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Clinical Chemistry > Synovial Fluid > Flashcards

Synovial Fluid Flashcards

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1
Q

Synovial Fluid

A

Synovial = syn (like) + ovia (egg)
Mucinous substance that lubricates most joints
Used in the analysis and diagnosis of joint disease

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2
Q

Synovial Fluid - mucinous substance that lubricates most joints

A

Articulated Joint Anatom

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3
Q

Synovial Membrane

A

Synovial membrane from a normal knee joint shows
joint space, synovial membrane composed of synovial cells embedded in a loose connective tissue stroma overlying dense collagen (hematoxylin and eosin).

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4
Q

Physiology and Composition

A

Clear viscous ultra filtrate of plasma
Glucose and uric acid equivalent to plasma
Protein lower than plasma
Hyaluronate protein complex containing mucin
Moistens and lubricates joints

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5
Q

Specimen Collection

A

Needle insertion
Placement of needle in arthrocentesis of (A) elbow and
(B) knee joints.

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6
Q

Testing: Macroscopic

A 
Volume
Color and Clarity
Inclusions
Viscosity
Clotting
Mucin Clot
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7
Q

Testing: Macroscopic: Volume

A

Normal up to 4 mL of fluid
Result usually recorded at bedside
Some laboratories may include volume in reports

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8
Q

Macroscopic Analysis: Color and Clarity

A 
Colorless and clear 
normal
Red, brown, or xanthochromic
	hemorrhage into the joint 
Yellow/clear 
noninflammatory effusions
Yellow/cloudy
inflammation
White/cloudy
crystals
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9
Q

Macroscopic Analysis: Inclusions

A

Ochronotic shards = A
debris from joint prosthesis
look like ground pepper

Rice bodies = B
rheumatoid arthritis (RA) 
synovium enriched with fibrin
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10
Q

Macroscopic Analysis: Viscosity

A

Evaluated using “String test”
Normal = 5cm long before breaking
Low viscosity indicates inflammation
String test showing normal synovial fluid viscosity.

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11
Q

Macroscopic Analysis: Clotting

A

Clotting of synovial fluid = fibrinogen
Damaged synovial membrane
Traumatic tap
Clots interfere with performance of cell counts

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12
Q

Macroscopic Analysis: Mucin Clot

A 
Estimation of hyaluronic acid–protein complex integrity
“Rope’s test”
Add acetic acid 
Good = tight ropey mass 
	= normal

Poor = beaks easily
haluronate destruction
haluronate dilution

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13
Q

Testing: Chemical

A 
Protein
Glucose
Uric Acid
Lactic Acid
Lactate Dehydrogenase
Rheumatoid Factor
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14
Q

Chemical Analysis: Protein

A 
All proteins found in plasma
Exception: various high–molecular weight proteins which may be present in very small amount
fibrinogen
beta 2 macroglobulin 
alpha 2 macroglobulin 
Use common serum protein procedures
All proteins found in plasma
Exception: various high–molecular weight proteins which may be present in very small amount
fibrinogen
beta 2 macroglobulin 
alpha 2 macroglobulin 
Use common serum protein procedures
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15
Q

Chemical Analysis: Glucose

A

Compare to serum glucose levels
Normal synovial glucose is no lower than 10mg/dl less than serum glucose levels.
Decreased – joint disorders
Greater than 20mg/dl decrease may indicate infection

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16
Q

Chemical Analysis: Uric Acid

A

Normal - 6 to 8 mg/dL
Increased – gout
May form crystals

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17
Q

Chemical Analysis: Lactic Acid

A

Rarely measured in synovial fluid
Can be helpful in diagnosing septic arthritis.
Normal = less than 25 mg/dL
Septic arthritis can show levels up to 1000 mg/dL

18
Q

Testing: Lactate Dehydrogenase

A

May be elevated in synovial fluid, while serum levels remain normal.
Increased in
Rheumatoid arthritis (RA)
infectious arthritis,
gout.
Neutrophils increased during the acute phase of these disorders contribute to this increased LD.

19
Q

Testing: Rheumatoid Factor

A

RF is an antibody to immunoglobulins.
Present in rheumatoid arthritis:
Serum – most cases
Synovial fluid - 50%
Rarely elevated only in synovial fluid and not serum
False positives in other chronic inflammatory diseases.

20
Q

Microscopic Analysis: Cell Counts

A 
Perform within 1 hour of specimen collection
Usually counted manually
Normal values:
RBCs = none
WBCs = 0 – 150/cumm
21
Q

Microscopic Analysis: Differential

A 
Cytocentrifuge prepared smears
Normal values:
Neutrophils                   7%
Lymphocytes               24%
Monocytes (Histocytes) 48%
Macrophages               10%
Synovial lining cells        4%
22
Q

Normal cellular elements found in synovial fluid

A 
A = neutrophil
B = lymphocyte
C = monocytes (histiocytes)
D = lining cells
23
Q

Elevated neutrophils

A

Septic arthritis
Later stages of RA
phagocytes
Synovial fluid with acute inflammation demonstrating
neutrophilic pleocytosis (Wright–Giemsa).

24
Q

Elevated Monocytes

A

Serum sickness associated arthritis
Viral infections
Crystal-induced arthritis

25
Q

Elevated lymphocytes

A

Early stages of RA

26
Q

LE cells = neutrophil

A

Lupus erythematosus

27
Q

Tart cells

A

macrophage or monocytes

28
Q

Reiter cells

A

macrophage engulfed multiple neutrophils

29
Q

Differential-Lipophage

A

Lipid-laden macrophage

30
Q

Crystals-Uric Acid

A

Synovial fluid with acute inflammation and monosodium urate crystals. (Wright–Giemsa stain and polarized light).

31
Q

Crystals-Uric Acid

A

acute inflammation and monosodium urate crystals. The needle-shaped crystals demonstrate negative birefringence, because they are yellow when aligned with the ompensator filter and blue when perpendicular to the filter (Wright–Giemsa stain and polarized/compensated light).

32
Q

Crystals-other

A

Synovial fluid with acute inflammation and calcium pyrophosphate dihydrate crystals (Wright–Giemsa stain and polarized light).

33
Q

Crystal-Other

A

acute inflammation and calcium pyrophosphate dihydrate crystals. The rhomboidal intracellular crystal (center) demonstrates positive birefringence, because it is blue when aligned with the compensator filter (Wright–Giemsa stain and polarized/compensated ligh

34
Q

Corticosteroid crystals

A

intra-articular injections

35
Q

Cholesterol crystals

A

chronic effusions from patients with osteoarthritis or RA

36
Q

Apatite crystals

A

calcific peri-arthritis
osteoarthritis
inflammatory arthritis

37
Q

Infectious organisms

A

Bacteria
Fungi
Mycobacteria
Viruses

38
Q

Route of entry

A 
Bloodstream
Penetrating wounds
Osteomyelitis rupture
Arthroscopy 
intra-articular steroid injections
prosthetic joint surgery
39
Q

Staining

A

Smears prepared by centrifugation or cytocentrifugation
Saline dilution reduces clustering of cells
Gram’s stain most common
Positive in only 50% of cases

40
Q

Culture

A

Aerobic

anaerobic

Clinical Chemistry (8 decks)

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