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AUBF Lecture Final Term > SYNOVIAL FLUID > Flashcards

SYNOVIAL FLUID Flashcards

1
Q

Other term is “JOINT FLUID”

A

SYNOVIAL FLUID

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2
Q

Specifically, for the movable type of joints

A

SYNOVIAL FLUID

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3
Q

SF Came from the Latin word “synovial” which is the term for?

A

Egg

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4
Q

Why egg?

A

the viscosity of the egg white resembles the same as the synovial fluid

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5
Q

These are specialized cell in the synovial membrane that secretes Hyaluronic acid and small amounts of protein

A

SYNOVIOCYTES

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6
Q

is the joint that connect the 3 Bones (which are the Femur, Tibia, and Patella).

A

Synovial joint

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7
Q

This type of cartilage provides a big support for the joints so that your bones won’t tear apart

A

Articular cartilage

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8
Q

What part of the synovial joint will be aspirated during specimen collection?

A

Synovial cavity

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9
Q

(3) MAIN FUNCTION OF SYNOVIAL FLUID

A

→ Reduce friction between the bones during joint movement by providing lubrication
→ Provides nutrients to articulating cartilages
→ Lessen shock of joint compression during activities (Walking/Jogging) or any leg movements

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10
Q

is the main support system of the bones

A

articulating cartilages

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11
Q

T or F
only the Medtech’s are the one who collects the synovial fluid.

A

F
only the doctors are the one who collects the synovial fluid. MedTech only receive the sample.

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12
Q

what do doctors use for aspiration of SF?

A

syringe

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13
Q

The special characteristic of the syringe used for aspiration

A

is that there is a Moistening the barrel of syringe with heparin.

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14
Q

Why Moistening? And not powder?

A

because if you’ll be using powdered, you’re anticoagulant being applied in the barrel, it can interfere during microscopic examinations.

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15
Q

During microscopic examinations for SF, we will do what procedure?

A

differential count

we will also seek for the presence of elements (especially crystals)

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16
Q

If powder is being used, there is a greater chance for?

A

False Positive for presence of crystals.

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17
Q

On aspiration, what will doctors feel first before they will estimate on where they will hit and aspirate.

A

Patella

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18
Q

2 disorders that are related when we’re talking about Synovial fluid

A

Osteoarthritis and Rheumatoid Arthritis
(they are arthritic joints)

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19
Q

This is the “wear and tear” of your joints. Usually this happens to old people (tigulang), elder patients which ages >60.

A

Osteoarthritis.

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20
Q

This is arthritis that cause Autoimmune disorder. This are the cells inside your body that attack your synovial cells or synoviocytes.

A

Rheumatoid Arthritis

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21
Q

DISTRIBUTION
Basaha lang

A

After collection, plastar them in the coagulated tube even if they are being moisted with heparin (barrel) in the initial collection, proceed to Anticoagulated tubes (IF you’re going to laboratory examination).

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22
Q

5 Common laboratory examination being done for synovial fluid would be

A

WBC count
Differential count
Gram Staining
Culture and Sensitivity
microscopic examination

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23
Q

Every fluid must undergo _________ beforehand.

A

Macroscopic examination

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24
Q

4 specific tubes for SF to be transferred

A

Gram stain and culture - Heparinized tube/Green top(sterile)

Cell counts - heparin or EDTA

Non-anticoagulated tube for other tests - Non anticoagulated tube or Red top or Yellow top.

Sodium fluoride - Gray top (sodium fluoride)

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25
Q

NORMAL LIMITS OF SYNOVIAL FLUID
Volume

A

<3.5 ml

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26
Q

NORMAL LIMITS OF SYNOVIAL FLUID
Color

A

Colorless to pale yellow
(Supposed to be, no color pigments involved)

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27
Q

NORMAL LIMITS OF SYNOVIAL FLUID
Clarity

A

Clear

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28
Q

NORMAL LIMITS OF SYNOVIAL FLUID
Viscosity

A

Able to form a string 4 to 6 cm long
(During bedside collection)
(normal: same like egg white)

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29
Q

NORMAL LIMITS OF SYNOVIAL FLUID
Leukocyte count

A

<200 cells/ul

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30
Q

NORMAL LIMITS OF SYNOVIAL FLUID
Neutrophil

A

<25% of the differential

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31
Q

NORMAL LIMITS OF SYNOVIAL FLUID
Crystals

A

None present

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32
Q

NORMAL LIMITS OF SYNOVIAL FLUID
Glucose-Plasma difference

A

<10 mg/dl lower than the blood glucose level

(Remember: that synovial fluid is an ultrafiltrate of your plasma. Meaning, the chemical constituents are very similar to current plasma value that is why there is glucose-plasma difference)

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33
Q

NORMAL LIMITS OF SYNOVIAL FLUID
Total Protein

A

3 g/dL

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34
Q

Routine Laboratory testing

A

WBC, Differential count, Gram staining and culture, Microscopic examination for presence of crystals

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35
Q

4 Groups of Classification of SF specimen

A

Noninflammatory
Inflammatory
Septic
Hemorrhagic

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36
Q

Identify the Groups Classification of SF specimen regarding with these pathologies;

Degenerative joint disorders, osteoarthritis

A

Noninflammatory

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37
Q

Identify the Groups Classification of SF specimen regarding with these pathologies;

Immunologic disorders, rheumatoid arthritis, lupus erythemato-sus, scleroderma, polymyositis, anklylosing spondylitis, rheumatic fever, and Lyme arthritis Crystal-induced gout and pseudogout

A

Inflammatory

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38
Q

Identify the Groups Classification of SF specimen regarding with these pathologies;

Microbial infection

A

Septic

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39
Q

Identify the Groups Classification of SF specimen regarding with these pathologies;

Traumatic injury, tumors, hemo-philia, other coagulation disorders, Anticoagulant overdose

A

Hemorrhagic

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40
Q

Group Classification of SF specimen where it is usually colored green synovial fluid

A

septic

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41
Q

What causes the green color SF in septic?

A

Commonly caused by Pseudomonas aeruginosa, with the presence of pigment called Cyanine.

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42
Q

Group Classification of SF specimen where it is usually colored red

A

Hemorrhagic

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43
Q

Group Classification of SF specimen where it is usually increased in WBC count

A

Inflammatory

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44
Q

Identify the Groups Classification of SF specimen regarding with these laboratory findings;

Clear, yellow fluid
Good viscosity
WBCs <1000 pL
Neutrophils 30%
Normal glucose (similar to blood glucose)

A

Noninflammatory

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45
Q

Identify the Groups Classification of SF specimen regarding with these laboratory findings;

Cloudy, yellow fluid
Poor viscosity
WBCs 2000-75,000 pL
Neutrophils =50%
Decreased glucose level
Possible autoantibodies present

A
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45
Q

Identify the Groups Classification of SF specimen regarding with these laboratory findings;

Cloudy, yellow fluid
Poor viscosity
WBCs 2000-75,000 pL
Neutrophils =50%
Decreased glucose level
Possible autoantibodies present

A

Inflammatory IMMUNOLOGIC ORIGIN

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46
Q

Identify the Groups Classification of SF specimen regarding with these laboratory findings;

Cloudy or milky fluid
Low viscosity
WBCs up to 100,000 pL
Neutrophils <70%
Decreased glucose level
Crystals present

A

Inflammatory CRYSTAL-INDUCED ORIGIN

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47
Q

Identify the Groups Classification of SF specimen regarding with these laboratory findings;

Cloudy, yellow-green fluid
Variable viscosity
WBCs 50,000-100,000 ML
Neutrophils >75%
Decreased glucose level
Positive culture and Gram stain

A

Septic

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48
Q

Identify the Groups Classification of SF specimen regarding with these laboratory findings;

Cloudy, red fluid
Low viscosity
WBCs equal to blood
Neutrophils equal to blood
Normal glucose level

A

Hemorrhagic

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49
Q

Group Classification of SF specimen

you can proceed to glucose testing and cultures since this relates to bacterial infection. This is also performed in the microbiology section.

A

Septic

50
Q

COLOR AND CLARITY
Normal

A

colorless to pale yellow

51
Q

COLOR AND CLARITY
Non-inflammatory and inflammatory

A

deeper yellow

52
Q

COLOR AND CLARITY
Septic

A

greenish tinge

53
Q

COLOR AND CLARITY
Hemorrhagic

A

presence of blood

(Determine if from traumatic tap – Nasayop ug tusok)

54
Q

T or F
traumatic tap is considered to be clinically significant

A

F
In traumatic tap, we do not consider that as clinically significant since it is faulty error during collection. If compared to venipuncture, that is being hemolyzed.

55
Q

Know the clarity

A

you can also read it against the newsprint. Same reading as the urine which we have Clear, cloudy and turbid.

56
Q

if MILKY synovial fluid this may indicate?

A

a sign with the presence of crystals. More or less abnorma

57
Q

comes from the polymerization of the hyaluronic acid and is essential for the proper lubrication of the joints

A

VISCOSITY

58
Q

How to observe the viscosity of the SF

A

Observe the ability of the fluid to form a string from the tip of a syringe, and can be done at the bedside

String test – press the plunger slowly and observe

59
Q

Normal length of the string test for viscosity?

A

4 to 6 cm

60
Q

If you want more chemically incline viscosity test:

A

Ropes or mucin clot test

61
Q

Measurement of the amount of hyaluronate polymerization

A

Ropes or mucin clot test

(Normal synovial fluid forms a solid clot surrounded by clear fluid)

62
Q

Used solution for Ropes or mucin clot test

A
  • added to 2% to 5% acetic acid
63
Q

Reporting of Ropes or mucin clot test

A

▪ good (solid clot)
▪ fair (soft clot)
▪ low (friable clot)
▪ poor (no clot)

64
Q

To prevent cellular disintegration, counts should be performed ___________ or the specimen should be ________

A

as soon as possible, refrigerated RESPECTIVELY

65
Q

T or F
If you’re using the specimen for the presence of crystals in the examination, you can always refrigerate it for preservation

A

you should not try to refrigerate it because it can cause insignificant debris or artifact

66
Q

Very viscous fluid may need to be pretreated by adding a pinch of?

A

hyaluronidase to 0.5 mL of fluid or one drop of 0.05% hyaluronidase in phosphate buffer per milliliter of fluid

67
Q

hyaluronidase penetration to the viscous fluid should be incubated at what temp? At what time?

A

incubate at 37⁰C for 5 minutes

68
Q

T or F
Manual counts using the Neubauer counting chamber is the same manner as cerebrospinal fluid counts

A

T

69
Q

Basaha lang ah

A

Clear fluids can usually be counted undiluted, but dilutions are necessary when fluids are turbid or bloody

70
Q

T or F
traditional WBC diluting fluid cannot be used

A

T

71
Q

(2) Differential counts for SF should be performed on

A

cytocentrifuged preparations
thinly smeared slides

72
Q

ALWAYS DO THIS STEP PRIOR TO SLIDE PREPARATION

A

Fluid should be incubated with hyaluronidase prior to slide preparation.

(Specially for very viscous fluid)

73
Q

(2) Primary cells found on Diff. count of SF

A

Mononuclear cells (monocytes, macrophages) and synovial tissue cells

74
Q

Normal range of your WBCs of the differential count

A

<25 percent

75
Q

This is described through your neutrophil containing cell. It looks like a macrophage in a way that neutrophil characteristic with ingested round body. It is big and its lobes are on the side, its cytoplasm covers the whole. Just look for the round body ingestion.

A

LE cells – Lupus erythematosus cells

76
Q

These are vacuolated macrophages containing neutrophil.

A

Reiter Cells

77
Q

These cells are considered normal when you see during differentiation counts. Very similar to your Macrophages but they are multinucleated. Sizes are big. It can be mistaken as neutrophil but these doesn’t have segments.

A

Synovial Lining Cell

78
Q

These are neutrophil-like characteristic with dark cytoplasmic granules. These granules contain immune complexes specifically immunoglobulins and antibodies inside.

Medical condition: Rheumatoid arthritis and Immunologic disorders

A

Ragocyte, also known as RA cells

79
Q

(4) Causes of Crystal formation:

A
  1. Metabolic disorders
  2. Decreased renal excretion that produce elevated blood levels of crystallizing chemicals
  3. Degeneration of cartilage and bone
  4. Injection of medications, such as corticosteroids into a joint
80
Q

2 Primary crystals seen in synovial fluid

A

Monosodium urate (uric acid) (MSU) - gout, very common condition
Calcium pyrophosphate (CPPD) - seen with pseudogout

81
Q

(4) Other crystals found in SF

A
  1. Apatite (basic calcium phosphate)
  2. Cholesterol crystals
  3. Corticosteroids
  4. Calcium oxalate crystals
82
Q

Other crystals found in SF
associated with calcified cartilage degeneration

A

Apatite (basic calcium phosphate)

83
Q

Other crystals found in SF
associated with chronic inflammation

A

Cholesterol crystals

84
Q

Other crystals found in SF
following injections

A

Corticosteroids

85
Q

Other crystals found in SF
in renal dialysis patients

A
86
Q

pabalik balik nga note basta crystals in SF

A

When talking crystals, do not use powdered anticoagulants during specimen collection since it can contribute to False positive presence of crystals.

87
Q

(4) In microscopic examination, we cannot deny that we can see some artifacts. In synovial fluid, artifacts include:

A
  1. Talcum powder- use this to smoothen the pain
  2. Starch from gloves- Due to specimen handling or collection
  3. Precipitated anticoagulants
  4. Dust
  5. Scratches on slides and coverslips
88
Q

T or F
Crystal examination should be performed soon after fluid collection to ensure that crystals are not affected by changes in temperature and pH

A

T

89
Q

T or F
Both MSU and CPPD crystals are reported as being located extracellularly and intracellularly (within Synoviocytes)

A

F
Both MSU and CPPD crystals are reported as being located extracellularly and intracellularly (within NEUTROPHILS)

90
Q

T or F
Fluid must be examined prior to WBC disintegration

A

T

91
Q

Identify what type of Crystal

Appear as needle-shaped crystals
* crystals lyse phagosome membranes and therefore do not appear in vacuoles
* Clinical Significane: Gout

A

MSU CRYSTALS

92
Q

Identify what type of Crystal
* may be extracellular or located within the cytoplasm of neutrophils
* are frequently seen sticking through the cytoplasm of the cell

A

MSU CRYSTALS

93
Q

Detection of MSU CRYSTALS

A

Drop of synovial fluid and then Microscope examination

94
Q

Identify what type of Crystal
* appear rhombic-shaped or square but may appear as short rods
* usually located within vacuoles of the neutrophils (intracellularly)

A

CPPD CRYSTALS

95
Q

To avoid misidentification of CPPD crystals, the classic rhomboid shape should be observed and confirmed with?

A

compensated polarized microscopy

96
Q

Best microscope used for identification of CPPD crystals

A

Polarized Microscope

97
Q

presence of the crystals has been determined using?

A

direct polarization

98
Q

positive identification of crystals is made using

A

compensated polarized light

99
Q

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

A

betamethasone acetate corticosteroid

100
Q

T or F
MSU and CPPD crystals have the ability to polarize light

A

T

101
Q

T or F
CPPD is more highly birefringent and appears brighter against the dark background

A

F
It should be MSU

102
Q

when Compensated polarized light is used, a _____ compensator is placed in the microscope between the crystal and the analyzer

A

red compensator

103
Q

Red compensator principle

A

separates the light ray into slow-moving and fast-moving vibrations and produces a red background

104
Q

3 Crystals that exhibit birefringence

A
  1. Cholesterol - negative
  2. Oxalate - negative
  3. Corticosteroids crystals- negative and positive (cuz sa meds mostly)
105
Q

A crystal that does not exhibit birefringence

A

Apatite crystals

(Medical condition: Osteoarthritis)

106
Q

T or F
Chemistry test values are approximately the same as serum values

A

T

(but note that Chemistry tests are just back-up tests)

107
Q

The most frequently requested chemisty test is?

as markedly decreased values are indicative of inflammatory (group 2) or septic (group 3) disorders

A

glucose determination

108
Q

Simultaneous blood and synovial fluid samples should be obtained, preferably after the patient has fasted for __ hours to allow equilibration between the two fluids

A

8 hours

109
Q

Normal synovial fluid glucose should not be more than? ____ (mg/dL) lower than the blood value

specimens should be analyzed within ___ hour or preserved with????

A

10 mg/dL

1 hour

sodium fluoride (gray top tube)

110
Q

(2) Other chemistry tests that may be requested are the:

A
  1. Total protein
  2. Uric acid determinations
111
Q

Normal synovial fluid contains ____ (g/dL) of protein

A

3 g/dL of protein (approximately one third of the serum value)

112
Q

Increased levels of Protein in SF Indicates?

A

inflammatory and hemorrhagic disorders

113
Q

-elevation of serum uric acid

A

GOUT

114
Q

demonstration of an elevated synovial fluid _________ may be used to confirm the diagnosis when the presence of crystals cannot be demonstrated in the fluid

A

uric acid level

115
Q

Measurement of serum uric acid is often performed as a _____ evaluation of suspected cases of gout

A

first

116
Q

(3) MICROBIOLOGIC TESTS

A
  • Gram stains and cultures
  • Bacterial infections are most frequently seen; however, fungal, tubercular, and viral infections also can occur
  • Routine bacterial cultures should include an enrichment medium, such as chocolate agar
117
Q

MICROBIOLOGIC TESTS
4 Organisms that infect synovial fluid

A
  1. Staphylococcus
  2. Streptococcus
  3. Haemophilus species
  4. N. gonorrhoeae

(Note: Anything any fluid that are greenish-blue is more or less related to Pseudomonas)

118
Q

uses Non-anticoagulant tube or red top tube. This is to assess autoimmune diseases.

A

SEROLOGIC TESTS

119
Q

The 2 autoimmune diseases

A
  1. Rheumatoid arthritis
  2. Lupus erythematosus
120
Q

_________is a frequent complication of Lyme disease = demonstration of antibodies to the causative agent ______________in the patient’s serum can confirm the cause of the arthritis

A

Arthritis

Borrelia burgdorferi

121
Q

The extent of inflammation can be determined through measurement of the concentration of?

A

acute phase reactants

  • For detection and early signs of inflammation
122
Q

2 acute phase reactants

A
  1. Fibrinogen
  2. C-reactive protein

AUBF Lecture Final Term (5 decks)

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