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Synovial fluid Flashcards

1
Q

SYNOVIAL FLUID A viscous liquid found in the cavities of?

A

Diarthroses

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1
Q

SYNOVIAL FLUID Also known as the

A

joint fluid

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2
Q

o The viscosity is due to the

A

hyaluronic acid

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2
Q

needle aspiration of fluid from joints

A

Arthrocentesis:

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3
Q

Tube?
Heparin
Liquid EDTA

Microscopic
examination: cell
counts

A

tube 2

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3
Q

Tube?
Non-anticoagulated
NaF

Chemistry
Glucose analysis

A

tube 1

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3
Q

Total protein:

A

<3 g/dL

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3
Q

Glucose testing: fasting for

A

6 hours

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3
Q

Neutrophils:

A

<25% of total WBCs

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3
Q

Tube?

Sterile heparinized
tube
SPS tube

Microbiology: Gram
stain and culture

A

tube 3

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4
Q

Crystals:

A

none present

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4
Q

Glucose:

A

10 mg/dL lower than blood

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4
Q

why should you not use powdere anticoags?

A

it interferes with crystal analysis

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4
Q

normal Volume:

A

< 3.5 mL

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5
Q

VARIATIONS AND CLINICAL SIGNIFICANCE:
inflammatory process

A

Yellow and cloudy:

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5
Q

inflammation volume?

A

> 25 ml with inflammation.

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5
Q

hemorrhage

A

Red, brown or xanthochromic:

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5
Q

color

A

colorless to pale yellow

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5
Q

Leukocyte count

A

<200 cells/uL

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5
Q

Clarity:

A

clear

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5
Q

Viscosity

A

: able to from 4 to 6 cm long

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6
Q

equal to blood concentration?

A

Uric acid

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6
Q

Crystals color?

A

milky

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6
Q

 Increased volume means?

A

severe joint involvement

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6
Q

Poor/low viscosity (<3cm strings):

A

arthritis

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7
Q

Bacterial infection

A

Greenish:

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8
Q

Vacuolated macrophages with
ingested neutrophils
Seen in Reiter’s syndrome and
non-specific inflammation

A

Reiter cells

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9
Q

diluent for hyperviscous sample?

A

NSS
0.1N HCl
1% saponin in saline

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10
Q

Seen in rheumatoid arthritis and
immunologic inflammation

A

RA cells/Ragocytes

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10
Q

Neutrophils with small, dark,
cytoplasmic granules of
precipitated rheumatoid factor

A

RA cells/Ragocytes

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10
Q

Seen in systemic lupus
erythematosus

10
Q

Monocytes that contain an
engulfed nuclear material

10
Q

Macroscopically resemble
polished rice
Microscopically show collagen
fibers and fibrin strands

A

Rice bodies

10
Q

Similar to macrophage, but may
be multinucleated

A

Synovial lining cell

10
Q

Large, multinucleated cell
Seen in osteoarthritis

A

Cartilage cell

10
Q

May be mistaken as an LE cell

10
Q

Neutrophil containing a
characteristic ingested round
body

10
Q

Debris from metal and plastic
joint prosthesis

A

Ochronotic shards

10
Q

Also resembles mesothelial cells
Normally seen in synovial fluid

A

Synovial lining cell

10
Q

Look like ground pepper
No significant diagnostic value

A

Ochronotic shards

10
Q

Refractile intracellular and
extracellular globules
Seen in traumatic injury

A

Fat droplets

11
Q

Seen in tuberculosis, sepsis and
rheumatoid arthritis

A

Rice bodies

11
Q

Inclusions within clusters of
synovial cells

A

Hemosiderin

11
Q

Seen in pigmented villonodular
synovitis

A

Hemosiderin

11
Q

increased in ankylosing spondylitis, arthritis, arthropathies (Crohn’s
disease), gout, psoriasis, Reiter syndrome and ulcerative
colitis

11
Q

Seen in bacterial sepsis and
crystal-induced inflammation
Normally seen and accounts for
25% of the total leukocyte
But increased levels may
indicate bacterial sepsis and
crystal induced inflammation

A

Neutrophil

11
Q

Seen in non-septic inflammation

A

Lymphocyte

11
Q

Seen in acute rheumatoid
arthritis, parasitism and Lyme
disease

A

Eosinophil

11
Q

GLUCOSE DETERMINATION
 normal value

A

10mg/dL lower than serum

11
Q

protein normal value

A

1 to 3 g/dL

12
Q

May contain vacuolations
Normally seen in synovial fluid,
but may also indicate viral
infection

A

Macrophage and Monocyte

12
Q

 Determination of the integrity of the hyaluronic acid-protein
complex

A

MUCIN CLOT TESTS

12
Q

rgt of mucin clot test?

A

2 to 5% HAc

13
Q

results from the anaerobic glycolysis in the synovium
 for rapid differentiation or inflammatory and septic arthritis

A

LACTIC ACID DETERMINATION

13
Q

decreased in  infectious joint disorders

14
Q

URIC ACID normal value

A

: 6 to 8 mg/dL

14
Q

LACTIC ACID normal value:

A

: <25mg/dL(as high as 1000/dL): septic
arthritis

15
Q

in total wbc coun if the specimen is turbid or bloody what diluent should you use?

A

NSS + methylene blue

15
Q

appearance: Needle-like

A

Monosodium
urate

15
Q

To promote RBC lysis in total wbc count what rgt should you use?

A

hypotonic saline with
saponin
 Very viscous specim

15
Q

Normally absent in synovial fluid

A

CRYSTALS IN SYNOVIAL FLUID

15
Q

in total wbc count if the specimen is very viscous what rgt should you use>

A

hyaluronidase to 0.5 ml of fluid or
0.05%

16
Q

 needle-like appearance seen in gout

A
  1. MONOSODIUM URATE/URIC ACID
16
Q

Appears yellow in compensated polarized light indicating
negative birefringence

A

MONOSODIUM URATE/URIC ACID

16
Q

Clinical Significance of crytals: Gout

A

Monosodium
urate

16
Q

appearance: Small particles

16
Q

needle-like appearance or in rods seen in Pseudogout

A

CALCIUM PYROPHOSPHATE:

17
Q

Appears blue in compensated polarized light indicating
positive birefringence

A

CALCIUM PYROPHOSPHATE:

17
Q

appearance: Notched,
rhombic plates

A

Cholesterol

17
Q

appearance:Rhombic
squares or
rods

A

Calcium
pyrophosphate

18
Q

appearance: Envelope-like

A

Calcium
oxalat

18
Q

appearance: Flat, variableshaped plates

A

Corticosteroid

19
Q

Clinical Significance of crytals: Pseudogout

A

Calcium
pyrophosphate

20
Q

Clinical Significance of crytals: Osteoarthritis

A

Calcium
phosphate

20
Q

Clinical Significance of crytals: Injections

A

Corticosteroid

20
Q

Clinical Significance of crytals: Renal dialysis

A

Calcium
oxalate

20
Q

Clinical Significance of crytals: Chronic
effusion

A

Cholesterol

ANURBF (8 decks)

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