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MODULE 17 - Urinary, Endocrine and Oncological Disease > PATHOLOGY - Body Fluid Analysis > Flashcards

PATHOLOGY - Body Fluid Analysis Flashcards

1
Q

Which tube types should you use to collect body cavity effusion samples?

A

EDTA tube
Plain serum tube

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2
Q

What are benefits of using EDTA tubes when sampling body cavity effusions?

A

EDTA tubes prevent the samples from clotting which can affect the nucleated cell count and helps to preserve the cellular morphology

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3
Q

What are benefits of using plain serum tubes when sampling body cavity effusions?

A

Plain serum tubes can be used for bacterial culture as EDTA tubes are bacteriostatic

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4
Q

What should you assess when evaluating effusion samples?

A

Colour and turbidity
Protein concentration
Nucleated cell count
Cytology

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5
Q

What do you use to assess the protein concentration of effusion samples?

A

Refractometer (like you would for total serum proteins)

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6
Q

What do you use to assess the nucleated cell count of effusion samples?

A

Automated analyser
Haemocytometer
Estimated from a direct smear

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7
Q

What do you use to assess cytology of effusion samples?

A

Direct smear

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8
Q

What are the three main classifications of body cavity effusion?

A

Transudate
Modified transudate
Exudate

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9
Q

What causes transudate effusions?

A

Decreased oncotic pressure
Increased hydrostatic pressure

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10
Q

What causes decreased oncotic pressure?

A

Hypoalbuminaemia

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11
Q

What causes hypoalbuminaemia?

A

Hepatic dysfunction
Protein-losing enteropathy
Protein-losing nephropathy

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12
Q

What can cause increased hydrostatic pressure?

A

Congestive heart failure
Portal hypertension

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13
Q

What is the gross appearance of transudate?

A

Colourless to straw coloured

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14
Q

What are the features of transudate?

A

Low protein levels (less than 25g/L)
Low nucleated cell count (less than 1.5 x 10^9 cells/L)

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15
Q

Which cells are typically found in transudate?

A

Mesothelial cells
Macrophages
Non-degenerate neutrophils

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16
Q

How does the composition of transudate differ in horses?

A

Horse transudate can have nucleated cell counts up to 10 x 10^9 cells/L and have more non-degenerate neutrophils

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17
Q

What causes exudate effusions?

A

Inflammation as it increases vascular permeability which allows intravascular fluid, cells and proteins to move out of the intravascular space

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18
Q

What are features of exudate?

A

High protein levels (above 25g/L)
High nucleated cell counts (above 5 x 10^9 cells/L)

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19
Q

How does the composition of exudate differ in horses?

A

Horse exudate will have nucleated cell counts above 10 x 10^9 cells/L

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20
Q

What do you need to determine if you are presented with an exudate effusion sample?

A

You need to determine if the exudate is septic or not through doing a direct smear to look for the presence of pathogens and degenerative neutrophils. You can also culture the fluid if you suspect there is bacteria involved but you cannot see in on the smear

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21
Q

What is modified transudate?

A

Modified transudate is where the protein levels and nucleated cell count are elevated beyond a transudate but are not within the exudate reference range

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22
Q

What are the causes of a modified transudate?

A

Progression of a transudate
Mild inflammation

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23
Q

How can a transudate progress to a modified transudate?

A

When a transudate accumulates in a body cavity this can cause increased pressure on the mesothelium resulting in irritation of the mesothelial cells. The mesothilial cells will proliferate and slough off in response to this irritation (reactive mesothelial cells) as well as draw in macrophages which will increase the nucleated cell count

24
Q

What can reactive mesothelial cells sometimes be mistaken for?

A

Neoplastic cells

25
Q

What are the classifications of ‘special’ body cavity effusions?

A

Chylous effusion
Feline infectious peritonitis (FIP) effusion
Neoplastic effusion
Haemorrhagic effusion
Urinary tract rupture
Bile peritonitis

26
Q

What is a chylous effusion?

A

A chylous effusion is caused by the leakage of chyle from the lymphatic system into the body cavities

27
Q

What is the most common site for a chylous effusion?

A

Chylothorax

28
Q

What are the potential causes of a chylous effusion?

A

Idiopathic
Mediastinal mass
Cardiovascular disease
Diaphragmatic hernia
Lung lobe torsion
Trauma

29
Q

What is the gross appearance of a chylous effusion?

A

Chyle has a milky white to ‘strawberry milk’ appearance if there is erythrocytes present

30
Q

What causes the milky appearance of a chylous effusion?

A

Chylomicrons are formed in the small intestinal mucosa and transported to the blood stream via the lymphatic system. The chylomicrons give a chylous effusion a milky appearance

31
Q

How does the appearance of a chylous effusion differ in anorexic patients?

A

In anorexic patients, there will be no chylomicron formation and thus the chylous effusion will not have a milky appearance

32
Q

What are the features of a chylous effusion?

A

Lymphocytes predominately
Neutrophils and macrophages if there has been inflammation

33
Q

Which additional test can you do to confirm a diagnosis of a chylous effusion?

A

You can compare the serum triglyceride levels to the effusion triglyceride levels. If the effusion triglyceride levels are higher than the serum levels, this indicates a chylous effusion

34
Q

What is the gross appearance of a feline infectious peritonitis (FIP) effusion?

A

Odourless, straw-coloured to gold fluid

35
Q

What are the features of a feline infectious peritonitis (FIP) effusion?

A

Hight protein levels (above 35g/L)
Variable but often low nucleated cell count

36
Q

Which cell type usually predominates a feline infectious peritonitis (FIP) effusion?

A

Neutrophils

37
Q

Which additional tests can you do to investigate a potential feline infectious peritonitis (FIP) effusion?

A

Feline coronavirus (FCoV) antibiody titre on the sample
Alpha 1-AGP levels (acute phase protein)
Albumin:globulin ratio
PCR for FCoV RNA

38
Q

What are the limitations of a feline coronavirus (FCoV) antibody titre?

A

A feline coronavirus (FCoV) antibody titre only confirms exposure to FCoV but does not confirm an active infection. Furthermore, it does not differentiate between enteric feline coronavirus and feline infectious peritonitis (FIP)

39
Q

What are the benefits of assessing the albumin:globulin ratio of effusions?

A

Increased globulins relative to albumin are indicative of inflammation

40
Q

What are the limitations of a PCR for FCoV RNA?

A

A PCR for FCoV RNA does not differentiate between enteric feline coronavirus and feline infectious peritonitis (FIP)

41
Q

How do you differentiate between a true haemorrhagic effusion and an iatrogenic haemorrhagic effusion?

A

A true haemorrhagic effusion will have erythrophagocytosis, haematoidin and haemosiderin unlike an iatrogenic haemorrhagic effusion. If you note platelets this is indicative of an iatrogenic haemorrhage during sampling as platelets have a short lifespan

42
Q

What are the characteristics of a uroabdomen?

A

This type of effusion will vary depending on the urine specific gravity (USG) of the urine that has leaked (i.e. it may be transudate, modified transudate or exudate)

43
Q

Which additional tests can be done to confirm a uroabdomen?

A

You can compare the serum creatinine levels to the effusion creatinine levels. If the effusion creatinine levels are higher than the serum levels, this indicates urine

44
Q

Which additional test can be done to confirm a bile peritonitis?

A

You can compare the serum bilirubin levels to the effusion bilirubin levels. If the effusion bilirubin levels are higher than the serum levels, this indicates bile

45
Q

When is sampling of cereborspinal fluid (CSF) indicated?

A

Neurological disease
Neck or limb pain
Pyrexia of unknown origin

46
Q

Which type of tube should you use to take a cerebrospinal fluid (CSF) sample?

A

Plain serum tube

47
Q

How should you send cerebrospinal fluid (CSF) samples to an external lab?

A

If you are posting cerebrospinal fluid (CSF) samples to an external lab, if the volume of sample allows, send two aliquots. Send one in a pain serum tube and one with autologous serum for better cell preservation

48
Q

Why does cerebrospinal fluid (CSF) require rapid analysis?

A

Cerebrospinal fluid (CSF) requires rapid analysis as the cells will degenerate very quickly

49
Q

What should you use to do a nucleated cell count on cerebrospinal fluid (CSF)?

A

Haemocytometer as the cell count is often too low for an automated analyser

50
Q

What should you use to do cytology on cerebrospinal fluid (CSF)?

A

Cytospin to concentrate the sample and stain with Romanowsky stain

51
Q

What are the characteristics of cerebrospinal fluid (CSF)?

A

Very low protein count
Very low nucleated cell count

52
Q

What are the indicators for synovial fluid sampling?

A

Joint swelling
Limping
Monoarthropathy
Polyarthropathy
Pyrexia on unknown origin
Generalised pain
Generalised weaknesss

53
Q

What is the gross appearance of synovial fluid?

A

Transparent and viscous fluid

54
Q

Which tests should you prioritise if you can only get a small sample of synovial fluid?

A

If you only get a small volume of synovial fluid, do a direct smear as this will allow for cytology

55
Q

Which tests should you do if you can get a larger sample of synovial fluid?

A

EDTA for nucleated cell count and protein levels
Direct smear

MODULE 17 - Urinary, Endocrine and Oncological Disease (12 decks)

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