CM LEC - Synovial fluid Part 2 Flashcards
most frequently performed cell
count on synovial fluid
Total leukocyte count
When is RBC count requested
when there is traumatic tap
what to do if there is a delay in processing/testing of sx
refrigerate
Very viscous fluid may be pretreated by adding
2
a pinch amount of hyaluronidase to 0.5mL of fluid OR
one drop of 0.05% hyaluronidase in PO4 buffer per mL of fluid
& incubate at 37°C for 5mins
dilution of clear fluids
none
dilution is needed in what kind of fluids (2)
bloody or turbid fluids
diluting fluid not suitable for synovial fluid cell count
traditional WBC dil. fluid or acetic acid
Traditional WBC diluting fluid cannot be used – acetic
acid will cause formation of ___
mucin clot
recommended diluent for synovial fluid cell counts
normal saline
To lyse RBCs use: (2)
hypotonic saline (0.3%) or saline that contains saponin as diluent
stain WBC nuclei permitting separation of RBCs & WBCs on mixed specimens
Methylene blue + normal saline
disadv of automated cell counters (2)
Highly viscous fluid may block the apertures
Presence of debris & tissue cells may falsely elevate
counts
differential counts must be performed on __
OR
specimen preparation used for diff count
Cytocentrifuged preparations or thinly smeared slides
in diff count, fluid should be incubated with ______ prior to
slide preparation
hyaluronidase
Primary cells seen in normal synovial fluid:
Monocytes
Macrophages
Synovial tissue cells
diff count
neutrophil %
diff count
lymphocyte %
Increased neutrophils means there is
septic condition
Increases lymphocytes = means
nonseptic inflammation
in diff count, in normal and abnormal specimen, cells may appear
more vacuolated than on a blood smear
lipid droplets may be present following ____
crash injuries
found in cases of pigmented villonodular synovitis
hemosiderin granules
Hemosiderin granules found in cases of ___
pigmented villonodular synovitis
other cell abnormalities (4)
- eosinophils
- LE cells
- Reiter cells
- RA cells or ragocytes
(vacuolated macrophages with ingested
neutrophils)
Reiter cells
(neutrophils with small, dark, cytoplasmic granules that consist of precipitated rheumatoid factor)
RA cells or ragocytes
Additional crystals present:
- basic calcium phosphate
- calcified cartilage degeneration
hydroxyapatite
Additional crystals present
following injections
corticosteroids
Additional crystals present
renal dialysis patients
calcium oxalate crystals
Crystal examination should be performed soon after fluid collection to ensure crystals are not affected by changes in (2)
temperature & pH
fluid must be examined before or after WBC disintegration
before because there is a need to report MSU & CPPD crystals as being located extracellularly & intracellularly (within neutrophils)
crystal type
needle-shaped, appears extracellularly
& within the cytoplasm of neutrophils
MSU crystals
crystal type
more highly birefringent & brighter against a dark
background
MSU crystals
crystal type
rhombic-shaped, intracellular
inclusions
CPPD crystals
most frequently requested chemical test
glucose determination
- blood & synovial fluid samples should be obtained after ??? hours of fasting to allow equilibration between the two
8
blood & synovial fluid samples should be obtained after 8hours of fasting to ???
allow equilibration between the two
