Synovial fluid Flashcards
1
Q
SYNOVIAL FLUID A viscous liquid found in the cavities of?
A
Diarthroses
1
Q
SYNOVIAL FLUID Also known as the
A
joint fluid
2
Q
o The viscosity is due to the
A
hyaluronic acid
2
Q
needle aspiration of fluid from joints
A
Arthrocentesis:
3
Q
Tube?
Heparin
Liquid EDTA
Microscopic
examination: cell
counts
A
tube 2
3
Q
Tube?
Non-anticoagulated
NaF
Chemistry
Glucose analysis
A
tube 1
3
Q
Total protein:
A
<3 g/dL
3
Q
Glucose testing: fasting for
A
6 hours
3
Q
Neutrophils:
A
<25% of total WBCs
3
Q
Tube?
Sterile heparinized
tube
SPS tube
Microbiology: Gram
stain and culture
A
tube 3
4
Q
Crystals:
A
none present
4
Q
Glucose:
A
10 mg/dL lower than blood
4
Q
why should you not use powdere anticoags?
A
it interferes with crystal analysis
4
Q
normal Volume:
A
< 3.5 mL
5
Q
VARIATIONS AND CLINICAL SIGNIFICANCE:
inflammatory process
A
Yellow and cloudy:
5
Q
inflammation volume?
A
> 25 ml with inflammation.
5
Q
hemorrhage
A
Red, brown or xanthochromic:
5
Q
color
A
colorless to pale yellow
5
Q
Leukocyte count
A
<200 cells/uL
5
Q
Clarity:
A
clear
5
Q
Viscosity
A
: able to from 4 to 6 cm long
6
Q
equal to blood concentration?
A
Uric acid
6
Q
Crystals color?
A
milky
6
Q
Increased volume means?
A
severe joint involvement
6
Poor/low viscosity (<3cm strings):
arthritis
7
Bacterial infection
Greenish:
8
Vacuolated macrophages with
ingested neutrophils
Seen in Reiter’s syndrome and
non-specific inflammation
Reiter cells
9
diluent for hyperviscous sample?
NSS
0.1N HCl
1% saponin in saline
10
Seen in rheumatoid arthritis and
immunologic inflammation
RA cells/Ragocytes
10
Neutrophils with small, dark,
cytoplasmic granules of
precipitated rheumatoid factor
RA cells/Ragocytes
10
Seen in systemic lupus
erythematosus
LE cell
10
Monocytes that contain an
engulfed nuclear material
Tart cell
10
Macroscopically resemble
polished rice
Microscopically show collagen
fibers and fibrin strands
Rice bodies
10
Similar to macrophage, but may
be multinucleated
Synovial lining cell
10
Large, multinucleated cell
Seen in osteoarthritis
Cartilage cell
10
May be mistaken as an LE cell
Tart cell
10
Neutrophil containing a
characteristic ingested round
body
LE cell
10
Debris from metal and plastic
joint prosthesis
Ochronotic shards
10
Also resembles mesothelial cells
Normally seen in synovial fluid
Synovial lining cell
10
Look like ground pepper
No significant diagnostic value
Ochronotic shards
10
Refractile intracellular and
extracellular globules
Seen in traumatic injury
Fat droplets
11
Seen in tuberculosis, sepsis and
rheumatoid arthritis
Rice bodies
11
Inclusions within clusters of
synovial cells
Hemosiderin
11
Seen in pigmented villonodular
synovitis
Hemosiderin
11
increased in ankylosing spondylitis, arthritis, arthropathies (Crohn’s
disease), gout, psoriasis, Reiter syndrome and ulcerative
colitis
PROTEIN
11
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
Neutrophil
11
Seen in non-septic inflammation
Lymphocyte
11
Seen in acute rheumatoid
arthritis, parasitism and Lyme
disease
Eosinophil
11
GLUCOSE DETERMINATION
normal value
10mg/dL lower than serum
11
protein normal value
1 to 3 g/dL
12
May contain vacuolations
Normally seen in synovial fluid,
but may also indicate viral
infection
Macrophage and Monocyte
12
Determination of the integrity of the hyaluronic acid-protein
complex
MUCIN CLOT TESTS
12
rgt of mucin clot test?
2 to 5% HAc
13
results from the anaerobic glycolysis in the synovium
for rapid differentiation or inflammatory and septic arthritis
LACTIC ACID DETERMINATION
13
decreased in infectious joint disorders
GLUCOSE
14
URIC ACID normal value
: 6 to 8 mg/dL
14
LACTIC ACID normal value:
: <25mg/dL(as high as 1000/dL): septic
arthritis
15
in total wbc coun if the specimen is turbid or bloody what diluent should you use?
NSS + methylene blue
15
appearance: Needle-like
Monosodium
urate
15
To promote RBC lysis in total wbc count what rgt should you use?
hypotonic saline with
saponin
Very viscous specim
15
Normally absent in synovial fluid
CRYSTALS IN SYNOVIAL FLUID
15
in total wbc count if the specimen is very viscous what rgt should you use>
hyaluronidase to 0.5 ml of fluid or
0.05%
16
needle-like appearance seen in gout
1. MONOSODIUM URATE/URIC ACID
16
Appears yellow in compensated polarized light indicating
negative birefringence
MONOSODIUM URATE/URIC ACID
16
Clinical Significance of crytals: Gout
Monosodium
urate
16
appearance: Small particles
Calcium
16
needle-like appearance or in rods seen in Pseudogout
CALCIUM PYROPHOSPHATE:
17
Appears blue in compensated polarized light indicating
positive birefringence
CALCIUM PYROPHOSPHATE:
17
appearance: Notched,
rhombic plates
Cholesterol
17
appearance:Rhombic
squares or
rods
Calcium
pyrophosphate
18
appearance: Envelope-like
Calcium
oxalat
18
appearance: Flat, variableshaped plates
Corticosteroid
19
Clinical Significance of crytals: Pseudogout
Calcium
pyrophosphate
20
Clinical Significance of crytals: Osteoarthritis
Calcium
phosphate
20
Clinical Significance of crytals: Injections
Corticosteroid
20
Clinical Significance of crytals: Renal dialysis
Calcium
oxalate
20
Clinical Significance of crytals: Chronic
effusion
Cholesterol
