteria, fungi, viruses, mycobacteria
69
All synovial fluid samples should be
Cultured

CLS 304 (8 decks)

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