Week 10: 10.2 body fluid highlights Flashcards
Describe a Lumbar Puncture (LP)
Needle in subarachnoid space to collect CSF for:
1) Dx
2) Tx (therapeutic)
What are some urgent indication for lumbar puncture (LP)?
Suspected:
1) CNS infection (meningoencephalitis)
-brain abscess is an exception (space-occupying lesion)
2) SAH
What are 3 potential contraindications for LP (lumbar puncture)?
1) Increased ICP [due to space-occupying lesion]
2) Coagulopathies/anticoagulation/thrombocytopenia
3) Infection overlying LP site
Potential LP complications include what?
1) Headaches due to persistent CSF leak
2) Bleeding [of SQ blood vessel from needle]
3) Infection
What amount of CSF pressure is generally abnormal?
>20
[know this]
LP / CSF Analysis:
1) Should it be opaque or clear? What would the opposite indicate?
2) What color should it be?
3) When may CSF also appear grossly bloody (red tinge)?
1) Clear; turbidity can occur w. high WBCs/ RBCs
2) Colorless
3) if significantly increased RBCs
CSF analysis:
1) What is Xanthochromia?
2) What causes it?
3) When may it be seen?
1) Yellow or pink discoloration
2) Breakdown of hemoglobin
3) Subarachnoid hemorrhage (SAH)
-Can also be seen if significantly increased CSF protein or serum bilirubin
CSF analysis: When should Xanthochromia NOT be present?
Acute bleeding from traumatic tap
Normal CSF is _________________, but may have a small number of certain __________ when sampled by LP
acellular (no cells); cells
CSF RBCs:
1) Normal?
1) 0-5 RBCs
2) Blood in CSF
3) Subarachnoid hemorrhage or traumatic puncture
CSF WBCs:
1) Number of WBCs?
2) Number of PMNs?
3) When can WBC elevations (pleocytosis) occur?
1) 0-5 WBCs/microL
2) 0-3
3) Infections, noninfectious inflammatory states, traumatic tap
Acute infectious meningitis: _______________________ usually predominate in bacterial; __________________ usually predominate in viral
Neutrophils (PMNs); lymphocytes
LP / CSF Analysis: Pathogen Testing
List 3 different types
1) Gram stain
2) Culture & Sensitivity (C&S): CSF culture
3) Molecular tests for viruses, bacteria, and fungi
CSF protein:
1) Does normal CSF have a lot of protein?
2) Albumin-to-globulin ratio normally _____________ in CSF than blood .
3) Increased CSF total protein can occur with many CNS diseases, like what?
1) Very little normal total protein
2) higher
3) Infectious and noninfectious conditions and those associated with obstruction of CSF flow; can also be elevated due to bleeding
CSF Protein- Immunoglobulins:
1) Should there be many IGs in CSF?
2) IGs are typically assessed when evaluating for CNS inflammatory disorders, in which what?
1) Very few
2) CSF immunoglobulins may be increased
Describe CNS Immunoglobulins (part of CNS protein)
-Normally very few in CSF, elevated in CNS inflammatory disorders
-Can ID with:
1) Increased IgG index
2) Spikes/bands on CSF protein electrophoresis + immunofixation
> Oligoclonal bands: common in neuroinflammatory disorders like MS
>Monoclonal band (monoclonal gammopathy) suggests B cell/plasma cell disorder (e.g., malignancy)
Oligoclonal bands are common in ____________ disorders like MS, and ____________ bands suggest malignancy
neuroinflammatory; monoclonal
Describe CSF glucose (when is it low, normal, or high?)
1)Low (hypoglycorrhachia) in bacterial/fungal CNS infections (+ certain noninfectious)
2) Normal (typically) during viral CNS infections
3) High if hyperglycemia
CSF Lactate (lactic acid):
1) Elevated CSF levels may occur in __________________ cerebral injury, SAH, infectious meningitis.
2) When is it often elevated? When is it normal?
1) hypoxic-ischemic
2) Often elevated in acute bacterial meningitis (prior to abx) but normal in viral meningitis (good diagnostic accuracy in differentiating)
LP/ CSF analysis: Cytology and Tumor markers may help identify what?
Malignancy/metastasis
For acute bacterial meningitis, ID what the following will be:
1) WBCs
2) Protein
3) Glucose
4) Others
starred; don’t need to know numbers
1) Very high (neutrophilic/ PMN predominance)
2) Very high
3) Low
4) Positive gram stain/ bacterial culture; CSF lactate high
For acute viral meningitis, ID what the following will be:
1) WBCs
2) Protein
3) Glucose
4) Others
starred; don’t need to know numbers
1) Modestly high; lymphocytic prominence
2) High [modestly]
3) Normal
4) CSF lactate is normal
For fungal meningitis, ID what the following will be:
1) WBCs
2) Protein
3) Glucose
4) Others
starred; don’t need to know numbers
Variable findings: WBC count, protein, and glucose may be similar to either bacterial or viral
For SAH, ID what the following will be:
1) RBCs
2) Xanthochromia
3) Others
starred; don’t need to know numbers
1) RBCs very high
2) Xanthochromic color
3) high opening pressure
For Traumatic LP, ID what the following will be:
1) RBCs
2) Xanthochromia
starred; don’t need to know numbers
RBC count elevated in first tube (initially red) but normal in final tube (clears with collection of fluid)
No xanthochromia
For multiple sclerosis, ID what the following will be:
1) WBCs
2) Protein
3) Others
starred; don’t need to know numbers
1) WBC count high; lymphocytic
2) Normal
3) Oligoclonal bands and high IgG index
For Guillain-Barré syndrome, ID what the following will be:
1) WBCs
2) Protein
starred; don’t need to know numbers
WBC count normal
Isolated high protein
Uric acid is excreted mostly by ______________
kidneys
Hyperuricemia is what?
Increased serum uric acid
Hyperuricemia:
1) What are the 2 potential problems?
2) What is the most common cause? Give examples
3) What is Hyperuricemia a predisposing factor for? Why?
1) Overproduction of urate or decreased elimination
2) Decreased efficiency of renal uric acid excretion; CKD, ketoacidosis, diuretics
3) Gout; monosodium urate (MSU) crystals can deposit
Uricosuria (increased urine uric acid): can lead to crystallization in the kidneys resulting in uric acid __________ (nephrolithiasis)
stones
Arthrocentesis & Synovial (Joint) Fluid Analysis: Indicated in patients with __________ or signs of ________ inflammation
joint effusion; suggestive inflammation
Most important indication for Arthrocentesis & Synovial (Joint) Fluid Analysis is to evaluate for what?
Septic arthritis
Synovial Fluid Analysis: List the 4 steps of routine analysis
1) Gross inspection: normally highly viscous, clear, and colorless
2) Cell count (with diff): normally nearly acellular
3) Gram stain + culture
4) Crystals (polarized light microscopy)
What do the following suggest on synovial fluid analysis?
2) Increased neutrophils
2) Increased eosinophils
1) Bacterial joint infection
2) Parasites, allergy, neoplasm, Lyme disease
Synovial Fluid Analysis: list + describe the 4 elements of routine inspection
1) Gross inspection: highly viscous, clear, and colorless
2) Cell count (with differential): nearly acellular
3) Gram Stain and culture
4) Crystals (polarized light microscopy)
a) Monosodium urate (MSU): gout
-“Negatively” birefringent; needle-shaped
b) Calcium pyrophosphate dihydrate (CPPD): pseudogout (CPPD deposition disease)
-“Positively” birefringent; rhomboid/rectangular
Crystals (polarized light microscopy): Describe the 2 types you may see in synovial fluid
1) Monosodium urate (MSU): gout
“Negatively” birefringent (and strong/bright birefringence); needle-shaped
2) Calcium pyrophosphate dihydrate (CPPD): pseudogout (CPPD deposition disease)
“Positively” birefringent (but weak) or no birefringence; rhomboid/rectangular shape
Describe WBC count of synovial fluid if:
1) Noninflammatory
2) Septic
3) What is between these 2?
starred
1) <2,000
2) >20,000
3) Inflammatory
Describe % neutrophils of synovial fluid if:
1) Noninflammatory
2) Hemorrhagic
3) Inflammatory
4) Septic
1) <25%
2) <50%
3) 50-75%
4) >75%
Describe synovial fluid in non-inflammatory, hemorrhagic, inflammatory, & septic conditions
1) Noninflammatory (e.g., osteoarthritis): <2,000 WBCs, <25% neutrophils.
2) Hemorrhagic: Up to 1 WBC for every 1,000 RBCs, <50% neutrophils, bloody crystals.
3) Inflammatory: 2,000-20,000, 50-75%, crystals
4) Septic: >20,000, >75%, G stain may be pos.
Seminal Fluid Analysis is a measure of ____________ _____________ and an important element of ____________ workup
testicular function; fertility
Bronchoalveolar Lavage (BAL):
1) How is it collected?
2) Can be used to evaluate immunologic, inflammatory, and infectious processes occurring at alveolar level in _______________ lung diseases
1) flexible bronchoscopy
2) diffuse
Testing of BAL fluid includes cell ________ (esp. WBCs) with _____________.
count; differential
What is a BAL?
Washing fluid over an area (usually R middle lobe or L upper lobe lingula)
Tumor Markers (TMs) are usually not sensitive or specific enough to be used for __________ screenings or to diagnose it
cancer
Tumor Markers are more often used for for monitoring response to __________ and to detect ______________
therapy; recurrence
Prostate Specific Antigen (PSA) (Tumor marker):
1) What is a controversy with this marker?
2) What are 2 causes of this controversy?
1) False positives
2) Recent rectal examination + Ejaculation can cause false positives
Tumor Markers: List and describe 4 (other than PSA)
1) AFP (alpha-fetoprotein): hepatocellular carcinomas
2) PRL: pituitary adenomas
3) hCG (Human chorionic gonadotropin): germ cell tumors
+ pregnancy
4) CEA (Carcinoembryonic antigen): colorectal cancer and breast cancer
Cancer antigens (CA): List the important ones and what they’re associated with
CA 19-9: pancreatic cancer (primarily)
CA 15-3 and CA 27-29: breast cancer
CA 125: ovarian cancer
Bioterrorism: List the 3 categories and describe
1) Category A:Most infectious
-Ex: Bacillus anthracis (anthrax), Yersinia pestis (plague), variola major (smallpox)
2) Category B: moderately infectious
3) Category C: emerging pathogens could be weaponized in the future
