[CM] OTHER BODY FLUIDS (Amniotic, Sputum & BAL, Sweat, CSF)

syncytiotrophoblast cells

constituent of placenta that produces hCG

1st trimester

hCG peaks at what trimester of pregnancy

beta

subunit of hCG that confers specificity

enzyme immunoassay

principle of hCG pregnancy test

1st morning urine

specimen for hCG pregnancy kit

25 mIU/mL

cut off point for pregnancy test kit

rabbit

anti-hCG source of pregnancy test kit

false positive

hematuria or proteinuria causes false (positive/negative) results in pregnancy test

false negative

dilute urine causes false (positive/negative) results in pregnancy test

Hogben

obsolete hCG bioassay: Uses Female frog

Galli-Mainini

obsolete hCG bioassay: Uses male frog

10 days

ELISA tests are very sensitive, giving positive reaction as early as ___ days after conception

1.015

urine SG for pregnancy test

amniotic fluid

fluid within the amniotic sac that surrounds and protects the fetus

amnion

membranous sac that surrounds the fetus

placenta

ultimate source of amniotic fluid water and solutes

Cushion for the fetus

Stabilizes temperature

Allows fetal movement

Proper lung development

primary functions of amniotic fluid

800-1,200 ml

normal amniotic fluid volume (3rd trimester)

maternal circulation

During 1st trimester, 35 mL of AF is derived primarily from the ________ _____________

fetal urine

major contributor to the Amniotic fluid AFTER the 1st trimester

poplyhydramnios

INCREASED amniotic fluid volume (>1200ml)

oligohydramnios

DECREASED amniotic fluid volume (<800 mL)

Decreased fetal swallowing

NTD

primary cause of polyhydramnios

Increased fetal swallowing

Membrane leakage

Urinary tract deformities

primary causes of oligohydramnios

amniocentesis

method of collection for amniotic fluid

up to 30ml

specimen volume of collected amniotic fluid

genetic defects (trisomy 21)

2nd trimester amniocentesis assesses

FLM

HDN

3rd trimester amniocentesis assesses

AFP

hCG

Unconjugated estriol

Inhibin A

quadruple screening tests prior to amniocentesis

refrigerated / FROZEN

specimen handling: Test for FLM

room temp or 37C

specimen handling: Test for Cytogenetic Studies

protected from light

specimen handling: Test for HDN

fern test

detects premature rupture of membranes

also used to diagnose early pregnancy

pH

nitrazine

biomarkers

other tests for premature rupture of membranes

amniotic fluid

Amniotic fluid or Maternal urine:

(+) Protein and Glucose

maternal urine

Amniotic fluid or Maternal urine:

Urea = > 300mg/dl

Crea = > 10 mg/dl

amniotic fluid

Amniotic fluid or Maternal urine:

Urea - <30mg/dl

Crea = <3.5 mg/dl

colorless pale yellow

normal color of amniotic fluid

Meconium

Dark green color of amniotic fluid indicates

Fetal death

Dark red-brown color of amniotic fluid indicates

meconium

the first bowel movement of the newborn

lamellar bodies

a phospholipid secreted by TYPE II pneumocytes

- Decreases surface tension

- allows inflation of alveoli

- open airways to allow diffusion of air

respiratory distress syndrome

Most frequent complication of early delivery

Lecithin / Sphingomyelin ratio

Reference method for FLM

lecithin

for alveolar stability (L/S ratio)

Sphingomyelin

serves as control due to constant production (L/S ratio)

> 2.0

L/S ratio indicating MATURE FETAL LUNGS

falsely increased

effect of blood or meconium to L/S ratio

amniostat-FLM

Immunologic test for phosphatidylglycerol

Not affected by blood or meconium

phosphatidylglycerol

Amniostat-FLM is an immunologic test for ________________________

95% ethanol

reagent used in Foam stability test (FLM test)

foam or bubbles

positive result of foam/shake test (FLM) indicating mature fetal lungs

microviscosity test

an obsolete FLM test that is measured by fluorescence polarization

> 32,000 / ul

Lamellar body count in Adequate FLM

impedance

since lamellar body diameter is similar to platelets, LBC can be done using _______________

creatinine

test for fetal age

1.5-2.0 mg/dl

AF creatinine prior to 36 weeks gestation

>2.0 mg/dl

AF creatinine at 36 weeks (9 months)

O.D. 450

test for HDN

increased at 450 nm

OD 450:

absorbance of amniotic fluid in the presence of HDN

liley graph

results in OD 450 are plotted on a __________ ________

zone I

Nonaffected/mildly affected fetus

zone II

moderately affected fetus (requires close monitoring)

zone III

severely affected fetus, may require induction of labor or intrauterine exchange transfusion

queenan curve

is a modified Liley curve that shows ΔA450 values from 14 to 40 weeks' gestation, providing an earlier prediction of a possible hemolytic crisis

spina bifida

A birth defect, and type of neural tube defect, where there is incomplete closing of the backbone and membranes around the spinal cord

anencephaly

absence of a major portion of the brain, skull, and scalp that occurs during embryonic development

Alpha-fetoprotein (AFP)

screening test for NTD

Increased

AFP in NTD

Decreased

AFP in Down syndrome

acetycholinesterase

confirmatory test for NTD

AFP

major protein produced by the fetal liver during early gestation

<10 SEC/LPF and >25 WBC/LPF

Acceptable sputum specimen

first morning sputum

most preferred/routine sample for tracheobronchial secretion

24 hr sputum

sample for volume measurement of tracheobronchial secretion

throat swab

tracheobronchial secretion sample for pediatric patients

sputum induction

tracheobronchial secretion sample for non cooperative patients

tracheal aspiration

tracheobronchial secretion sample for debilitated or unconscious patients

Refrigeration/ 10% Formalin

Sputum preservation

red or bright red

sputum color:

Fresh blood (hemorrhage)

TB, bronchiectasis

Anchovy sauce or rusty brown

sputum color:

Old blood, pneumonia, gangrene

olive green or grass green

sputum color:

cancer

rusty (with pus)

sputum color:

lobar pneumonia

rusty (without pus)

sputum color:

congestive heart failure

CCCD

Charcot-leyden crystals

Curschmann's spirals

Creola bodies

Dittrich's plugs

4 findings of bronchial asthma

Dittrich's plugs

Grayish to yellowish, pinhead size

Foul odor when squashed

Seen in bronchiectasis, bronchitis

Pneumoliths or Broncholiths

hard concretions in a bronchus (lung stones)

- yellow/white calcified TB structures

bronchial casts

branching tree-like casts of the bronchi

- lobar pneumonia

frothy mucus

1st/top layer of sputum

opaque water material

2nd/middle layer of sputum

pus, bacteria, tissues

3rd/bottom layer of sputum

elastic fibers

slender fibrils with curled ends -- Tuberculosis

Charcot-Leyden crystals

colorless, hexagonal, double pyramid, needle like, from disintegrated eosinophils -- bronchial asthma

Curschmann's spirals

coiled mucus strands

-- bronchial asthma

heart failure cells

hemosiderin laden macrophages

Carbon-laden cells

Angular black granules

Myelin globules

What resembles Blastomyces dermatitidis in sputum

creola bodies

Cluster of columnar cells (bronchial asthma)

Pneumocystis carinii (P. jiroveci)

bronchoalveolar lavage is important for the diagnostic test of

Grocott's methenamine silver (GMS) stain

best delineates the cysts of P. jiroveci