Joint Fluid Analysis - Parks Flashcards
What three things should you inspect joint fluid for visually?
Color
Viscosity
Turbidity
What two things should you do ala bacteriology to a joint fluid sample?
gram stain and culture
What three things should you use with the microscope to view joint fluid?
wet films
cell stains
polarized light
(blank) is a brown-orange-yellow color that indicates old degenerating red cells from a previous hemorrhage
xanthochromia
Cloudy joint fluid is full of (blank and blank)
neutrophils and protein
Why can an aspirate be both bloody and purulent?
the inflammation is necrosing the cells and releasing blood
What does a WBC <2000 tell you?
you have a non-inflammatory infiltrate
What does a WBC 2000-75k tell you?
You have an inflammatory infiltrate that could be septic arthritis and needs further eval. Likely to be gout or RA
What does a WBC >100k tell you
definite septic arthritis!
What does a PMN >50% tell you?
some type of inflammatory infiltrate, check for septic arthritis
What does a PMN less than 50 tell you?
probably not inflammatory
T/F: Even with a white count of 75k the joint culture may still be negative
true
What kinds of diseases will you see with a WBC 2000-75k?
RA gout pseudogout reactive arthritis (Reitter's disease) ankylosing spondylitis rheumatic fever TB
What kinds of diseases will you see with a WBC <2000?
Degenerative joint disease/osteoarthritis
trauma
subsidiing or EARLY inflammation
T/F: bacterial infections from anywhere in the body may seed hematogenously to the joints
true
T/F: you can have septic arthritis without any redness or heat
true
T/F: when tapping a joint, take out as much fluid as possible
true
T/F: uncaught septic arthritis can lead to major bone and cartilage destruction
true
What two other diseases besides septic arthritis can have a purulent looking tap?
gout and RA; but always think septic first
What are the two ways that gout causes tissue injury and inflammation?
- uric acid crystal uptake by PMNs causes them to lyse and release lysosomal contents
- uric crystal uptake by PMNs causes release of proinflammatory cytokines
WHich cytokines are released by PMNs in gout?
TNFa
IL6
IL1
IL8
release of LTB4, free radicals, and (blank) from the injured joint brings more PMNs into the gouty area
prostaglandins
Is a stat uric acid level sufficient for diagnosing gout?
No, you need to look under them microscope. Can have gout without systemic uricemia
What shape are gout cyrstals?
needle like
