ua week 8

synovial fluid formation

ultrafitrate of plasma, no high weight molecules, synoviocytes in membrane secrete hyaluronic acid making the fluid viscous (lubrication)

arthritis disorders due to synovial fluid

noninflam (degenerative, osteoarthritis), inflam, septic- microbial infec, hemorrhage- trauma tumor hemophilia coag def

inflammatory arthritis

immunologic, systemic lupus, RA, erythematosus, scleroderma, polymyositis, ankylosing spondylitis, rheumatic fever, lyme disease, gout

synovial fluid ref values

vol < 3.5, clear-pale yellow, high viscosity (4-6 string), <200 leuks, <25% neutro, glucose:plasma <10, total protein < 3, lactate <25

synovial fluid collection

sterile heparinized or SPS if micro, liquid EDTA for hem, hep or nonanticoag for other (centrifuge), Na Fl for glucose, test asap or refridgerate

deep yellow synovial fluid

nonumfla or inflam effusiins

green synovial fluid

infection

viscosity of synovial fluid

polymerization of hyaluronic acid, low in arthritis, 4-6 cm string from aspirate needle, ropes (mucin clot test) ID synovial fluid

ropes mucin clot test

add fluid to 2-5% acetic acid, good= solid clot, fair= soft, low= friable, poor= no clot

synovial fluid cell counts

wbc- use norm saline/methylene blue not norm wbc diluting fluid, if viscous add 0.05% hyluronidase or incub 37 C, neubauer, >100,000 = septic

counting set up

line petri dish with moist filter paper, put hemocytometer on 2 small sticks above paper, fill and count both sides of hemocytometer

counting procedure based on cell amount

<200 wbc count all 9 squares, >200 count 4 corner squares, >200 again count 5 small squares used for rbc count

differential count

incubate with hyaluronidase, centrifu, vacuolated, primary- mono macroph tissue cells, neutro <25%, lymphs <15% (high in noninflam)

reiter cells/neutrophages

vacuolated macrophages with ingested neutrophils

ragocytes RA cells

neutrophils with small dark granules containing RA factor IgM

lipid droplet

crush injury

hemosiderin granules

pigmented villpnpdular synovitis

primary crystals

monosodium urate MSU gout, calcium pyrophosphate dihydrate CPPD pseudogout

MSU

impaired purine metabolism, high purine foods, alc, fructose, leukemia chemo, low renal excretion of uric acid, needle shaped, intra and extra, sticking through cytoplasm

CPPD

degenerative arthritis, disorders causing high calcium levels, rhombic, square-short rod, in nutrophil vacuoles

hydroxyapatite crystals

cartillage degeneration, electron microscopy

cholesterol crystals

systemic autoimmune disease LE, RA, similar to urine crystals (notched corners)

corticosteroid crytals

injections, flat, variable plates

calcium oxalate crystal

renal dialysis pt

slide prep

asap (crystals in cells which disintegrate), wet prep (needle MSU), polarized wet prep (MSU highly birefrigent brighter than CPPD), confirm ID with compensated polar light

red compensated polarized light

between crystal and analyzer, red background, separates light into slow & fast moving vibrations, align crystals w/ slow vibration, linear structure of molecules causes diff colors

MSU compensated light

aligned with slow vibration, fast light is impeded= yellow parallel neg, blue if perpendic birefringence

CPPD compentated light

molecules run perpendicular to long axis, impede slow light producing blue color= pos birefringence

glucose test

obtain with blood sample, 8 hr fast, <10 than blood, within 1 hr or sodium fluoride preservative, low in inflamm and septic categories

increased total protein over 3

inflam and hemorrhagic

lactate test

high in septic arthritis, GPC and GNR, >9 = bacterial treat asap

enzyme test

measure the prognsis of RA

micro tests

infec by inflam trauma and systemic infec, GS, culture CHOC (staph, strep, H. influenzae, N. gonorrhoeae), PCR

serologic tests

confirmatory, common- RA and LE, lyme disease- common complication (borrelia burgdorferi ab)