Synovial Fluid Flashcards
Where is synovial fluid found?
In the movable joints (diarthoroses) or synovial joints
The joint is enclosed by_____ made of____?
Synovial membrane and made of synoviocytes (cells)
As well as lubrication synovial fluid_____?
provides nutrients to articular cartilage
Synoviocytes secrete?
mucopolysaccharide containing hyalrulonic acid. hyalrulonate molecules contribute to viscosity
Damage to articular membranes is called?
Arthritis
What are the 4 classifications of arthritis?
- non-inflammatory
- inflammatory (immunologic)
- septic (bacterial)
- hemorrhagic (traumatic)
Excessive accumulation of monosodium urate crystals in synovial fluid is associated with?
Gout
MSU is a byproduct of?
Purine metabolism
What can cause MSU excess leading to gout?
- High protien diet
- uric acid from kidneys and bowels
- asprin and diuretic drugs
What other conditions are associated with synovial fluid? (5)
- Pseudogout (CPPD crystals)
- Lyme Arthritis
- Scleroderma
- Septic arthritis
- Hemarthrosis
How is synovial fluid collected?
Arthrocentesis
what is the normal amount of synovial fluid? (eg in the knee)
What can happen with inflammation to this amount?
3.5 mL
increase up to 25 mL
Fluid from a diseased joint may contain fibrinogen and clot, how is this collected?
Needle moistened with heparin
How is the collected sample distributed? ( 4 tubes)
- heparinized tube for gram stain and culture
- heparin / EDTA tube for cell count
- non-antocoag tube for other tests (MUST centrifuge)
- Sodium flouride tube for glucose analysis
What color is normal synovial fluid?
what causes a depper yellow color?
green color?
Milky appearance?
- colorless to pale yellow
- inflammatory and non-inflammatory effusions
- bacterial infection
- crystals present
Normal viscosity in synovial fluis is a string from a syringe?
4 - 6 cm
Viscosity: Hyalrulonate polymerizarion is measured using?
- Ropes or mucin clot test
- 2 - 5% acetic acid; normal forms clot surrounded by clear fluid
What is the most frequent test performed on synovial fluid?
Total Leukocyte Count (TLC)
What is considered a normal WBC count?
in severe infection?
<200 cells uL
>100,000 in severe infection
Very viscous synovial fluid is treated with?
This is also done before slide preperation for differential counts of synovial fluid.
Hyalrulonidase
Pseudogout is associated with what type of arthritis?
What crystals are seen in the above?
- degenerative arthritis
- Calcium pyrophosphate (CPPD)
T/F: MSU and CPPD crystals are reported as intracellularly and extracellularly in neutros?
True
Seen as needle shaped crystals seen extracellularly or within the cytoplasm?
MSU
Rhombic shaped/ square but may appear as short rods. located within vaculoles?
CPPD
Which crystals lyse phagosome mebranes so are not seen in vacuoles?
MSU
Which crystal is more highly bifringent and appears brighter against a dark background?
MSU
Which crystals molecules run parallel to the long axis, slow light less impeded and produces a yellow color?
MSU
Which cystal’s molecules run perpendicular to the long axis and fast light is much quicker producing a blue color?
CPPD
The most frequently requested test is?
What is the glucose value based on?
- glucose
- blood gluosed and not more 10 mg/dL lower than blood value
Normal synovial protein contained is?
**Uric acid levels is related to gout so may also be tested for**
<3 g/dL
Microbiologic tests: what medium should be included and why?
Enriched like Chocolate agar because hemopholus species and N. gonorrjoeae can infect synovial fluid
Arthritis exten of inflammation can be determined testing?
Acute phase reactance like fibrinogen and C reative protien
