(P) Lec 5: Body Fluid Analysis (Others)

Question 1

• An ultrafiltrate of plasma
• Flows between 2 membranes (parietal and visceral)
• Can be pleural, peritoneal, or pericardial in nature

Answer 1

Serous Fluid

Question 2

Serous Fluid

Refers to the accumulation of serous fluids

Answer 2

Effusion

Question 3

Serous Fluid

Causes of Effusion:
1. Increased ____ pressure
2. Decreased ____ pressure
3. Increased capillary ____
4. ____ obstruction

Answer 3

1. Hydrostatic
2. Oncotic
3. Permeability
4. Lymphatic obstruction

Question 4

Serous Fluid

Give the 3 methods of serous fluid collection

Answer 4

1. Paracentesis (peritoneal)
2. Pericardiocentesis (pericardial)
3. Thoracentesis (pleural)

Question 5

Serous Fluid

Transudate vs. Exudate?
- There is disruption of fluid filtration and reabsorption
- No direct involvement of the membranes
- Caused by CHF, liver cirrhosis, hyperproteinemia, and nephrotic syndrome

Answer 5

Transudate

Question 6

Serous Fluid

Transudate vs. Exudate?
- Inflammatory processes that result in damage to blood vessel walls
- Body cavity membrane damage
- Decreased reabsorption by the lymphatic system
- There is direct involvement and injury to the membranes
- Caused by infections, inflammation, malignancy, infarction, and hemorrhages

Answer 6

Exudate

Question 7

Serous Fluid

Give the appropriate preservatives for the ff. tests:
1. Cell count and differential count
2. Chemical serology, microbial, and cytologic analysis
3. For pH determination

Answer 7

1. EDTA
2. Heparin
3. Ice

Question 8

Serous (Pleural) Fluid

This criteria helps differentiate pleural exudates from transudates:
- Pleural fluid/serum protein ratio > 0.5
- Pleural fluid/serum LDG ratio > 0.6
- Pleural fluid LDH should be > 2/3 the normal upper limit for serum (> 200 IU/L)

Answer 8

Light’s Criteria

Question 9

Serous (Pleural) Fluid

Give the ff. chemical examination analytes:
1. Decreased in infection or inflammation
2. Increased in infection and inflammation
3. Increased in pancreatitis
4. Increased in thoracic duct damage

Answer 9

1. Glucose
2. Lactate
3. Amylase
4. Triglycerides

Question 10

Serous (Pleural) Fluid

What pH levels correspond to:
- Infection
- Esophageal rupture

Answer 10

1. < 7.2
2. < 6.0

Question 11

Serous Fluid

Refers to excess peritoneal fluid (>50mL)

Answer 11

Ascites (Ascitic fluid)

Question 12

Serous (Peritoneal) Fluid

• A method for differentiating T and E
• You subtract the fluid albumin from the serum albumin

Answer 12

Serum–Ascites Albumin Gradient (SAAG)

Question 13

Serous (Peritoneal) Fluid

Transudate or Exudate?
1. SAAG of 1.1 g/dL or greater
2. SAAG of less than 1.1 g/dL

Answer 13

1. Transudate
2. Exudate

Question 14

Serous (Peritoneal) Fluid

What 2 markers indicate malignancy?

Answer 14

CEA and CA125

Question 15

Serous (Peritoneal) Fluid

Transudate or Exudate?
- Portal hypertension
- Obstructions to hepatic flow (cirrhosis)
- Congestive heart failure
- Hypoalbuminemia

Answer 15

Transudate

Question 16

Serous (Peritoneal) Fluid

Transudate or Exudate?
- Metastatic ovarian, prostate, and colon cancer
- Infective peritonitis

Answer 16

Exudate

Question 17

What is the other name for Hemolytic Disease of the Fetus and Newborn (HDFN)?

Answer 17

Erythroblastosis Fetalis

Question 18

HDFN

This test provides a measure of the severity of red cell destruction caused by the incompatibility of the maternal & fetal blood

Answer 18

Bilirubin Test

Question 19

HDFN

Bilirubin Test:
1. Specimen must be protected from ____
2. Perfomed through ____ analysis
3. Absorbance is measured from ____ to ____ nm
4. The absorbance peak is seen at ____ nm
5. The bilirubin concentration is the change at ____ nm

Answer 19

1. Light
2. Spectrophotometric
3. 550nm to 350nm
4. 450nm
5. 450nm

Question 20

HDFN

What are the 2 methods used for the spectrophotometric determination of bilirubin?

Answer 20

Liley and Freda’s Methods

Study the graphs in the PPT

Question 21

HDFN

Causes for interference (give the body fluid):
1. An increased absorbance at 410-415nm
2. Produces a broad curve; confirmatory tests include creatinine, urea, and protein
3. A greenish substance producing a flat absorbance curve

Answer 21

1. Blood
2. Urine
3. Meconium

Question 22

Refers to a phenomenon when the neural tube (what forms the early brain and spine) does not close properly

Answer 22

Neural Tube Defects (NTD’s)

Question 23

NTD’s

Give the neural tube defects:
1. Absence of a large part of the brain and the skull
2. Fetal spinal column doesn’t close completely during the first month of pregnancy

Answer 23

1. Anencephaly
2. Spina bifida

Question 24

NTD’s

Tests for Neural Tube Defects
- This is produced by the fetal yolk sac and liver; a major protein of the fetal liver prior to 18 weeks
- Is detectable for a maximum of 12-15 weeks and then afterwards, it will decline
- An increased level of this is correspondent to multiple pregnancies and neural tube defects

Answer 24

Alpha-feto Protein (AFP)

Question 25

# NTD's Alpha-feto Protein (AFP); increased or decreased maternal serum AFP? - Abdominal hernia - Cystic hygroma

Answer 25

Increased

Question 26

# NTD's Alpha-feto Protein (AFP); increased or decreased maternal serum AFP? - Down's syndrome - Aneuploidies

Answer 26

Decreased

Question 27

# NTD's TOF: In neural tube defects, AFP is increased in maternal serum but decreased in the amniotic fluid due to dilution

Answer 27

False (increased in both)

Question 28

# NTD's Protocol for AFP Testing (Quadruple Testing): Maternal serum is tested for AFP along with what 3 other analytes?

Answer 28

HCG, Estriol, and Inhibin

Question 29

# NTD's Protocol for AFP Testing (Quadruple Testing): To diagnose Down's Syndrome, what should be elevated?

Answer 29

Inhibin and Beta HCG

Question 30

# NTD's Protocol for AFP Testing (Quadruple Testing): To diagnose Down's Syndrome, what should be decreased?

Answer 30

AFP and Estriol

Question 31

# NTD's Protocol for AFP Testing (Quadruple Testing): If found positive for the preliminary tests, what should be done next?

Answer 31

Repeat and perform diagnostic ultrasound

Question 32

# NTD's This procedure is for confirmation during AFP testing

Answer 32

Amniocentesis

Question 33

# NTD's This is the confirmatory procedure to detect NTDs

Answer 33

Amniotic Fluid Alpha-Fetoprotein (AFAFP) Testing

Question 34

# NTD's 1. What is the normal AFP value according to gestational age? 2. This is the laboratory’s reference level for a given week of gestation

Answer 34

1. < 2.0 MoM (Multiples of Median) 2. Median

Question 35

- An enzyme present in nervous tissue, muscles, and RBCs - The CNS-specific variant of this analyte is more specific but not done on bloody specimen - Tests to be done include: enzymatic, immunologic, and electrophoretic with inhibition

Answer 35

Acetylcholinesterase (AChE)

Question 36

# Fetal Lung Maturity - This is a complex substance containing phospholipids - It is produced by Type II alveolar cells and it lines the alveoli and bronchioles - Functions to lowers the surface tension/prevent alveolar collapse

Answer 36

Surfactants

Question 37

# Fetal Lung Maturity Atelectasis is synonymous to?

Answer 37

Lung collapse

Question 38

# Fetal Lung Maturity A decreased surfactant level causes what syndrome?

Answer 38

Neonatal Respiratory Distress Syndrome (Hyaline Membrane Disease)

Question 39

# Fetal Lung Maturity Give the 4 phospholipids measured in amniotic fluid (and give what is the most important)?

Answer 39

■ Phosphatidylcholine (PC, lecithin) ■ Phosphatidylglycerol (PG) ■ Phosphatidylinositol ■ Sphingomyelin (SP) | Note: LECITHIN is the most important

Question 40

# Fetal Lung Maturity Surfactants are made up of how many percent phospholipids and protein?

Answer 40

- 90% phospholipids - 10% protein

Question 41

# Fetal Lung Maturity These provide a direct physical measure of amniotic fluid to assess the surfactant's ability to decrease surface tension

Answer 41

Functional Assays

Question 42

# Fetal Lung Maturity What are the 2 functional assays?

Answer 42

1. "Bubble or Shake" Test 2. Foam Stability Index (FSI)

Question 43

# Fetal Lung Maturity What are the 3 quantitative tests?

Answer 43

1. Lecithin-sphingomyelin ratio (L/S ratio) 2. Phosphatidylglycerol (PG) 3. Lamellar body counts

Question 44

# FLM Testing Amniotic fluid + 95% ethanol → shake for 15 seconds → stand for 15 minutes

Answer 44

Foam Shake Test (Bubble Test)

Question 45

# FLM Testing 1. What is the anti-foaming agent in the Foam Shake Test? 2. What is the normal result of the test?

Answer 45

1. Alcohol 2. Continuous line of bubbles (indicates sufficient amounts of phospholipids)

Question 46

# FLM Testing 0.5mL of amniotic fluid to 0.42 to 0.55mL in 0.01mL of 95% ethanol

Answer 46

Foam Stability Index

Question 47

# FLM Testing What is the normal value for the Foam Stability Index?

Answer 47

> 0.47

Question 48

# FLM Testing This is the gold standard as it is a primary component of surfactants

Answer 48

Lecithin-Sphingomyelin Ratio (L/S Ratio)

Question 49

# FLM Testing (Lecithin-Sphingomyelin Ratio) 1. ____ is slowly produced before 35 weeks but then increase after that 2. ____ is constantly produced after 26 weeks

Answer 49

1. Lecithin 2. Sphingomyelin

Question 50

# FLM Testing (Lecithin-Sphingomyelin Ratio) Give the corresponding ratios: 1. Before 35 weeks 2. After 35 weeks

Answer 50

1. < 1.6 2. > 2.0

Question 51

# FLM Testing (Lecithin-Sphingomyelin Ratio) What can be 2 causes of error for this test?

Answer 51

Blood and Meconium

Question 52

# FLM Testing (Lecithin-Sphingomyelin Ratio) What is the method used for this test?

Answer 52

Thin Layer Chromatography (TLC)

Question 53

# FLM Testing - Uses the amniostat-FLM method - It is rapid, uses antisera, and is not affected by blood and meconium - Diabetic mothers display a delayed development of this analyte

Answer 53

Phosphatidylglycerol (PG)

Question 54

# FLM Testing - Refers to packets of surfactant released by Type II cells (almost the size of platelets) - Are counted using the platelet channels of hematology analyzers

Answer 54

Lamellar Body Counts (LBCs)

Question 55

# Sweat Analysis - Autosomal recessive inherited disease - Affects exocrine glands - Causes electrolyte and mucous secretion abnormalities - Manifests with increased sweat electrolytes, viscous lung secretions, and pancreatic insufficiency

Answer 55

Cystic Fibrosis (mucoviscidosis)

Question 56

# Sweat Analysis Measurement Testing for this analyte is most useful for the diagnosis of CF in children as there is significantly elevated levels of this analyte

Answer 56

Chloride

Question 57

# Sweat Analysis Measurement CF in children caused by defective chloride channels (cystic fibrosis transmembrane conductance regulator) manifests with a chloride level of what?

Answer 57

Above 60 mmol/L

Question 58

# Sweat Collection Procedure - This uses an electric current that causes pilocarpine to migrate into the skin area (inside of forearm) - A special sweat collection device is attached to the clean skin surface

Answer 58

Pilocarpine Nitrate Iontophoresis Method of Gibson and Cooke

Question 59

- A viscous fluid found in the cavities of movable joints - An ultrafiltrate of plasma with hyaluronic acid - Collection is through arthrocentesis - Macroscopic apperance: clear, colorless to pale yellow, and viscous

Answer 59

Synovial Fluid

Question 60

# Synovial Fluid Give the appropriate preservative for collection: 1. For culture 2. For microscopic analysis 3. For glucose analysis 4. The anticoagulant of choice

Answer 60

1. Heparin or Sterile tube 2. Heparin or Liquid EDTA 3. Fluoride 4. Heparin | Note: Powdered anticoagulants should not be used

Question 61

# Synovial Fluid Chemical Examination Give the normal values of the ff. parameters: 1. Total protein level? 2. Glucose level? 3. Uric acid? 4. Lactate?

Answer 61

1. 1 to 3 g/dL 2. Less than 10 mg/dL lower than serum levels (a 0.9:1 ratio to plasma glucose) 3. 6 to 8 mg/dL 4. Less than 25 mg/dL

Question 62

# Synovial Fluid Chemical Examination Increased or Decreased Synovial Fluid? - Inflammation (gout, RA, and SLE) - Sepsis (bacterial and viral arthritis)

Answer 62

Decreased

Question 63

# Synovial Fluid Chemical Examination SF uric acid is (increased/decreased) in gouty arthritis

Answer 63

Increased

Question 64

# Synovial Fluid Chemical Examination SF lactate is (increased/decreased) in RA, infectious arthritis, and gout

Answer 64

Increased

Question 65

# Synovial Fluid Chemical Examination This factor is seen in Rheumatoid Arthritis

Answer 65

Rheumatoid Factor (RF)