Urinalysis Unit 4 - Body Fluids

The ________ are a tuft of capillaries found in the brain right above the end of the spinal chord.

choroid plexuses

The __________ area of the choroid plexus that has cells that limit large molecules from entering the spinal fluid.

blood brain barrier

Around _______ of CSF is made every hour.

20 mL

The total volume of CSF is usually __________ in adults.

90-150 mL

The total volume of CSF is usually _______ in newborns.

10-60 mL

What are the three functions of CSF?

supplies nutrients to the nervous tissue/removes metabolic waste/protects brain and spinal cord against trauma

You should draw and test CSF when you suspect the presence of...

meningitis/subarachnoid hemorrhage/CNS malignancy/demyelinating disease like MS

CSF should be tested...

ASAP

CSF should be taken from a lumbar puncture between the _____________ lumbar vertebrae.

3rd/4th/5th

CSF should appear...

clear/colorless

CSF can be turbid/cloudy due to the presence of...

cells/microorganisms/increased protein/lipid content increased

Term used to describe the appearance of CSF after centrifugation if the color is either pink, yellow or orange.

xanthochromia

A pink/orange color that remains after centrifuging CSF indicates the presence of ______.

oxyhemoglobin; a subarachnoid bleed within the previous 1-4 hours

A yellow color that remains after centrifuging CSF indicates the presence of ______.

bilirubin; subarachnoid hemorrhage within the last 12 hours

Clots found within CSF usually indicate...

a traumatic tap

A pink color found in the CSF that clears out in subsequent tubes usually indicates...

a traumatic tap

Cell counts on CSF should be done within...

one hour

What two substances are added to CSF before counting WBCs? What do they do?

crystal violet - differentiates WBCs/acetic acid - lyses RBCs

A CSF sample should be concentrated using a _________ before performing a WBC differential.

cytocentrifuge

Cells that are cytocentrifuged are forced into a _________ within a ______ diameter circle on a slide.

monolayer; 6 mm

What is the normal range for WBCs in CSF?

0-5 WBCs/uL

What is the predominant WBC found in the CSF of adults?

lymphocytes

What is the predominant WBC found in the CSF of children?

monocytes (macrophages)

Term for the presence of an increased number of normal cells.

pleocytosis

Increased neutrophils in the CSF indicates...

bacterial meningitis

Increased lymphs in the CSF indicates...

viral meningitis/fungal meningitis/tubercular meningitis

Increased eosinophils in the CSF indicates...

presence of parasites/fungal meningitis

Macrophages containing ingested RBCs, hemosiderin granules, or hematoidin crystals indicates...

previous hemorrhage (subarachnoid bleed)

What is the normal value for protein in the CSF?

15-45 mg/dL

What are the primary proteins found in CSF?

albumin/prealbumin/haptoglobin/ceruloplasm/transferrin/gamma globins (IgG and IgA)

Elevations of protein in the CSF can occur due to...

damage to the blood brain barrier (meningitis or hemorrhage)/production of Ig within the CNS (multiple sclerosis)/decreased clearance of protein from the fluid/degeneration of neural tissue

Decreased levels of protein in the CSF can occur due to...

fluid leaking from the CNS

The normal range for the CSF IgG index is...

< 0.70

If the CSF IgG index is > 0.70, this is indicative of...

multiple sclerosis

___________ on a CSF protein electrophoresis in the gamma region indicates multiple sclerosis.

oligoclonal banding

What methodologies are used to test total protein within CSF?

tubidimetry/dye binding

CSF glucose should be ________ of the patient's plasma.

60-70%

Plasma glucose should be drawn within ________ of a spinal tap when comparing results.

2 hours

A decreased amount of glucose in the CSF indicates...

bacterial meningitis

What methods are used to test for glucose in CSF?

glucose oxidase/hexokinase

A CSF lactate that is ___________ indicates bacterial meningitis.

> 35 mg/dL

A CSF lactate that is ________ indicates tubercular and fungal meningitis.

> 25 mg/dL

CSF lactate is __________ in viral meningitis.

normal

What media would you usually inoculate when testing CSF for bacteria?

BAP/CHOC/MAC

What are the most common pathogens responsible for bacterial meningitis?

S. agalactiae/H. influenza/S. pneumoniae/N. meningitidis/E. coli

What organism is most commonly responsible for bacterial meningitis in children?

S. agalactiae

What organism is most commonly responsible for bacterial meningitis in young adults.

H. influenza

Synovial fluid is made from filtered plasma, along with _________ and ________ secreted by cells in the synovial membrane.

hyaluronate/protein

What functions do synovial fluid perform?

provides nutrients to joints in cartilage/lubricant for joints

Synovial fluid is collected through a ___________.

arthrocentesis

What location is synovial fluid usually collected from?

knee

Normal synovial fluid will not ________.

clot

Synovial fluid samples drawn for cell counts should contain what anticoagulant?

heparin

Synovial fluid samples drawn for cultures should be drawn from a _______ tube?

sterile

Synovial fluid samples drawn for glucose testing should contain what anticoagulant?

sodium flouride

Synovial fluid samples drawn for uric acid should contain what anticoagulant?

no anticoagulant

What are the four types of joint disorders?

noninflammatory/inflammatory/septic/hemorrhagic

_________ joint disorders - due to degenerative joint disorders

noninflammatory

_________ joint disorders - due to immunological disorder like lupus or RA; gout.

inflammatory

________ joint disorders - due to infections.

septic

__________ joint disorders - due to traumatic injury or a coagulation deficiency.

hemorrhagic

Synovial fluid should usually appear

clear/viscous/pale yellow

Cloudy synovial fluid is seen in...

inflammatory disorders/septic disorders/when crystals are present

The viscosity of synovial fluid is due to...

hyaluronic acid

Increased viscosity of synovial fluid is indicative of...

noninflammatory joint disorders

Decreased viscosity of synovial fluid is indicative of...

inflammatory joint disroders

What two tests are used to ascertain the viscosity of synovial fluid?

string test/mucin clot test

A mucin clot is formed by adding _________ to synovial fluid.

acetic acid

A tight mucin clot surrounded by clear fluid indicates the synovial fluid is (normal/abnormal)

normal

A fragile mucin clot surrounded by cloudy fluid indicates the synovial fluid is (normal/abnormal)

abnormal

In a string test, synovial fluid should come out of the syringe as...

4-5 mm long string

A WBC count on synovial fluid should be done within ________ of collection.

1 hour

What stain is used to distinguish WBCs from RBCs when doing a cell count on synovial fluid.

methylene blue

What is the normal range for WBCs in synovial fluid?

< 200/uL

What is the predominate WBC in synovial fluid?

monocytes (macrophages)

An increased WBC count with > 80% segmented neutrophils in the synovial fluid indicates...

bacterial arthritis/gout

An increased WBC count with increased lymphs in the synovial fluid indicates...

early stages of RA

What crystal appears in the synovial fluid of gout patients?

monosodium urate (uric acid)

What crystal appears in the synovial fluid of pseudo gout?

calcium pyrophosphate

An increased glucose in the synovial fluid indicates...

inflammation/septic disorders

What is the normal range for glucose within synovial fluid?

no more than 10 mg/dL more or less than blood value

What is the normal range for uric acid in the synovial fluid of males?

< 8.0 mg/dL

Uric acid is increased in...

gout

What are the most commonly isolated microorganisms found in synovial fluid?

Haemophilus/Neisseria

Broad term for the fluid found in the closed cavities of the body.

serous fluid

Term for the fluid found around the lungs.

pleural fluid

Term for the fluid found around the heart.

pericardial fluid

Term for the fluid found around the abdominal cavity and the pelvic organs.

peritoneal fluid/ascitic fluid

Serous fluids are a _________ as it filters through the membrane.

filtrate of plasma

A buildup of serous fluid in cavities is known as a ________.

effusion

A _________ effusion results from a systemic disease which affects the balance of fluid.

transudate

A ________ effusion results from a localized process.

exudate

Examples of conditions that can cause a transudate effusion.

CHF/cirrhosis

Examples of conditions that can cause a exudate effusion.

inflammation/malignancy/infection

If a effusion is ________, further testing is needed.

exudate

Transudate fluid usually has a SG that is __________ and a protein that is ________.

< 1.015; < or = 3.0 g/dL

Exudate fluid usually has a SG that is __________ and a protein that is ________.

> 1.015; > 3.0 g/dL

What function does serous fluid perform?

lubricates the surface of the serous membrane as they move

Term for the process of collecting pleural fluid:

thoracentesis

Term for the process of collecting pericardial fluid:

pericardiocentesis