MTAP 1: AUBF Flashcards
- A.k.a Joint fluid
SINOVIAL FLUID
SINOVIAL FLUID
a.k.a
Joint fluid
SINOVIAL FLUID
Found in ____
diathroses
- Ultrafiltrate of plasma with hyaluronic acid
SINOVIAL FLUID
SINOVIAL FLUID
- Ultrafiltrate of _____ with ____
plasma
hyaluronic acid
→ It is derived from blood that is filtered by joint cavities (synovium)
hyaluronic acid
hyaluronic acid
→ It is derived from blood that is filtered by joint cavities (____)
synovium
○ The synovium is composed of ______ which produce hyaluronic acid
synoviocytes
→ ____contributes to viscosity of synovial fluid
Hyaluronic acid
SINOVIAL FLUID
- Came from the word ____ = _____
Synovia
egg white
T/F: The characteristic viscosity of synovial fluid is the same as the viscosity of egg white
TRUE
FUNCTIONS OF SYNOVIAL FLUID:
- _______
- _______________
- Provides ______ to the ______
- Lessens shock of ________ occurring during activities such as _____ and _____
Lubricates joints
Reduces friction between bones
nutrients, articular cartilage
joint compression, walking, jogging
SYNOVIAL FLUID
Method of collection: ______
Arthrocentesis
SYNOVIAL FLUID
Specimen collection
→ When collected, _______
it should NOT clot
SYNOVIAL FLUID
Specimen collection
; if it clots, there is a presence of _____ which indicates ______ or _____
fibrinogen
joint damage
disease
SYNOVIAL FLUID (Specimen Collection)
Volume:
→ Normal: _____
<3.5 mL
SYNOVIAL FLUID (Specimen Collection)
Volume:
→ Inflammation: _____
> 25 mL
SYNOVIAL FLUID (Specimen collection)
Tube distribution:
- Na Heparin (sterile)/SPS:
- Liquid EDTA/Na Heparins
- Non-anticoagulated tubes
- Sodium fluoride
SYNOVIAL FLUID (Specimen collection)
Tube distribution:
1. Na Heparin (sterile)/SPS: ________
for microbiology
SYNOVIAL FLUID (Specimen collection)
Tube distribution:
2. Liquid EDTA/Na Heparin: ______
for hematology
SYNOVIAL FLUID (Specimen collection)
Tube distribution:
○ ______ A is NOT used since it may be mistaken for ______
Powdered EDT
crystals
SYNOVIAL FLUID (Specimen collection)
Tube distribution:
3. Non-anticoagulated tubes: ______
for chemistry and other tests (serology)
SYNOVIAL FLUID (Specimen collection)
Tube distribution:
4. Sodium fluoride: ______
for glucose
SYNOVIAL FLUID
Color:
Normal
Colorless to pale yellow
SYNOVIAL FLUID
Color:
inflammation
Deeper yellow
SYNOVIAL FLUID
Color:
Bacterial infection (septic arthritis)
Greening tinge
SYNOVIAL FLUID
Color:
Traumatic tap or hemorrhagic arthritis
Red
Traumatic tap is due to the ____________________ during arthrocentesis, while hemorrhagic arthritis is bleeding in the _______
vessels beings punctured
cavity itself
TRAUMATIC TAP
Clot formation:
Dark red
(+)
TRAUMATIC TAP
Clot formation:
Light red
(-)
TRAUMATIC TAP
Clot formation:
Yellowish
(-)
HEMORRHAGIC ARTHRITIS
Clot formation:
Dark red
(-)
SYNOVIAL FLUID
Clarity:
Normal
Clear
SYNOVIAL FLUID
Clarity:
Turbid
- Leukocytes
- Fibrin
- Cell debris
SYNOVIAL FLUID
Clarity:
Radiographic contrast media (RCM)
Opaque, Oily, Shimmering
SYNOVIAL FLUID
Clarity:
Milky
Crystals
SYNOVIAL FLUID
Clarity:
Ground pepper-like inclusions
Ochronosis-degenerative bone disease
SYNOVIAL FLUID
Clarity:
Ground pepper-like inclusions a.k.a
ochronotic shards
SYNOVIAL FLUID
Clarity:
Free-floating rice bodies
- Rheumatoid arthritis
- Degenerative synovium with fibrin
SYNOVIAL FLUID
Viscosity:
* Normally, it should be able to form a string that is _____long
4-6 mm
SYNOVIAL FLUID
Viscosity:
normal hyaluronic acid level _____
0.3-0.4 g/dL
SYNOVIAL FLUID
Test for viscosity
- Ropes/Mucin Clot test
SYNOVIAL FLUID
Viscosity:
* Ropes/Mucin Clot test a.k.a ____
→ “Hyaluronate polymerization test”
SYNOVIAL FLUID (Viscocity)
Ropes/Mucin Clot test
Reagent: ______
2-5% acetic acid (HAC)
SYNOVIAL FLUID (Viscocity)
Ropes/Mucin Clot test
○ This polymerizes hyaluronic acid and forms clot
2.5% acetic acid (HAC)
SYNOVIAL FLUID (Viscocity)
Ropes/Mucin Clot test
○ 2.5% acetic acid (HAC) polymerizes _______ and forms ____
hyaluronic acid
clot
SYNOVIAL FLUID (Viscocity)
Ropes/Mucin Clot test
○ Clot = (+/-) reaction
(+) reaction
SYNOVIAL FLUID (Viscocity)
Ropes/Mucin Clot test (Reporting)
Good - _____
Solid clot
SYNOVIAL FLUID (Viscocity)
Ropes/Mucin Clot test (Reporting)
Fair - ___
soft clot
SYNOVIAL FLUID (Viscocity)
Ropes/Mucin Clot test (Reporting)
Low - ______
friable clot
SYNOVIAL FLUID (Viscocity)
Ropes/Mucin Clot test (Reporting)
Poor - ____
no clot
SYNOVIAL FLUID
Cell count:
Uses ____
hemocytometry
SYNOVIAL FLUID
Cell count:
Diluting fluids
- NSS with methylene blue
- Hypotonic saline (0.3%)
- Saline with saponin
SYNOVIAL FLUID (Cell count)
Two methods:
→ Add a pinch of ________ to _____ synovial fluid
→ Add ____drop of ________ in ________
per mL of fluid
○ Incubate at ____ for ______
hyaluronidase, 0.5 mL
one, 0.05% hyaluronidase, phosphate buffer
37°C, 5 minutes
T/F: Hypotonic saline (0.3%) and saline with saponin can both cause RBC lysis.
TRUE
They are for counting WBCs.
Hypotonic saline (0.3%)
Saline with saponin
- _______ must NOT be used for cell counting
Acetic acid
→ It polymerizes hyaluronic acid causing the SF to clot
Acetic acid
SYNOVIAL FLUID (Differential count)
RBC Normal value: _____
<2000/uL
SYNOVIAL FLUID (Differential count)
WBC Normal value: ______
<200/uL
SYNOVIAL FLUID (Differential count)
WBC Differential:
Monocytes/Macrophage Normal Value: ______
65%
SYNOVIAL FLUID (Differential count)
WBC Differential:
Neutrophils normal value: ____-
25%
SYNOVIAL FLUID (Differential count)
WBC Differential:
Lymphocytes normal value: _____
<15%
CELLS AND INCLUSIONS SEEN IN SYNOVIAL FLUID
NEUTROPHILS
Description:
Polymorphonuclear leukocytes (multilobulated)
CELLS AND INCLUSIONS SEEN IN SYNOVIAL FLUID
NEUTROPHILS
Significance:
- Bacterial sepsis
- Crystal-induced inflammation
CELLS AND INCLUSIONS SEEN IN SYNOVIAL FLUID
Mononuclear leukocytes (no lobules)
Lymphocytes
CELLS AND INCLUSIONS SEEN IN SYNOVIAL FLUID
LYMPHOCYTES
Significance:
Non-septic inflammation
CELLS AND INCLUSIONS SEEN IN SYNOVIAL FLUID
Large mononuclear monocytes, may be vacuolated
Macrophages (monocytes)
_________ are the most abundant WBC in synovial fluid
Macrophages (monocytes)
CELLS AND INCLUSIONS SEEN IN SYNOVIAL FLUID
MACROPHAGES (MONOCYTES)
Significance:
- Normal
- Increased in viral infection
CELLS AND INCLUSIONS SEEN IN SYNOVIAL FLUID
Similar to macrophage, but may be multinucleated, resembling a mesothelial cell
Synovial lining cells
CELLS AND INCLUSIONS SEEN IN SYNOVIAL FLUID
SYNOVIAL LINING CELLS
Similar to _____, but may be _____, resembling a _______
macrophage
multinucleated
mesothelial cell
CELLS AND INCLUSIONS SEEN IN SYNOVIAL FLUID
SYNOVIAL LINING CELLS
Significance:
Normal
CELLS AND INCLUSIONS SEEN IN SYNOVIAL FLUID
Neutrophil containing characteristics ingested “round body”
Lupus erythematosus cell (LE cells)
CELLS AND INCLUSIONS SEEN IN SYNOVIAL FLUID
LE CELLS
Neutrophil containing characteristics ingested _______
“round body”
CELLS AND INCLUSIONS SEEN IN SYNOVIAL FLUID
LE CELLS
Significance:
Lupus erythematosus
CELLS AND INCLUSIONS SEEN IN SYNOVIAL FLUID
Vacuolated macrophage with ingested neutrophil
Reiter cells
CELLS AND INCLUSIONS SEEN IN SYNOVIAL FLUID
REITER CELLS
Vacuolated ______ with ingested _____
macrophage
neutrophil
CELLS AND INCLUSIONS SEEN IN SYNOVIAL FLUID
REITER CELLS
Significance:
- Reiter syndrome
- Non-specific inflammation
CELLS AND INCLUSIONS SEEN IN SYNOVIAL FLUID
Neutrophil with dark cytoplasmic granules containing immune complexes
RA CELLS
RA CELLS a.k.a
Ragocytes
CELLS AND INCLUSIONS SEEN IN SYNOVIAL FLUID
RA CELLS
Neutrophil with ______ containing _______
dark cytoplasmic granules
immune complexes
CELLS AND INCLUSIONS SEEN IN SYNOVIAL FLUID
RA CELLS
Significance:
- Rheumatoid arthritis
- Immunologic inflammation
CELLS AND INCLUSIONS SEEN IN SYNOVIAL FLUID
Macroscopically resembles polished rice; Microscopically shows collagen and fibrin
Rice bodies
CELLS AND INCLUSIONS SEEN IN SYNOVIAL FLUID
RICE BODIES
(Macroscopically/Microscopically) resembles polished rice
Macroscopically
CELLS AND INCLUSIONS SEEN IN SYNOVIAL FLUID
RICE BODIES
Macroscopically resembles _____
polished rice
CELLS AND INCLUSIONS SEEN IN SYNOVIAL FLUID
RICE BODIES
(Microscopically/Microscopically shows collagen and fibrin
Microscopically
CELLS AND INCLUSIONS SEEN IN SYNOVIAL FLUID
RICE BODIES
Microscopically shows _____ and ____
collagen
fibrin
CELLS AND INCLUSIONS SEEN IN SYNOVIAL FLUID
RICE BODIES
Significance:
- Tuberculosis
- Septic and rheumatoid arthritis
CELLS AND INCLUSIONS SEEN IN SYNOVIAL FLUID
- Refractive intracellular and extracellular globules
Fat droplets
CELLS AND INCLUSIONS SEEN IN SYNOVIAL FLUID
FAT DROPLETS
* Refractive intracellular and extracellular _____
globules
CELLS AND INCLUSIONS SEEN IN SYNOVIAL FLUID
Stained with sudan dyes
Fat droplets
CELLS AND INCLUSIONS SEEN IN SYNOVIAL FLUID
FAT DROPLETS
Significance:
- Traumatic injury
- Chronic inflammation
CELLS AND INCLUSIONS SEEN IN SYNOVIAL FLUID
Inclusions within clusters of synovial cells
Hemosiderin
CELLS AND INCLUSIONS SEEN IN SYNOVIAL FLUID
HEMOSIDERIN
Significance:
Pigmented villonodular synovitis (PVNS)
SYNOVIAL FLUID (Crystal Identification)
Shape: Needles
Monosodium Urate
SYNOVIAL FLUID (Crystal Identification)
Shape: Rhombic square rods
Calcium pyrophosphate dihydrate (CPPD)
SYNOVIAL FLUID (Crystal Identification)
Shape: Notched, rhombic plates
Cholesterol
SYNOVIAL FLUID (Crystal Identification)
Shape: Flat, variable-shaped plates
Corticosteroid
SYNOVIAL FLUID (Crystal Identification)
Shape: Envelope
Calcium oxalete
SYNOVIAL FLUID (Crystal Identification)
Shape: Small particles; requires electron microscope
Hydroxyapatite/apatite
SYNOVIAL FLUID (Crystal Identification)
Hydroxyapatite a.k.a
Calcium phosphate
SYNOVIAL FLUID (Crystal Identification)
Monosodium urate
Shape: _____
Needles
SYNOVIAL FLUID (Crystal Identification)
Calcium pyrophosphate dihydrate (CPPD)
Shape: _____
Rhombic square rods
SYNOVIAL FLUID (Crystal Identification)
Cholesterol
Shape: _____
Notched, rhombic plates
SYNOVIAL FLUID (Crystal Identification)
Corticosteroid
Shape: _____
Flat, variable-shaped plates
SYNOVIAL FLUID (Crystal Identification)
Calcium oxalate
Shape: _____
Envelope
SYNOVIAL FLUID (Crystal Identification)
Hydroxyapatite/apatite a.k.a
Calcium phosphate
SYNOVIAL FLUID (Crystal Identification)
Hydroxyapatite/apatite
Shape: _____
Small particles;
SYNOVIAL FLUID (Crystal Identification)
Which crystal required Electron microscopy?
Hydroxyapatite/apatite
SYNOVIAL FLUID (Crystal Identification)
Enumerate the crystal/s with NEGATIVE birefringence
Monosodium urate (MSU)
Cholesterol
Calcium oxalate
SYNOVIAL FLUID (Crystal Identification)
Enumerate the crystal/s with POSITIVE birefringence
Calcium pyrophosphate dihydrate (CPPD)
SYNOVIAL FLUID (Crystal Identification)
Enumerate the crystal/s with BOTH positive and negative birefringence
Corticosteroid
SYNOVIAL FLUID (Crystal Identification)
Why does Corticosteroid have the ability to have both negative and positive birefringence?
Due to the variability in shape of corticosteroids
SYNOVIAL FLUID (Crystal Identification)
Enumerate the crystal/s with NO birefringence
Hydroxyapatite/apatite
SYNOVIAL FLUID (Crystal Identification)
why does Hydroxyapatite/apatite have no birefringence?
Because it is NOT visible under polarizing microscopes
SYNOVIAL FLUID (Crystal Identification)
Monosodium urate (MSU)
Significance:
Gout (inc uric acid)
SYNOVIAL FLUID (Crystal Identification)
Calcium pyrophosphate dihydrate (CPPD)
Significance:
Pseudogout
SYNOVIAL FLUID (Crystal Identification)
Calcium pyrophosphate dihydrate (CPPD)
Significance: Pseudogout (associated with _______)
degenerative arthritis
SYNOVIAL FLUID (Crystal Identification)
Cholesterol
Significance:
Extracellular
SYNOVIAL FLUID (Crystal Identification)
Corticosteroid
Significance:
Injections
SYNOVIAL FLUID (Crystal Identification)
Calcium oxalate
Significance:
Renal dialysis
SYNOVIAL FLUID (Crystal Identification)
Hydroxyapatite/apatite
Significance:
- Osteoarthritis
- Calcified cartilage degeneration
- _______ is the relationship between the velocity of ____ and the arrangement of _____.
Birefringence
light
crystals.
- Crystals appear yellow
POSITIVE BIREFRINGENCE
- Crystals appear blue
NEGATIVE BIREFRINGENCE
POSITIVE BIREFRINGENCE
- Light is _____
parallel
NEGATIVE BIREFRINGENCE
- Light is _____
perpendicular
→ Determine/detect Presence/Absence of birefringence
- Polarizing microscope
Compensated Polarizing Microscope
→ Uses _____
red compensator
→ The microscope used to detect type of birefringence.
- Compensated Polarizing Microscope
SYNOVIAL FLUID (Chemical Examination)
- Increases when SF glucose is low; because of bacterial infection
GLUCOSE
SYNOVIAL FLUID (Chemical Examination)
Significance:
* Most frequently tested chemistry test
Glucose
SYNOVIAL FLUID (Chemical Examination)
GLUCOSE
Significance:
* Blood glucose – synovial fluid glucose = _______ (normal)
<10 mg/dL
SYNOVIAL FLUID (Chemical Examination)
Significance:
* Increased in infections
Lactate
SYNOVIAL FLUID (Chemical Examination)
The byproduct of glycose during infections
Lactate
SYNOVIAL FLUID (Chemical Examination)
LACTATE
Significance:
* Normal: _______
<250 mg/dL
SYNOVIAL FLUID (Chemical Examination)
- Increased in inflammatory and hemorrhagic disorders
Protein
SYNOVIAL FLUID (Chemical Examination)
PROTEIN
Significance:
* Increased in _____ and _______ disorders
inflammatory
hemorrhagic
SYNOVIAL FLUID (Chemical Examination)
PROTEIN
Significance:
* Normal: _____
<3 g/dL
SYNOVIAL FLUID (Chemical Examination)
Significance:
* Increased in gout
Uric Acid
SYNOVIAL FLUID (Chemical Examination)
URIC ACID
Significance:
* Normal: ______
same as blood
SYNOVIAL FLUID (Microbiology Test)
- Common organisms that infect synovial fluid
- Staphylococcus aureus
- Streptococcus
- Haemophilus
- Neisseria gonorrhea
SYNOVIAL FLUID (Microbiology Test)
Which is the most predominant organism that infects the SF
Staphylococcus aureus
SYNOVIAL FLUID (Microbiology Test)
Which causes gonococcal arthritis?
Neisseria gonorrhea
SYNOVIAL FLUID (Serologic Tests)
- Autoantibody detection:
SLE
RF
SYNOVIAL FLUID (Serologic Tests)
Autoantibody detection:
SLE :_______
Antinuclear antibody (ANA)
SYNOVIAL FLUID (Serologic Tests)
Autoantibody detection:
RA :_______
Rf (Rheumatoid factor)
SYNOVIAL FLUID (Serologic Tests)
→ Frequent complication is arthritis
Lyme disease
SYNOVIAL FLUID (Serologic Tests)
LYME DISEASE
Caused by: _____
Borrelia burgdorferi
JOINT DISORDERS (SYNOVIAL FLUID)
Enumerate the different Group Classifications
Non-inflammatory
Inflammatory (Immunologic)
Inflammatory (Crystal-induced)
Septic
Hemorrhagic
JOINT DISORDERS (SYNOVIAL FLUID)
NON-INFLAMMATORY
Significance: ______
Degenerative joint disorder (osteoarthritis)
JOINT DISORDERS (SYNOVIAL FLUID)
INFLAMMATORY (Immunologic)
Significance: ______
Immunologic disorders (RA, SLE etc.)
JOINT DISORDERS (SYNOVIAL FLUID)
INFLAMMATORY (Crystal-induced)
Significance: ______
- Gout (MSU);
- Pseudogout (CPPD)
JOINT DISORDERS (SYNOVIAL FLUID)
SEPTIC
Significance: ______
Microbial infection
JOINT DISORDERS (SYNOVIAL FLUID)
HEMORRHAGIC
Significance: ______
- Traumatic injury
- Coagulation deficiencies
JOINT DISORDERS (SYNOVIAL FLUID)
NON-INFLAMMATORY
Color and Clarity: ______
Clear, yellow fluid
JOINT DISORDERS (SYNOVIAL FLUID)
INFLAMMATORY (Immunologic)
Color and Clarity: ______
Cloudy, yellow fluid
JOINT DISORDERS (SYNOVIAL FLUID)
INFLAMMATORY (Crystal-induced)
Color and Clarity: ______
Cloudy or milky fluid
JOINT DISORDERS (SYNOVIAL FLUID)
SEPTIC
Color and Clarity: ______
Cloudy, green fluid
JOINT DISORDERS (SYNOVIAL FLUID)
HEMORRHAGIC
Color and Clarity: ______
Cloudy, red fluid
JOINT DISORDERS (SYNOVIAL FLUID)
NON-IMFLAMMATORY
Viscosity: ______
Good
JOINT DISORDERS (SYNOVIAL FLUID)
IMFLAMMATORY (Immunologic)
Viscosity: ______
Poor
JOINT DISORDERS (SYNOVIAL FLUID)
IMFLAMMATORY (Crystal-induced)
Viscosity: ______
Low
JOINT DISORDERS (SYNOVIAL FLUID)
SEPTIC
Viscosity: ______
Variable
JOINT DISORDERS (SYNOVIAL FLUID)
HEMORRHAGIC
Viscosity: ______
Low
JOINT DISORDERS (SYNOVIAL FLUID)
NON-INFLAMMATORY
WBC Count: ______
<1,000/uL
JOINT DISORDERS (SYNOVIAL FLUID)
INFLAMMATORY (Immunologic)
WBC Count: ______
2,000-75,000/uL
JOINT DISORDERS (SYNOVIAL FLUID)
INFLAMMATORY (Crystal-induced)
WBC Count: ______
Up to 100,000/uL
JOINT DISORDERS (SYNOVIAL FLUID)
SEPTIC
WBC Count: ______
50,000-100,000/uL
JOINT DISORDERS (SYNOVIAL FLUID)
HJEMORRHAGIC
WBC Count: ______
Equal to blood
JOINT DISORDERS (SYNOVIAL FLUID)
NON-INFLAMMATORY
Neutrophils: ______
<30%
JOINT DISORDERS (SYNOVIAL FLUID)
INFLAMMATORY (Immunologic)
Neutrophils: ______
> 50%
JOINT DISORDERS (SYNOVIAL FLUID)
INFLAMMATORY (Crystal-induced)
Neutrophils: ______
<70%
JOINT DISORDERS (SYNOVIAL FLUID)
SEPTIC
Neutrophils: ______
> 75%
JOINT DISORDERS (SYNOVIAL FLUID)
HEMORRHAGIC
Neutrophils: ______
Equal to blood
JOINT DISORDERS (SYNOVIAL FLUID)
NON-INFLAMMATORY
Glucose: ______
Normal
JOINT DISORDERS (SYNOVIAL FLUID)
INFLAMMATORY (Immunologic)
Glucose: ______
Decreased
JOINT DISORDERS (SYNOVIAL FLUID)
INFLAMMATORY (Crystal-induced)
Glucose: ______
Decreased
JOINT DISORDERS (SYNOVIAL FLUID)
SEPSIS
Glucose: ______
Decreased (Increase in lactate)
JOINT DISORDERS (SYNOVIAL FLUID)
HEMORRHAGIC
Glucose: ______
Normal
JOINT DISORDERS (SYNOVIAL FLUID)
NON-INFLAMMATORY
Others: ______
N/A
JOINT DISORDERS (SYNOVIAL FLUID)
INFLAMMATORY (Immunologic)
Others: ______
Autoantibodies
JOINT DISORDERS (SYNOVIAL FLUID)
INFLAMMATORY (Crystal-induced)
Others: ______
(+) Crystals
JOINT DISORDERS (SYNOVIAL FLUID)
SEPTIC
Others: ______
(+) gram stain; (+) culture
JOINT DISORDERS (SYNOVIAL FLUID)
HEMORRHAGIC
Others: ______
(+) RBCs
Ultrafiltrate of plasma
SEROUS FLUID
- Fluid between parietal and visceral membranes
SEROUS FLUID
SEROUS FLUID
- Fluid between ______ and _____ membranes
parietal
visceral
lines the cavity wall
PARIETAL MEMBRANCE
Covers the organs
VISCERAL MEMBRANE
THREE TYPS OF SEROUS FLUIDS:
→ Pleural fluid
→ Pericardial fluid
→ Peritoneal fluid
THREE TYPS OF SEROUS FLUIDS:
→ Pleural fluid (_____)
lungs
THREE TYPS OF SEROUS FLUIDS:
→ Pericardial fluid (________)
cardiac muscles/heart
THREE TYPS OF SEROUS FLUIDS:
→ Peritoneal fluid (______)
abdominal area
SEROUS FLUID
Main function: to provide ______between _____ and __________
lubrication
parietal
visceral membranes
- Accumulation of excess fluid between the membranes
Effusion
SEROUS FLUID (Effusion)
Two types:
Transudate
Exudate
SEROUS FLUID (Effusion)
- Caused by systemic conditions
Transudate
SEROUS FLUID (Effusion)
- Caused by membrane damage
Exudate
SEROUS FLUID (Effusion)
- Affects ALL serous fluids
Transudate
SEROUS FLUID (Effusion)
- Affects ONLY ONE serous fluid
Exudate
SEROUS FLUID (Effusion)
TRANSUDATE
Causes:
- Hypoproteinemia
- Congestive heart failure
- Nephrotic syndrome
- Cirrhosis
- Malnutrition
SEROUS FLUID (Effusion)
EXUDATE
Causes:
Causes:
* Infection
→ Pneumonia (pleural)
→ TB
→ Endocarditis (Pericardial)
* Inflammation
* Malignancy (e.g., Adenoma)
T/F: The values of exudate effusions are often ‘less than’ or decreased
FALSE; The values of TRANSUDATE effusions are often ‘less than’ or decreased
- Differentiates exudates(+) from transudates(-)
Rivalta’s Test
Rivalta’s Test
a.k.a
- “Serosamucin clot test”
Rivalta’s Test
Procedure: ______
→ Unknown fluid (effusion) + water + acetic acid
Rivalta’s Test
○ If (+) heavy precipitation = (transudate/exudate)
EXUDATE
SEROUS FLUID (Specimen Collection)
PLEURAL FLUID
MOC: ________
Thoracentesis
SEROUS FLUID (Specimen Collection)
PERICARDIAL FLUID
MOC: ________
Pericardiocentesis
SEROUS FLUID (Specimen Collection)
PERITONEAL FLUID
MOC: ________
Paracentesis
SEROUS FLUID (Specimen Collection)
T/F: All three methods are different/unique on its own
FALSE; All three methods are the same and called as ‘needle aspiration’
SEROUS FLUID (Specimen Collection)
EDTA
Tests/laboratory section: ______
Cell count; differential count
SEROUS FLUID (Specimen Collection)
STERILE HEPARIN TUBE
Tests/laboratory section: ______
Microbiology; cytology
SEROUS FLUID (Specimen Collection)
HEPARIN TUBE
Tests/laboratory section: ______
Chemistry
SEROUS FLUID (Specimen Collection)
PLAIN TUBE
Tests/laboratory section: ______
Clotting test
SEROUS FLUID (Specimen Collection)
- If testing for ____, store fluid _____ in _____ during transport
pH
anaerobically
ice
- Normal volume is <30 mL
PLEURAL FLUID
PLEURAL FLUID
- Normal volume is _____
<30 mL
PLEURAL FLUID (Color)
NORMAL
Clear, pale yellow
PLEURAL FLUID (Color)
Microbial infection
Turbid, white
PLEURAL FLUID (Color)
Ruptured amoebic abscess
Brown
Type of extraintestinal amoebiasis
Ruptured amoebic abscess
PLEURAL FLUID (Color)
Brown (_________)
Anchovy-sauce like
PLEURAL FLUID (Color)
Aspergillosis
Black
PLEURAL FLUID (Color)
Malignant mesothelioma
Viscous
Produced hyaluronic acid causing viscous pleural fluid
Malignant mesothelioma
Produced hyaluronic acid causing viscous pleural fluid
Produced _______ causing viscous pleural fluid
hyaluronic acid
PLEURAL FLUID (Color)
Chylous material, pseudochylous material
Milky
PLEURAL FLUID (Color)
Hemothorax, hemorrhagic effusion
Bloody
MILKY PLEURAL FLUID
Inc. TAG
Chylous Effusion
MILKY PLEURAL FLUID
inc. CHOLE
Pseudochylous Effusion
MILKY PLEURAL FLUID
CHYLOUS EFFUSION
Cause: ____
Thoracic duct leakage
The thoracic duct is a lymphatic duct, thus, it is rich in ______ and _______
lymphocytes
chylomicrons
- Lipoproteins with high concentrations of TAG
lymphocytes
chylomicrons
MILKY PLEURAL FLUID
PSEUDOCHYLOUS EFFUSION
Cause: ____
Chronic inflammation/infection
MILKY PLEURAL FLUID
CHYLOUS EFFUSION
Appearance: ____
Milky/white
MILKY PLEURAL FLUID
PSUEDOCHYLOUS EFFUSION
Appearance: ____
Milky/green tinge/”gold paint”
MILKY PLEURAL FLUID
CHYLOUS EFFUSION
Leukocytes: ____
Lymphocytes
MILKY PLEURAL FLUID
PSEUDOCHYLOUS EFFUSION
Leukocytes: ____
Mixed cells
MILKY PLEURAL FLUID
CHYLOUS EFFUSION
Cholesterol crystal: ____
Absent
MILKY PLEURAL FLUID
PSEUDOCHYLOUS EFFUSION
Cholesterol crystal: ____
PRESENT
MILKY PLEURAL FLUID
CHYLOUS EFFUSION
TAG: ____
> 100 mg/dL
MILKY PLEURAL FLUID
PSEDOCHYLOUS EFFUSION
TAG: ____
<50 mg/dL
Primarily stains TAG
Sudan III staining
MILKY PLEURAL FLUID
CHYLOUS EFFUSION
Sudan III staining: ____
(+)
MILKY PLEURAL FLUID
PSEDOCHYLOUS EFFUSION
Sudan III staining: ____
(-)
T/F: Psuedochylous effusion can sometimes stain weakly (+) in Sudan III Staining
TRUE
BLOOD PLEURAL FLUID
Conditions:
Hemothorax
Hemorrhagic effusion
BLOOD PLEURAL FLUID
- Normal amount of pleural fluid but with blood
HEMOTHORAX
BLOOD PLEURAL FLUID
Examples of Hemothorax
Truamatic tap injury
BLOOD PLEURAL FLUID
- Due to membrane damage
Hemorrhagic Effusion
BLOOD PLEURAL FLUID
- Increased pleural fluid with blood
Hemorrhagic Effusion
BLOOD PLEURAL FLUID
HEMOTHROAX
Distribution of blood: _____
Uneven
BLOOD PLEURAL FLUID
HEMORRHAGIC EFFUSION
Distribution of blood: _____
Even
BLOOD PLEURAL FLUID
Differentiates hemothorax from hemorrhagic effusion
Hematocrit
BLOOD PLEURAL FLUID
HEMOTHORAX
Hematocrit: PF Hct is ____ of WB Hct
≥1/2
BLOOD PLEURAL FLUID
HEMORRHAGIC EFFUSION
Hematocrit: PF Hct is ____ of WB Hct
<1/2
PLEURAL FLUID CELLS
Enumerate:
Neutrophil
Lymphocyte
Mesothelial cells
Plasma cells
Malignant cells
Eosinophil
PLEURAL FLUID CELLS
NEUTROPHIL
Significance:
- Pneumonia
- Pancreatitis
- Pulmonary infarction
PLEURAL FLUID CELLS
LYMPHOCYTE
Significance:
- Tuberculosis
- Viral infections
- Autoimmune disorders
- Malignancy
PLEURAL FLUID CELLS
- Normally present regardless of form
Mesothelial cells
PLEURAL FLUID CELLS
- If it is decreased, indicative of tuberculosis
Mesothelial cells
Lines the serous membrane lining; it has two forms: normal and reactive
MESOTHELIAL CELLS
MESOTHELIAL CELLS
Lines the ______; it has two forms: ____ and ____
serous membrane lining
normal; reactive
PLEURAL FLUID CELLS
PLASMA CELLS
Significance:
Tuebrculosis
PLEURAL FLUID CELLS
MALIGNANT CELLS
Significance:
- Primary adenocarcinoma
- Small cell carcinoma
- Metastatic carcinoma
PLEURAL FLUID CELLS
Eosinophil must be ____
(>10%)
PLEURAL FLUID CELLS
- Trauma resulting from presence of air or blood in pleural fluid sample
Eosinophil (>10%)
PLEURAL FLUID CELLS
EOSINOPHIL (>10%)
Significance:
* May be due to ____ or ____infection
allergy
parasitic
Tumor Markers for Effusions of Malignant Origin
ENUMERATE
CEA
CA125
CA 15-3, CA 549
CYFRA 21-1
Meaning of CEA
Carcino Embryonic Antigen
Meaning of CYFRA
Cytokeratin fragment
Tumor Markers for Effusions of Malignant Origin
Tumor marker for COLON CANCER
CEA
(Carcino Embryonic Antigen)
Tumor Markers for Effusions of Malignant Origin
Tumor marker for METASTATIC URINE CANCER
CA125
Tumor Markers for Effusions of Malignant Origin
Tumor marker for BREASTCANCER
CA 15-3, CA 549
Tumor Markers for Effusions of Malignant Origin
Tumor marker for LUNG CANCER
CYFRA 21-1
(Cytokeratin fragment)
PLEURAL FLUID (Chemistry)
What are the different test/panels?
Glucose
Lactate
TAG
pH
Adenosine deaminase
Amylase
PLEURAL FLUID (Chemistry)
Significance:
Decreased in cases of rheumatoid inflammation, tuberculosis, and purulent infections
GLUCOSE
PLEURAL FLUID (Chemistry)
GLUCOSE
Significance:
Decreased in cases of ____, ___, and _______
rheumatoid inflammation
TB
purulent infections
PLEURAL FLUID (Chemistry)
Significance:
Increased in bacterial infection
LACTATE
PLEURAL FLUID (Chemistry)
Significance:
Chylous effusion
TAG
PLEURAL FLUID (Chemistry)
Significance:
* Decreased/acidic in cases of:
→ when pneumonia is NOT responding to antibiotics
→ complicated parapneumonic effusion (associated with emphyema)
pH
PLEURAL FLUID (Chemistry)
pH
Significance:
* ______ in cases of:
→ when ____ is NOT responding to antibiotics
→ complicated _______ (associated with _____)
Decreased/acidic
pneumonia
parapneumonic effusion; emphyema
PLEURAL FLUID (Chemistry)
Significance:
Malignancy, tubercular effusion
ADENOSINE DEAMINASE
PLEURAL FLUID (Chemistry)
ADENOSINE DEAMINASE
Significance:
______, _____
Malignancy
tubercular effusion
PLEURAL FLUID (Chemistry)
Significance:
Esophageal rupture, malignancy, increased in pancreatitis
AMYLASE
PLEURAL FLUID (Chemistry)
AMYLASE
Significance:
____, _______, increased in _____
Esophageal rupture
malignancy
pancreatitis
PLEURAL FLUID (Microbiologic Test)
- Common causes of pleural effusion are:
→ S. aureus
→ Enterobacteriaceae
→ M. tuberculosis
→ Anaerobic bacteria
PLEURAL FLUID (Microbiologic Test)
○ These can cause septic pleural effusion
→ Anaerobic bacteria
- Normal volume is <50 mL
PERICARDIAL FLUID
PERICARDIAL FLUID
- Normal volume is ____
<50 mL
PERICARDIAL FLUID (Appearance)
- Normal
- Transudate presence
Clear, pale yellow
PERICARDIAL FLUID (Appearance)
- Infection
- Malignancy
Blood-streaked
PERICARDIAL FLUID (Appearance)
- Cardiac puncture
- Anticoagulant medication
Grossly bloody
PERICARDIAL FLUID (Differential Count)
Bacterial endocarditis
Increased neutrophils
PERICARDIAL FLUID (Differential Count)
Metastatic carcinoma
Malignant cells
PERICARDIAL FLUID (TESTS/PANELS)
Purpose:
* Bacterial infection
* Malignancies
Decreased glucose
PERICARDIAL FLUID (TESTS/PANELS)
Purpose:
Bacterial endocarditis
Gram stain and culture
PERICARDIAL FLUID (TESTS/PANELS)
Purpose:
Tubercular effusion (MTB)
Acid-fast stain
PERICARDIAL FLUID (TESTS/PANELS)
Purpose:
Tubercular effusion
Adenosine deaminase
Common Causes of Pericardial Effusion
- Haemophilus
- Staphylococcus
- Streptococcus
- Viruses: Adenovirus and coxsackievirus
PERITONEAL FLUID
a.k.a
- “Ascitic fluid”
PERITONEAL FLUID
effusion in the peritoneal cavity
Ascites
PERITONEAL FLUID
- Normal volume: ____
<100 mL
→ Most abundant serous fluid due to size of ______
PERITONEAL FLUID
abdominal area
PERITONEAL FLUID (Appearance)
Normal
Clear, pale yellow
PERITONEAL FLUID (Appearance)
Microbial infection
Turbid
PERITONEAL FLUID (Appearance)
Gall bladder or pancreatic disorder
Green
PERITONEAL FLUID (Appearance)
- Trauma
- Infection
- Malignancy
Blood-streaked
PERITONEAL FLUID (Appearance)
Lymphatic trauma and leakage
Milky
PERITONEAL FLUID (Cell Count)
WBC COUNT
Normal: ___
<500 uL
PERITONEAL FLUID (Cell Count)
WBC COUNT: 500 uL
Significance: ____
- Bacterial peritonitis
- Cirrhosis
PERITONEAL FLUID (Cell Count)
DIFFERENTIAL COUNT
Bacterial peritonitis
Increased neutrophils
PERITONEAL FLUID (Cell Count)
DIFFERENTIAL COUNT
Malignancy
Malignant cells
PERITONEAL FLUID (Tests)
Enumerate the Tests/Panels
Peritoneal lavage
CEA
CA 125
Glucose
Amylase
Alkaline phosphatase
BUN/Creatinine
Gram stain and culture
Acid-fast stain
Adenosine deaminase
PERITONEAL FLUID (Tests)
a sensitive test to detect intraabdominal bleeding
Peritoneal lavage
PERITONEAL FLUID (Tests)
Significance: 100,000 RBC/uL
Peritoneal lavage
PERITONEAL FLUID (Tests)
PERITONEAL LAVAGE
Significance: _____ indicances blunt trauma injury
100,000 RBC/uL
PERITONEAL FLUID (Tests)
Significance: Malignancy - GI origin
CEA
PERITONEAL FLUID (Tests)
Significance: Malignancy - Ovarian origin
CA 125
PERITONEAL FLUID (Tests)
Significance: Decreased in tubercular peritonitis, malignancy
Glucose
PERITONEAL FLUID (Tests)
Significance: Increased in pancreatitis
Amylase
PERITONEAL FLUID (Tests)
Significance: Increased in GI perforation
Alkaline phosphatase
PERITONEAL FLUID (Tests)
Significance: Ruptured/punctured bladder
BUN/Creatinine
PERITONEAL FLUID (Tests)
Significance: Bacterial peritonitis
Gram stain and culture
PERITONEAL FLUID (Tests)
Significance: Tubercular peritonitis
Adenosine deaminase
- Contains concentric striations of collagen-like material
Psammoma Bodies
Psammoma Bodies
- Seen in benign conditions associated with
→ ____; and
→ ____malignancies
Ovarian
Thyroid
3rd major body fluid
CSF
CSF
Functions:
* Supplies nutrients to the ____
* Removes _____ in the brain
* Produces a _____ to cushion the brain and ___ against ___.
nervous system
metabolic waste
mechanical barrier; spinal cord; trauma
- Brain is lined/covered by
Meninges
MENINGES
- Singular is ___
meninx
MENINGES
- Consists of three layers: ________
dura mater
arachnoid mater
pia mater
MENINEGS
- Outermost layer
Dura Mater
MENINEGS
Dura mater a.k.a
Tough mother
MENINEGS
- ‘Spider-like’ appearance because it is filamentous
Arachnoid Mater
MENINEGS
- Filamentous inner membrane
Arachnoid Mater
MENINEGS
→ Filaments are known as ____
trabeculae
MENINEGS
- Innermost layer
Pia Mater
MENINEGS
- Literally means “______”
Pia Mater
* tender mother
MENINEGS
- Directly lines the brain and the spinal cord
Pia Mater
- Space between the arachnoid mater and the pia mater where the CSF flows
Subarachnoid Space
ultrafiltrate of plasma
csf
CSF PRODUCTION
- ____ is filtered by the ____, producing CSF
Plasma
choroid plexus
CSF PRODUCTION
Choroid Plexus
Rate of production/filtration: ________
20 mL/hr (~500 mL/day; 0.3-0.4 mL/min)
CSF PRODUCTION
→ Rate of production is regulated by arachnoid villi
Choroid Plexus
CSF PRODUCTION
Choroid Plexus:
→ Rate of production is regulated by ____
arachnoid villi
CSF PRODUCTION
- Composed of tight junctions of endothelial cells
Choroid Plexus
CSF PRODUCTION
Choroid Plexus
* Composed of tight junctions of ______
endothelial cells
CSF PRODUCTION
→ Make up the blood brain barrier
tight junctions of endothelial cells
CSF PRODUCTION
- Prevents passage of many molecules, protecting the brain from toxins or other harmful materials that can harm the brain
Blood Brain Barrier (BBB)
CSF PRODUCTION
Arachnoid Villi a.k.a
- “Arachnoid granulation”
CSF PRODUCTION
- Granulations that reabsorb circulating CSF back to the peripheral circulation
Arachnoid Villi
CSF PRODUCTION
Arachnoid Villi
Rate or reabsorption: ____
20 mL/hr
CSF COLLECTION AND HANDLING
Method of Collection:
- Lumbar/External puncture
- Cisternal puncture
CSF COLLECTION AND HANDLING
Method of Collection:
* Lumbar/External puncture a.k.a
spinal tap
CSF COLLECTION AND HANDLING
Method of Collection:
* Cisternal puncture a.k.a
suboccipital puncture
CSF COLLECTION AND HANDLING
Method of Collection:
→ Needle is inserted between the 3rd and 4th vertebra or between the 4th and 5th vertebra
- Lumbar/External puncture or spinal tap
CSF COLLECTION AND HANDLING
Lumbar/External puncture or spinal tap
→ Needle is inserted between the ____ and ____ vertebra or between the ___ and ____ vertebra
3rd
4th
4th
5th
CSF COLLECTION AND HANDLING
Method of Collection:
→ Puncture is directly below the occipital bone
- Cisternal puncture or suboccipital puncture
CSF COLLECTION AND HANDLING
Method of Collection:
→ More dangerous since it is near the brain stem
- Cisternal puncture or suboccipital puncture
CSF COLLECTION AND HANDLING
Cisternal puncture or suboccipital puncture:
→ Puncture is directly (above/below) the ______
below
occipital bone
CSF COLLECTION AND HANDLING
Maximum amount of volume to be collected: ____
20 mL
CSF tubes
First tube:
Chemistry/Serology
T/F: The first tube is brought to the chemistry and serology section because the tests performed are least affected by blood or bacteria that is present or introduced during collection
TRUE
CSF Tubes
Second tube:
Microbiology
T/F: The second tube is brought to the microbiology section because it is no longer at risk of bacterial contamination due to collection of CSF.
True
CSF Tubes
Third tube
Hematology
The third tube is delivered to the hematology section because it is least likely to have ___
skin cells
CSF TUBES
T/F: Fourth tubes are optional
Truth
CSF TUBES
Fourth tube:
Microbiology
Chemistry
Serology
The fourth tube is brought to ____ to further ensure the absence of bacteria
microbiology
Chemistry/Serology
Storage: ______
Frozen
Microbiology
Storage: ____
RT
Hematology
Storage: ___
Refrigirated
- If one tube only due to insufficient amount of sample, deliver CSF first to ____ –> _____ –> ____
microbiology
hematology
chemistry and serology
CSF GROSS ANALYSIS
CSF Normal Volume
Adults: ____
90-150 mL
CSF GROSS ANALYSIS
CSF Normal Volume
Neonates: ____
10-60 mL
CSF APPEARANCE
Normal
Crystal clear
CSF APPEARANCE
Hazy/Turbid/Milky/Cloudy
- WBCs (>200/uL)
- RBCs (>400/uL)
- Microorganisms
- Proteins
- Lipids
- Infection (meningitis)
Abnormal discoloration of CSF
Xanthochromia
CSF APPEARANCE
- Presence of RBC degradation products (pink, orange, and yellow CSF)
Xanthochromia
CSF APPEARANCE
Xanthochromia
* Presence of RBC degradation products (__, ___, and ___CSF)
pink
orange
yellow
CSF APPEARANCE
XANTOCHROMIA
* Pink – Slight amount of ___
O2Hgb
CSF APPEARANCE
XANTOCHROMIA
* Orange – _____
Heavy hemolysis
CSF APPEARANCE
XANTOCHROMIA
Yellow (2):
→ ____ conversion to ___
→ Presence of ____ in CSF is known as ____
Oxyhemoglobin; bilirubin
bilirubin; bilirachia
supernatant
Xanthochromia
Other causes:
→ Increase in protein (>150 mg/dL)
→ Presence of melanin
→ Presence of carotene
→ Presence of anti-TB drugs (Rifampicin)
→ Anti-septic contamination (iodine)
CSF APPEARANCE (Checking for xanthochromia)
- Centrifuge CSF sample and check _____ against ____
supernatant
white background
CSF APPEARANCE
XANTOCHROMIA:
Increase in ___ may be due to damage of ___ and may lead to ___
protein
BBB
yellowish discoloration
CSF APPEARANCE
XANTOCHROMIA:
Presence of ____ may be due to _____
melanin
meningeal melanosarcoma
- Vitamin A precursor
Carotene
- May be seen during hypervitaminosis A
Carotene
CAROTENE
- May be seen during _______
hypervitaminosis A
- Gives an orange discoloration to CSF
Carotene
CSF APPEARANCE
XANTOCHROMIA
_____ gives a red-orange color
Rifampicin
CSF APPEARANCE
XANTOCHROMIA
____ gives a yellowish discoloration to CSF
Iodine
CSF APPEARANCE
Increased RBCs (____)
BLOODY
>6000/uL
CSF APPEARANCE
BLOODY
Increased RBCs (>6000/uL) which may be due to:
- Traumatic tap
- Intracranial hemorrhage
CSF APPEARANCE
Radiographic contrast media
Oily
CSF APPERANCE
- Main reason is due to fibrinogen
Clotted
CSF APPEARANCE
- Meningitis
- Froin syndrome
- Blockage of CSF circulation
- Traumatic tap
Clotted
a mixture of xanthochromia, increased protein, and hypercoagulability
Froin syndrome
FROIN SYNDROME
a mixture of ____, increased ___, and ____
xanthochromia
protein
hypercoagulability
CSF APPEARANCE
Tubercular meningitis
Pellicle (web-like surface)
CSF APPEARANCE
In tubercular meningitis, ___ appear only if CSF is stored ___ in a ____
pellicles
overnight
refrigerator
BLOODY CSF
May be caused by 2 conditons:
Traumatic trap
Intracranial Hemorrhage
BLOODY CSF
Distributuon of blood: uneven
TRAUMATIC TAP
BLOODY CSF
Even distrubution
Intracranial Hemorrhage
BLOODY CSF (Traumatic tap)
Clot formation: ___
(+)
BLOODY CSF (Intracranial Hemorrhage)
Clot formation: ____
(-)
BLOODY CSF (Traumatic tap)
Supernatant: ___
Clear
BLOODY CSF (Intracranial Hemorrhage)
Supernatant: ____
Reddish (Xantrochromic)
Macrophages with ingested RBC
Erythrophages
BLOODY CSF (Traumatic tap)
Erythropages: ___
(-)
BLOODY CSF (Intracranial Hemorrhage)
Eryhthrophages: ___
(+)
BLOODY CSF (Intracranial Hemorrhage)
ERYHTROPHAGES (-):
Aside from RBCs, ____ and _____ can be seen in the macrophage
hemosiderin
hematoidin crystals
an RBC degradation pigment
Hematodin
BLOODY CSF (Traumatic tap)
D-dimer: ___
(-)
BLOODY CSF (Intracranial Hemorrhage)
D-dimer: __
(-)
a fibrin degradation product
D-dimer
CSF (Viscocity)
Normal
Water-like
CSF (Viscosity)
Viscous CSF
Clinical significance:
- Metastatic mucin-producing adenocarcinoma
- Cryptococcal meningitis
- Liquid nucleus pulposus
- Polysaccharide capsule of C. neoformans contributes to the viscosity of CSF
Fungal meningitis
Fungal meningitis
* ____ of ____contributes to the viscosity of CSF
Polysaccharide capsule
C. neoformans
CSF CELL COUNT
- Any cell count procedures must be performed _____
IMMEDIATELY
CSF CELL COUNT
→ WBC and RBC begin to lyse within____ after collection
1 hour
CSF CELL COUNT
→ ____ of WBCs disintegrate within ___
40%
2 hours
- Routinely performed on CSF
WBC count
WBC COUNT
Normal values
→ Adults: ___
0-5 WBC/uL
WBC COUNT
Normal values:
→ Neonates: _____
0-30 WBC/uL
WBC COUNT
Diluting fluid: ___
3% HAc with methylene blue
WBC COUNT (diluting fluid)
→ ____ lyses RBCs (it is ___)
3% HAc
hypotonic
WBC COUNT (diluting fluid)
to stain the WBC for easier visualization
Methylen blue
- NOT routinely done in CSF since it is is NOT normally present in CSF
RBC Count
→ Done in cases of traumatic tap
RBC Count
- To correct for WBC count and total protein concentration
RBC Count
RBC Count
To correct:
→ Subtract __ WBC (in the WBC count) for every ___RBCs seen
1 WBC
700
RBC COUNT
To correct:
→ Subtract _____in total protein concentration for every _____
8 mg/dL
10,000 RBCs/uL
- Performed on a stained CSF smear
CSF DIFFERNTIAL COUNT
- Specimen should be concentrated first before preparing a smear
CSF DIFFERNTIAL COUNT
CSF DIFFERNTIAL COUNT
- Ways to concentrate CSF
→ Routine centrifugation
→ Cytocentrifugation
→ Sedimentation
→ Filtration
CSF (Routine Centrifugation)
- CSF is centrifuged for ____
5-10 minutes
CSF (Routine Centrifugation)
→ ____is removed; can be used for other tests (___)
Supernatant
chemistry
CSF (Routine Centrifugation)
→ ____ is used for smear preparation
Sediment
CSF (Routine Centrifugation)
SEDIMENT:
After making a smear, the sediment should be air dried in what temperature?
Room temperature
CSF (Routine Centrifugation)
SEDIMENT:
After airdrying, the sediment is stained with ___
Wright stain
CSF (Routine Centrifugation)
- ___cells are classified
100
CSF (Routine Centrifugation)
- Reported in terms of ___-
percentage
CSF (Cytocentrifugation)
- Fluid is added to a ____
conical chamber
CSF (Cytocentrifugation)
- Cells are forced into a ____ within a ___ diameter circle on the slide
monolayer
6mm
CSF (Cytocentrifugation)
- Addition of _____
30% albumin
CSF (Cytocentrifugation)
The addition of 30% albumin promotes:
→ Increases ____
→ Decreases ______
→ Increases cell yield or recovery
→ Decreases cellular distortion
Predominant Cells in CSF
Enumerate
Lymphocytes and monocytes
Neutrophils
Macrophage
Blast forms
Lymphoma cells
plasma cells
Ependymal, choroidal and spindle-shaped cells
Malignant cells
Predominant Cells in CSF
- Normal[
Lymphocyes and monocyetes
Predominant Cells in CSF
Normal lymphocytes and monocytes:
* Adults: __ lymphocytes, __ monocytes
70%
30%
Predominant Cells in CSF
Normal lymphocytes and monocytes:
* Neonates: ___lymphocytes, _____ monocytes
30%
70-80%
Predominant Cells in CSF
increased in lymphocytes and monocytes called:
pleocytosis
Predominant Cells in CSF
PLEOCYTOSIS
Clincial signfiicance:
→ Viral, tubercular, and fungal meningitis
→ Multiple sclerosis
Predominant Cells in CSF
NEUTROPHILS
Clinical significance:
- Normal
- Bacterial meningitis
- Early case of viral, tubercular, and fungal meningitis
- Cerebral hemorrhage
Predominant Cells in CSF
Intracranial hemorrhage
Macrophage
Predominant Cells in CSF
Acute leukemia
Blast forms
Predominant Cells in CSF
Examples fo blast forms are:
lymphoblasts
myeloblasts
monoblasts.
Predominant Cells in CSF
Disseminated lymphoma
Lymphoma cells
Predominant Cells in CSF
PLASMA CELLS
Clinical significance:
- Multiple sclerosis
- Lymphocyte reactions
Predominant Cells in CSF
Diagnostic procedures performed in the brain
Ependymal, choroidal, and spindle-shaped cells
Predominant Cells in CSF
Examples of procedures performed in the brain:
Neurosurgery
Pneumoencephalography
is the removal of CSF from the meninge/brain to make the brain more visible in x-rays
Neurosurgery
Pneumoencephalography
Predominant Cells in CSF
MALIGNANT CELLS
Clinical Significance:
- Metastatic carcinoma
- Primary CNS carcinoma
- Most frequently performed CSF chemistry test
CSF CHEMISTRY
CSF CHEMISTRY
Normal values:
→ Adults: _____
15-45 mg/dL
CSF CHEMISTRY
Normal values:
→ Infants: ____
150 mg/dL
CSF CHEMISTRY
Normal values:
→ Immature: _____
500 mg/dL
CSF CHEMISTRY
Normal values:
→ Infants and immature babies have higher ____ values since their ____ is not well intact
protein
BBB
- The major CSF protein is _____
albumin
- The 2nd most prevalent CSF protein is _____
pre-albumin
OTHER CSF PROTEINS
ALPHA-GLOBULINS:
Haptoglobin
ceruloplasmin
OTHER CSF PROTIENS
BETA-GLOBULINS:
ß2-transferrin
“Tau” protein
OTHER CSF PROTEINS
GAMMA-GLOBULINS:
IgG and IgA
___ is a carbohydrate-deficient transferrin; it is only present in CSF
Tau
Proteins NOT found in CSF:
IgM
FIBRINOGEN
LIPORPTOEINS
Why is IgM Not found in the CSF?
filtered out by ____
→ Is a ___ (bigger molecular size)
→ Cannot pass through the ___
BBB
CLINICAL CAUSES OF ABNORMAL CSF PROTEIN VALUES
ELEVATED RESULTS:
- Meningitis
- Hemorrhage
- Primary CNS tumors
- Multiple sclerosis
- Guillain-Barre syndrome
- Neurosyphilis
- Polyneuritis
- Myxedema
- Cushing diseases
- Connective tissue disease
- Polyneuritis
- Diabetes
- Uremia
CLINICAL CAUSES OF ABNORMAL CSF PROTEIN VALUES
Most common cause of elevated results is damage to ____ (___ and _____)
BBB
meningitis
hemorrhage
CLINICAL CAUSES OF ABNORMAL CSF PROTEIN VALUES
results to an increase in plasma cells;
Multiple Sclerosis
CLINICAL CAUSES OF ABNORMAL CSF PROTEIN VALUES
MULTIPLE SCLEROSIS
results to an increase in ____
plasma cells
plasma cells produce ____
immunoglobulins
CLINICAL CAUSES OF ABNORMAL CSF PROTEIN VALUES
DECREASED RESULTS
- CSF leakage/trauma
- Recent puncture
- Rapid CSF production
- Water intoxication
