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Blood II > Effusions > Flashcards

Effusions Flashcards

1
Q

Effusion

A

Accumulation of fluid within anatomic space
* pleural: thorax
* peritoneal/ascites: abdomen
* pericardial: heart

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2
Q

Pleural Effusion Removal

A

Thoracocentesis
* removal of fluid from chest
* go between 7-8th intercostal space (avoids intercostal vessel)
* do prior to taking rads - gives better vision, helps patient feel better, starts diagnostics

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3
Q

Abdominal Effusion Removal

A

Abdominocentesis
* removal of fluid from abdomen
* go right of and cranial to umbilicus (best if ultrasound guided)
* perform rads or ultrasound first - ensures fluid is there and something else is not being poked

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4
Q

Effusion Sample Collection

A
  • IV catheter placed in site (decreases trauma)
  • Use of 3-way stop-cock beneficial
  • Sedation normally not required (may be contraindicated due to being compromised)
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5
Q

Effusion Sample Testing

A
  • Place some sample into EDTA tube - prevents clotting and allows for further testing
  • Place some in No Additives tubes - culture
  • Make fresh smear directly from fluid
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6
Q

Effusion Analysis

A
  • Protein content
  • TNCC
  • Types of cells present
    (inflammatory vs neoplastic)
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7
Q

Protein Count

A

Done with Refractometer
* same way that would do with blood

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8
Q

TNCC

A

Can do either automated or manual method
* count and differentiate 100 nucleated cells
* nucleated cells: leukocytes and mesothelial cells

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9
Q

Identify Cell

A

Mesothelial Cell
* lines the body cavities
* large cells

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10
Q

Types of Fluids

A
  • Transudate
  • Modified Transudate
  • Exudate
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11
Q

Transudate
Basic

A
  • Low Protein
  • Low TNCC
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12
Q

Modified Transudate
Basic

A
  • High Protein
  • Low-Mod TNCC
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13
Q

Exudate
Basic

A
  • High Protein
  • High TNCC
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14
Q

Normal Fluid

A
  • Hard to get due to being scant amounts
  • Colorless / Clear / Odorless
  • Protein: <2.5 g/dL
  • TNCC: <3000 /uL
  • Mix of macrophages, lymphocytes, and mesothelial cells
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15
Q

Transudate

A
  • Large amount (or normal fluid)
  • Clear / Colorless or Red-tinged
  • Protein: <2.5 g/dL
  • TNCC: <1500 /uL
  • Mix of macrophages, lymphocytes, mesothelial cells (normal or reactive)
  • Happens when blocked blood flow or lymphatic chanel; low protein or pressure
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16
Q

Modified Transudate

A
  • Variable amount
  • Variable color, usually clear
  • Protein: 2.5-7 g/dL
  • TNCC: 1000-7000 /uL
  • Mostly lymphocytes, some mesothelial cells, non-degenerate neutrophils
  • See with chylous or lymphatic effusions
17
Q

Exudate

A
  • Variable amount
  • Turbid, white or slightly yellow
  • Protein: >3 g/dL
  • TNCC: >7000 /uL
  • Neutrophils, macrophages, lymphocytes, eosinophils
  • See with inflammation response - increasing permeability of capillaries (infection, necrosis)
18
Q

Cell Cytology

A
  • Use fresh direct sample
  • If low TNCC (<5000/uL), use fluid sediment
  • Stain slide
  • Note predominant cell type, distribution of other cell types, any microorganisms
19
Q

Neutrophil Morphology Change

A
  • Non-septic inflammation
  • Aging neutrophils
  • Septic inflammation
20
Q

Non-septic Inflammation

Neutrophil Morphology Change

A
  • Fairly normal appearance
  • Inflammation without bacteria
21
Q

Aging Neutrophils

Neutrophil Morphology Change

A
  • Hypersegmented
  • Pyknotic
22
Q

Septic Inflammation

Neutrophil Morphology Change

A
  • Bacterial infection along with inflammation
  • Neutrophils dying quickly
  • Karyolysis
23
Q

Lymphocytes

A
  • Appear as they do in blood
  • Lymphoblasts may be seen
24
Q

Identify Cell
(not myeloblasts)

A

Lymphoblasts
* Large size and nucleolus
* Not normal to be seen in effusions

25
Q

Identify Cell

A

Plasma Cells
* Similar to small lymphocytes
* Nuclear chromatin more dense
* Cytoplasm is blue and abundant
* Golgi apparatus (perinuclear clear zone)

26
Q

Identify Cell

A

Macrophage
* monocytes in blood, macrophages in tissue
* round / oval nucleus
* may have nucleolus
* light blue, usually vacuolated cytoplasm
* eat debris from surroundings and other cells; may see this or microorganisms within cell

27
Q

Lymph Node Aspirates

A

If enlarged, need to do a FNA to diagnose
* reactivity - hyperplasia or inflammation
* neoplasia - primary or metastatic

28
Q

What is this from?
Normal or Not?

A

Normal Lymph Node
* small mature lymphocytes are 3/4th TNCC
* small numbers of immature lymphocytes, lymphoblasts, and macrophages
* occasional plasma cells
* tell it is lymph tissue by the lymphoglandular bodies - small cytoplasmic fragments in background

29
Q

Identify Cell

A

Mott Cell
* “plasma cell on steroids”
* filled with immuno-globulins
* creates vacuoles

30
Q

What is this from?
Normal or Not?

A

Reactive LN
* responding to antigentic stimulation
* still mainly small mature lymphocytes
* but more medium lymphocytes, lymphoblasts, and plasma cells
* inflammatory cells may be present

31
Q

What is this from?
Normal or Not?

A

Malignant Neoplasia (Lymphoma)
* primary lymphoid neoplasia
* mainly has lymphoblasts with mitotic figures

32
Q

Normal or Not?

A

Malignant Neoplasia - Metastatic
LN Associated
* large clusters
* may see “granulation” within the cluster

33
Q

Normal or Not?

A

Malignant Neoplasia - Metastasis
LN associated
* Mast Cells
* nucleus/nucleolus within cell
* abundant cytoplasm
* small granuoles throughout

34
Q

Normal Synovial Fluid
Color and Turbidity

A
  • Light yellow color
  • Non-turbid
  • Increased turbidity caused by cells, protein, or cartilage
35
Q

Normal Synovial Fluid
Viscosity

A

Quality and concentration of hyaluronic acid (joint lubrication)
* assess prior to EDTA additive (degrades HA)
* normal: 1-2 inch before breaking
* decreased = septic or significant effusion

36
Q

Normal Synovial Fluid
Cellularity

A

90% mononuclear cells
* lymphocytes, monocytes (nonvaculated and non-phagocytic)

<10% neutrophils

37
Q

What is this from?
Normal or Not?

A

Normal synovial fluid - Background mucin
* gives eosinophilic granular background
* cells align in direction of smear (windrow)
* fluid is so viscous, cells pulled in same direction

38
Q

Synovial Fluid
Normal or Not?

A

Abnormal - infectious arthropathy
* windrow (cells pulled in one direction)
* neutrophils predominant
* culture recommended if neutrophils seen

39
Q

Synovial Fluid
Identify Cells

A

Non-Infectious Arthropathy - Rheumatoid Arthritis
* increased neurophils
* arrows: vacuolated / phagocytic macrophages
* arrowhead: lupus erythematous cells (nuclear chromatin within neutrophils)

Blood II (13 decks)

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