Strasinger AUBF - Serous Fluid Ultimate Reviewer

Transudates

Effusion formed because of a systemic disorder that disrupts the balance in the regulation of fluid filtration and reabsorption

Hydrostatic pressure

Changes in ____ created by congestive heart failure or the hypoproteinemia associated with the nephrotic syndrome is an example of a transudate

Exudates

Formed by conditions that directly involve the membranes of the particular cavity

Initial diagnostic, aid

Classifying whether transudate or exudate can provide valuable ___ step and ___ in further testing

Transudate

Transudate/ exudate: It is not necessary to test this fluid

Protein and lactic dehydrogenase blood ratio

Most reliable differentiation between transudate and exudate fluids

Transudate

Transudate/ exudate: Clear

Exudate

Transudate/ exudate: Cloudy

Transudate

Serum protein ration: <0.5

Exudate

Serum protein ration: >0.5

Transudate

Serum LD ratio: <0.6

Exudate

Serum LD ratio: >0.6

Transudate

WBC count: <1000/uL

Exudate

WBC count: >1000/uL

Transudate

No spontaneous clotting

Exudate

Possible spontaneous clotting

Transudate

Pleural fluid cholesterol: <45 to 60 mg/dL

Exudate

Pleural fluid cholesterol: >45 to 60 mg/dL

Transudate

Pleural fluid serum cholesterol ratio: <0.3

Exudate

Pleural fluid serum cholesterol ratio: >0.3

Transudate

Pleural fluid bilirubin ratio: <0.6

Exudate

Pleural fluid bilirubin ratio: >0.6

Transudate

Serum ascites albumin gradient: >1.1

Exudate

Serum ascites albumin gradient: <1.1

Pleural fluid

Obtained from the pleural cavity, located between the parietal pleural membrane lining the chest wall and the visceral pleural membrane covering the lungs

Pleural fluid cholesterol, serum cholesterol ratio, serum total bilirubin ratio

Tests to analyze pleural fluid

>60 mg/dL - exudate

Pleural fluid cholesterol

>0.3 - exudate

Pleural fluid serum cholesterol ratio

>0.6 - exudate

Fluid serum total bilirubin ratio

Clear, pale yellow

Appearance of normal fluid

Turbid, white

Appearance of the fluid when there is presence of WBC, bacterial infection, tuberculosis, immunologic disorder (rheumatoid arthritis)

Bloody

Appearance of the fluid when there is hemothorax (traumatic injury), malignancy, hemorrhagic effusion, pulmonary embolus, tuberculosis

Milky

Appearance of the fluid when chylous material from thoracic duct has a leakage, pseudochylous material from chronic inflammation

Brown

Appearance of the fluid when there is a rupture of amoebic liver abscess

Black

Appearance of the fluid when there is Aspergillus infection

Viscous

Malignant mesothelioma (increased hyaluronic acid)

Hematocrit

Used to differentiate between hemothorax and hemorrhagic exudate

Chylous material

Contains high concentration of triglycerides

Pseudochylous material

High concentration of cholesterol

Sudan III

Staining positive for chylous material

Cholesterol

Pseudochylous effusions contains ___ crystals

Chylous Effusion

Chylous Effusion/ pseudochylous effusion: Caused by thoracic duct damage

Pseudochylous effusion

Chylous Effusion/ pseudochylous effusion: Caused by chronic inflammation or lymphatic obstruction

Chylous Effusion

Chylous Effusion/ pseudochylous effusion: Appears milky/white

Pseudochylous effusion

Chylous Effusion/ pseudochylous effusion: Appears milky/green tinge

Chylous Effusion

Chylous Effusion/ pseudochylous effusion: Predominantly contains lymphocytes

Pseudochylous effusion

Chylous Effusion/ pseudochylous effusion: Contains mixed cells

Chylous Effusion

Chylous Effusion/ pseudochylous effusion: Absent cholesterol crystals

Pseudochylous effusion

Chylous Effusion/ pseudochylous effusion: Present cholesterol crystals

Chylous Effusion

Chylous Effusion/ pseudochylous effusion: Triglycerides of >110 mg/dL

Pseudochylous effusion

Chylous Effusion/ pseudochylous effusion: Triglycerides of <50 mg/dL

Chylous Effusion

Chylous Effusion/ pseudochylous effusion: Sudan III Staining whows strongly positive

Pseudochylous effusion

Chylous Effusion/ pseudochylous effusion: Sudan III Staining shows negative/weakly positive

Differential cell count

Most diagnostically significant hematology test performed on serous fluids

Increased pleural fluid neutrophils

Indicates bacterial infections

Elevated lymphocytes

Caused by effusions resulting from tuberculosis, viral infections, malignancy, and autoimmune disorders

Mesothelial cells

Single layer, lines serous cavities and may be pleomorphic, making identification difficult

Mesothelial cells

Often appear as single small or large round cells with abundant blue cytoplasm and round nuclei with uniform dark purple cytoplasm

Reactive mesothelial cells

May appear in clusters; varying amounts of cytoplasm, eccentric nuclei, and prominent nucleoli, and be multinucleated

Malignant cells

May include nuclear and cytoplasmic irregularities, hyperchromatic nucleoli, cellular clumps with cytoplasmic molding, and abnormal nucleus cytoplasm ratio

Malignant pleural effusions

Most frequently contain large, irregular adenocarcinoma cells, small or oat cell carcinoma cells resembling large lymphocytes, and clumps of metastatic breast carcinoma cells

Pancreatitis, pulmonary infarction

Neutrophils in the pleural fluid indicates this disease/ condition

Tuberculosis, viral infection, autoimmune disorders, malignancy

Lymphocytes in the pleural fluid indicates these diseases/ conditions

Mesothelial cells

Normal and reactive forms have no clinical significance

Mesothelial cells

Decrease of these cells are associated with tuberculosis

Tuberculosis

Plasma cells in the pleural fluid indicates this disease/ condition

Primary adenocarcinoma, small cell carcinoma, metastatic carcinoma

Malignant cells in the pleural fluid indicates these diseases/ conditions

Malignant Cells

Shows increased nucleus cytoplasm (N:C) ratio

Nuclear chromatin

Malignant Cells have irregularly distributed ____

Size, shape

Malignant Cells have variation in ___ and ___ of nuclei

Nucleoli

Malignant Cells shows increased number and size of ___

Hyperchromatic

Malignant Cells have ___ nucleoli

Malignant Cells

Shows giant cells and multinucleation

Malignant Cells

Shows nuclear molding, cytoplasmic molding, vacuolated cytoplasm, mucin production, cellular crowding, phagocytosis

Glucose, pH, adenosine deaminase (ADA), and amylase

Most common chemical test performed on pleural fluid

Triglyceride levels

May also be measured to confirm presence of chylous materials

Decreased glucose

Level of glucose seen in tuberculosis, rheumatoid inflammation, and purulent infections

<60 mg/dL

Level of decreased glucose

Plasma

Fluid values should be compared with ___ values

Elevated lactate

Level of lactate in bacterial infections

< 7.2 pH

Pleural fluid with this pH indicate a need for chest-tube drainage

6.0

This fluid pH indicates an esophageal rupture allowing influx of gastric fluid

>40U/L

Level of adenosine deaminase (ADA) that is highly indicative of tuberculosis

Glucose

Decreased in rheumatoid inflammation and in purulent infection

Lactate

Elevated in bacterial infection

Triglyceride

Elevated in chylous effusions

pH

Decreased in pneumonia not responding to antibiotics;

pH

Markedly decreased with esophageal rupture

Adenine deaminase (ADA)

Elevated in tuberculosis and malignancy

Amylase

Elevated in pancreatitis, esophageal rupture, and malignancy

Microorganisms in pleural effusions

Staphylococcus aureus,Enterobacteriacieae, anaerobes, and Mycobacterium tuberculosis

Serologic testing

Used to differentiate effusions of immunologicorigin from noninflammaatory processes

Test for antinuclear antibody (ANA) and rheumatoid factor (RF)

Most frequently performed serologic test

Effusion of malignant origin

Detection of the tumor markers carcinoembryonic antigen (CEA), CA 125 (metastatic uterine cancer), CA 15.3 and CA 549 (breast cancer), and CYFRA 21-1 (lung cancer)

10 to 50 mL

Amount of fluid is found between the pericardial serous membrane

Pericardial effusions

Result of changes in the membrane permeability due to infection, malignancy, and trauma-producing exudates

Pericardial transudates

Result from metabolic disorders

Effusions

Suspected when cardiac compression (tamponade) is noted during the physician's examination

Clear, pale yellow pericardial effusion

Normal transudate

Blood streaked

Indicates infection, malignancy