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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
Q

Finding for hemorrhage arthritis vs traumatic aspiration

A

Bloody

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26
Q

Finding for bacterial infection

A

Greenish

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27
Q

Finding for normal 4-6 cm string formation. Absent suggest bacterial infection

A

Viscosity (presence of hyaluronic acid)

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28
Q

Finding for normal: solid clot formation with acetic acid (ropes test)

A

Mucin clot for hyaluronate polymerization

29
Q

Arthritis decreases

A

Polymerization

30
Q

Normal amount of RBCs

A

<2000 per microliter

31
Q

Traumatic tap or hemorrhage effusions cause

A

Increased RBCs

32
Q

Normal amount of WBCs

A

<200 per microliter

33
Q

Bacterial arthritis can cause

A

Increased WBCs

34
Q

Used to concentrate cells and preserve morphology

A

Cytocentrifugation

35
Q

More than 80% neutrophils associated with

A

Bacterial arthritis and urate gout

36
Q

Normal amount of monocytes/macrophages, lymphocytes, and neutrophils

A

60% monocytes/macrophages, 30% lymphocytes, 10% neutrophils

37
Q

Most common types of crystals present (5)

A
  • Monosodium urate (gout)
  • calcium pyrophosphate (pseudogout seen in degenerative arthiritis)
  • cholesterol (chronic arthritic inflammation)
  • steroid injections
  • calcium based
38
Q
A

Monosodium urate (MSU) crystals

39
Q
A

Calcium pyrophosphate dihydrate (CPPD) crystals

40
Q

Wet prep or Wright stained examination for crystals

A

Light microscopy

41
Q

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

A

Polarizing microscopy for birefringence

42
Q

Examination for crystals:

ID crystal based on the velocity of light rays passing through the crystal’s grain (axis): positive or negative

A

Quartz red line compensator

43
Q

Characteristics of monosodium urate crystals (4)

A
  • Intra-or extracellular
  • long, thin, and needle-like, pointed ends
  • single or in bundles
  • strongly birefringent, brilliant with polarized light
44
Q

MSU Quartz red line compensator: parallel to the axis compensater=

A

Yellow color

45
Q

MSU Quartz red like compensator: perpendicular to axis compensator=

A

Blue color

46
Q

Runs parallel to the long axis, aligned with slow vibration; fast light is impeded, producing a yellow color (negative bifringence)

A

MSU molecules

47
Q

Run perpendicular to long axis and impede the slow light producing a blue color (positive bifringence)

A

CPPD

48
Q
A

MSU crystal with a plain light microscope

49
Q
A

MSU crystal with polarized light

50
Q
A

MSU crystal with quartz compensator

51
Q

Characteristics of calcium pyrophosphate (CPP) (3)

A
  • Intra- or extracellular
  • short, rectangular
  • weakly birefringent - may be difficult to see
52
Q

CPP quartz red line compensator: parallel to the axis compensator=

A

Blue color

53
Q

CPP Quartz red line compensator: perpendicular to axis compensatory =

A

Yellow color

54
Q
A

CPP crystal with a plain light

55
Q
A

CPP crystal with polarized light

56
Q
A

CPP crystal with quartz compensator

57
Q
  • notched-plate shape
  • birefringent
  • seen in chronically inflamed joints- RA
A

Cholesterol crystals

58
Q
  • Distinguish from pathogenic crystals

- Maltese cross

A

Starch particles

59
Q
A

Cholesterol crystals in joint fluid

60
Q
  • observe intracellularly on electron microscope

- tiny, needle-like crystals

A

Hydroxyapatite crystals

61
Q
  • Seen for months after steroid infections
  • no clinical significance
  • Look like MSU or CPP but yield conflicting results based on their birefringence
A

Corticosteroids

62
Q

Normal glucose amount

A

Not less than 10 mg/dL of plasma glucose

63
Q

Most frequent chemistry test

A

Glucose

64
Q

A result of variety of joint diseases; only indicates inflammatory process

A

Increased total protein

65
Q

Same levels as plasma; increased levels in fluid may cause monosodium rate (MSU) crystals

A

Uric acid

66
Q

Increased from anaerobic glycolysis in the synovium; clinical value not yet established

A

Lactate

67
Q

What test?

  • infections caused by inflammation, trauma, and systemic infections
  • gram stain and cultures are routinely performed
A

Microbiology tests

68
Q

Infections agents seen on gram stain and culture

A

Bacteria, fungi, viruses, mycobacteria

69
Q

All synovial fluid samples should be

A

Cultured

CLS 304 (8 decks)

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