Synovial Fluid Flashcards by Eldren Joi Malsi

Synovial fluid, often referred to as

Joint fluid

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Viscous liquid found in the cavities of the movable joints (diarthroses) or synovial joints

Synovial fluid

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The bones in the synovial joints are lined with _____ and separated by a _____ containing the _____

Smooth articular cartilage
Cavity
Synovial fluid

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The joint is enclosed in a fibrous joint capsule lined by the _____

Synovial membrane

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The synovial membrane contains specialized cells called

Synoviocytes

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Function of smooth articular cartilage and synovial fluid

Lubricates joints
Reduce friction between the bones during joint movement
Provides nutrients to the articular cartilage/ vascular-deficient cartilage
Lessens shock of joint compression during walking and jogging

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Synovial fluid is formed as nonselective ultrafiltrate of plasma across the synovial membrane except for the exclusion of high-molecular-weight proteins. True or False?

True

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The synoviocytes secrete a _____ containing _____ and a small amount of _____ which contribute to the noticeable viscosity of synovial fluid

Mucopolysaccharide
Hyaluronic acid
Protein

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Synovial fluid is formed as nonselective ultrafiltrate of plasma. True or False?

True

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Most of the chemical constituents of synovial fluid have concentrations similar to plasma values. True or False?

True

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Damage to the articular membranes produces pain and stiffness in the joints, collectively referred to as

Arthritis

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Classification of joint disorder due to degenerative causes

Noninflammatory

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Classification of joint disorder due to immunologic/crystal-induced causes

Inflammatory

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Classification of joint disorder due to microbial causes

Septic

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Classification of joint disorder due to anticoagulant overdose

Hemorrhagic

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REVIEW LABORATORY FINDINGS IN JOINT DISORDERS

REVIEWHIN MO SA NOTES

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Synovial fluid is collected by needle aspiration called

Arthrocentesis

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Normal amount of fluid in the adult knee cavity

<3.5 mL

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> 25 mL synovial fluid indicates

Inflammation

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Normal synovial fluid does not clot. True or False?

True

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Fluid from a diseased joint may contain _____ and will _____

Fibrinogen
Clot

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Synovial fluid is often collected in a syringe that has been moistened with _____

Heparin

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Powdered anticoagulants should not be used. True or False? If so, why?

True; because they may produce artifacts that interfere with crystal analysis

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All testing should be done _____ to prevent _____ in crystals

As soon as possible
Cellular lysis and possible changes

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Required tube type for Gram stain and culture

Sterile heparinized or sodium polyanethol sulfonate

Required tube type for Cell counts

Heparin or liquid ethylenediaminetetraacetic acid (EDTA)

Required tube type for Glucose analysis

Sodium fluoride

Required tube type for all other tests

Nonanticoagulated

Normal color and clarity of synovial fluid

Colorless to pale yellow

Turbid synovial fluid indicates

WBCs, Synovial cell debris, and Fibrin

Deeper yellow synovial fluid indicates

Noninflammatory and inflammatory effusions

Greenish synovial fluid indicates

Bacterial infection

Red synovial fluid indicates

Traumatic tap, Hemorrhagic arthritis

Milky synovial fluid indicates

Crystal induced

The word “synovial” comes from the Latin word for

Egg, ovum

Normal viscous synovial fluid resembles

Egg white

How to distinguish hemorrhagic arthritis from traumatic aspiration

Observe uneven distribution of blood or blood streak in the specimens

Arthritis affects both the production of hyaluronate and its ability to polymerize. True or False?

True

Viscosity test for synovial fluid

String test Hyaluronate Polymerization Test

Positive result of String test

String measuring 4-6 cm

Positive result of Hyaluronate Polymerization Test

Solid clot surrounded by clear fluid

Describe the grading of synovial fluid viscosity

Good=Solid clot Fair=Soft clot Low=Friable clot Poor=No clot

How to identify a questionable fluid as synovial fluid?

Formation of a mucin clot after adding acetic acid

Most frequently performed cell count on synovial fluid

Total leukocyte count

Normal RBC count in synovial fluid

<2000 cells/µL

Normal WBC count in synovial fluid

<200 cells/µL

WBC count in synovial fluid that indicates severe infections

100,000 WBC/µL or higher

Why is it that traditional WBC diluent cannot be used?

Because it contains acetic acid that causes the formation of mucin clots

Neutrophil containing characteristic ingested “round body”

LE cell

Vacuolated macrophage with ingested neutrophils

Reiter cell (Neutrophages)

Neutrophil with small, dark cytoplasmic granules consisting precipitated rheumatoid factor

RA cell (Ragocyte)

Refractile intracellular and extracellular globules

Fat droplets

Ground pepper appearance inclusion

Ochronotic shards

Primary crystal; found in cases of gout

Monosodium urate (uric acid) (MSU)

Primary crystal; seen with pseudogout

Calcium pyrophosphate dihydrate (CPPD)

Crystal associated with calcified cartilage degeneration, cholesterol crystals associated with chronic inflammation, corticosteroids after injections

Hydroxyapatite (basic calcium phosphate)

Crystal seen in renal dialysis patients

Calcium oxalate crystals

Crystal examination should be performed soon after fluid collection to ensure that crystals are not affected by changes in temperature and pH. True or False?

True

CPPD crystals are usually located within ______ while MSU crystals _____ and therefore do not appear in vacuoles

Vacuoles of the neutrophils Lyse phagosome membranes

Positive identification of crystal is made by using

First order red-compensated polarized light

A control slide for the polarization properties of MSU can be prepared using

Betamethasone acetate corticosteroid

MSU crystal is more highly birefringent and appears brighter against the dark background than CPPD crystal. True or False?

True

Microscope that detects for the presence or absence of birefringence

Polarizing microscope

Microscope that confirms the type of birefringence (positive or negative)

Compensated polarizing microscope

_____ : run parallel to the long axis = _____ Birefringence = _____ color

MSU Negative Yellow

CPPD: run _____ to the long axis = _____ Birefringence = _____ color

Perpendicular Positive Blue

Cholesterol, oxalate, corticosteroid crystals, and contaminants exhibit birefringence. True or False?

True

Apatite crystals are birefringent. True or False?

False; not birefringent

Most frequently requested chemistry test for synovial fluid

Glucose test

Normal synovial fluid glucose value

<10 mg/dL lower than the blood value

To prevent falsely decreased values caused by glycolysis, specimens should be analyzed within _____ or preserved with _____

1 hour Sodium fluoride

Lactic acid levels are usually increased in patients with _____ arthritis

Septic

Normal synovial fluid lactic acid value

<30mg/dL

>30mg/dL lactic acid indicates

Septic arthritis

Normal synovial fluid total protein value

<3 g/dL

Increased levels of total protein are found in _____ and _____disorders

Inflammatory Hemorrhagic

Measured as a first evaluation in suspected cases of gout

Uric acid

Used to monitor the severity and prognosis of rheumatoid arthritis (RA)

Lactate or acid phosphatase

Two of the most important tests performed on synovial fluid

Gram stains Cultures

Routine bacterial cultures should include an enrichment medium, such as

Chocolate agar

Common organisms that infect synovial fluid

Staphylococcus and Streptococcus, fastidious Haemophilus species and Neisseria gonorrhoeae

Causative agent of Lyme disease

Borrelia burgdorferi