MLS Review - AUBF - Seroud Fluid

MEDICAL LABORATORY SCIENCE REVIEW ANALYSIS OF URINE AND OTHER BODY FLUIDS: SEROUS FLUID OUTLINE • Serous Fluid o Effusion o Method of Collection o Pleural Fluid o Pericardial Fluid o Peritoneal Fluid SEROUS FLUID • • • • Fluid between parietal & visceral membranes Ultrafiltrate of plasma Provides lubrication between parietal & visceral membranes 3 types: o Pleural Fluid - in lungs o Pericardial Fluid - in cardiac muscles o Peritoneal Fluid - in abdominal area Transudate Appearance Clear Fluid:Serum Protein <0.5 Ratio Fluid:Serum LD Ratio <0.6 Exudate Cloudy >0.5 WBC Count Spontaneous Clotting Pleural Fluid Cholesterol (mg/dL) PF:Serum Cholesterol Ratio PF:Bilirubin Ratio <1,000/uL No <45-60 >1,000/uL possible >45-60 <0.3 >0.3 <0.6 >0.6 >0.6 Serum-Ascites >1.1 <1.1 Albumin Gradient Glucose Increased Decreased Rivalta’s Test (-) (+) o Fluid:Serum Protein Ratio & Fluid:Serum LD Ratio - most reliable and accurate test to differentiate exudate & transudate o Transudate - decreased values except SerumAscites Albumin Gradient o Esucate - increased values except Serum-Ascites Albumin Gradient • Rivalta’s Test o Aka Serosamucin clot test o Differentiates exudates from transudates o Unknown Fluid + Water + Acetic Acid ↓ (+) heavy precipitation = EXUDATES METHOD OF COLLECTION • • • • • EFFUSION • • • Accumulation of excess fluid between the membranes Transudate o Caused by systemic condition o Causes: ▪ Hypoproteinemia ▪ Congestive Heart Failure ▪ Nephrotic Syndrome ▪ Cirrhosis ▪ Malnutrition Exudate o Caused by membrane damage/problem o Only one serous fluid is affected o Causes: ▪ Infection (e.g., Pneumonia, TB, Endocarditis) ▪ Inflammation ▪ Malignancy (e.g., Adenoma) Acquired through needle aspiration Pleural Fluid - Thoracentesis Pericardial Fluid - Pericardiocentesis Peritoneal Fluid - Paracentesis Tubes & Test/Laboratory Section o EDTA - Cell & differential count o Sterile Heparin Tube - Microbiology, cytology o Heparin Tube - Chemistry o Plain Tube - Clotting test o For pH testing, serous fluid must be stored during transport anaerobically in ice during transport PLEURAL FLUID • Normal Volume: <30 mL APPEARANCE OF PLEAURAL FLUID • • • • • • • Clear, (Pale) Yellow - Normal Turbid, white - microbial infection Brown - Ruptured Amoebic Abscess o Anchovy sauce-like appearance Black - Aspergillosis Viscous - Malignant Mesothelioma (produces hyaluronic acid causing viscous pleural fluid) Milky - Chylous material, pseudochylous material Bloody - Hemothorax, Hemorrhagic effusion 1 • MILKY PLEURAL FLUID Cause Chylous Effusion Thoracic duct leakage Milky/white Pseudochylous Chronic inflammation/ infection Appearance Milky/green tinge/ ”gold paint appearance” Leukocytes ↑ Lymphocytes Mixed cells Cholesterol Crystal Absent Present Triglycerides >100 mg/dL <50 mg/dL Sudan III Staining (+) (-); weakly (+) Inc. triglycerides Inc. cholesterol • Thoracic duct - lymphatic duct rich in lymphocytes and chylomicrons o Chylomicrons - lipoprotein with high conc. of TAG • Sudan III - primarily stains TAG • • MICROBIOLOGIC TEST • Hemorrhagic Effusion Bleeding in cavity due to membrane defect; increase PF with blood even • • • • PF Hct is <1/2 of WB Hct • • • • • Neutrophil - Pneumonia, pancreatitis, pulmonary infarction Lymphocyte - TB, viral infections, autoimmune disorders, malignancy Mesothelial Cells - normally present, ↓↓ in TB o Mesothelial cells - Lines the serous membrane lining ▪ Has two forms: normal & reactive o Decreased in cases of TB Plasma Cells - TB Malignant Cells - Primary adenocarcinoma, small cell carcinoma, metastatic carcinoma Eosinophil (>10%) - Trauma resulting from presence of air or blood in pleural fluid sample; allergy or parasitic infection TUMOR MARKERS FOR EFFUSIONS OF MALIGNANT ORIGIN • • • • CEA - Colon cancer CA125 - Metastatic uterine cancer CA 15-3, CA 549 - Breast cancer CYFRA 21-1 - Lung cancer o CYFRA - cytokeratin fragment PLEURAL FLUID CHEMISTRY • • • Glucose - ↓ Rheumatoid inflammation, TB, purulent inf. Lactate - ↑ bacterial inf. o Biproduct of bacterial metabolism of glucose Triglyceride - chylous effusion Normal Volume: < 50 mL Appearance: o Clear, pale yellow - Normal, transudate o Blood-streaked - Infection, malignancy o Grossly Bloody - cardiac puncture, anticoagulant medication Differential: o ↑ Neutrophil - Bacterial Endocarditis o Malignant Cells - Metastatic carcinoma Tests o ↓ Glucose - Bacterial infection, malignancies o Gram Stain and Culture - Bacterial endocarditis ▪ Caused by Haemophilus, Staphylococcus, Streptococcus, Adenovirus, Coxsackievirus o Acid-fast Stain - Tubercular effusion o Adenosine deaminase - Tubercular effusion ▪ Assoc with tubercular effusion of pleural, pericardial, and peritoneal fluid PERITONEAL FLUID PLEURAL FLUID CELLS • Cause of septic pleural effusion or infection of pleural effusion o S. aureus, Enterobacteriaceae, M. tuberculosis, anaerobic bacteria PERICARDIAL FLUID BLOODY PLEURAL FLUID Hemothorax Bleeding due to injury; normal PF with inc. blood Distribution Uneven Of Blood Hematocrit PF Hct is ≥1/2 of WB Hct pH - ↓ pneumonia not responding to antibiotics o ↓ complicated parapneumonic effusion (assoc. with emphyema) o pH 6.0 - ↓↓ esophageal rupture Adenosine deaminase - Malignancy, tubercular effusion Amylase - Esophageal rupture, malignancy, ↑ pancreatitis • • • • Aka ascitic fluid Ascites - effusion in the peritoneal cavity Normal Volume: < 100 mL o Most volume among the 3 serous fluid o Due to large area of the abdominal area Appearance: o Clear, pale yellow - Normal o Turbid - Microbial infection o Green - Gall bladder, pancreatic disorder o Blood-streaked - Trauma, infection, malignancy o Milky - Lymphatic trauma and leakage PERITONEAL FLUID – CELL COUNT • • WBC Count o <500/uL - Normal o >500/uL - Bacterial peritonitis, cirrhosis Differential Count o ↑ Neutrophils - Bacterial peritonitis o Malignant Cells - Malignancy PERITONEAL FLUID TESTS • • Peritoneal Lavage o Sensitive test to detect intraabdominal bleeding o >100,000 RBC/uL - indicates blunt trauma injury CEA o Malignancy - due to GI origin 2 • • • • • • • • CA 125 o Malignancy - due to ovarian origin Glucose - ↓ Tubercular peritonitis, malignancy Amylase - ↑ pancreatitis Alkaline phosphatase - ↑ in GI perforation BUN/Creatinine - Ruptured/punctured bladder Gram Stain & Culture - Bacterial peritonitis Acid-fast Stain - Tubercular peritonitis Adenosine deaminase - Tubercular peritonitis PSAMMOMA BODIES • • Contains concentric striations/circles of collagen-like material Seen in benign conditions and associated with: o Ovarian malignancies o Thyroid malignancies 3