Body Fluids

State the time frame for testing a body fluid, and how body fluid specimens are stored.

• Processed within 4 hours

• body fluids are stored in the Micro fridge for several days 

State how to process a body fluid, list reasons why the test might need to be cancelled, and list the frequent testing done on body fluids.

• mix well

• observe for volume, clots, mucus, consistency

• fluids are observed for color and clarity, have cell counts done, and evaluate the WBCs present

• fluids often have chemical exam and cultures done

Define CSF. Name the functions of CSF, where it is produced and function of the blood brain barrier.

• clear, colorless fluid that surrounds the brain and spinal cord

• produced by the choroid plexuses in the brain

• used to evaluate the central nervous system 

• functions

  • cushion for brain

  • lubricant for CNS

  • supplies nutrients and removes waste

Name the procedure used to collect CSF. List indications for collection, and which tubes are used for each area of testing

• procedure: lumbar puncture

• indications

  • CNS malignancy

  • demyelinating diseases

  • meningeal infection

  • subarachnoid hemorrhage

• Collection (4 tubes)

  • 1: send outs

  • 2: chemistry

  • 3: microbiology

  • 4: hematology

Describe what normal and abnormal CS looks like and correlate what conditions it may indicate.

• Normal: clear and colorless

• Abnormal: cloudy or hazy

  • WBCs or RBCs

  • increased lipids and proteins

  • microorganisms (infection)

• Blood 

  • Traumatic tap: contaminated with blood by a nicked vessel

  • Subarachnoid hemorrhage: leakage of blood from vessels to spaces inside the body

Define traumatic tap, hemorrhage, and xanthochromia. Describe how to differentiate between a traumatic tap and hemorrhage

• Traumatic tap

  • lumbar puncture contaminated with blood by a nicked vessel or vertebrae

  • blood concentration will decrease across 4 tubes

  • clear, colorless supernatant

  • clotting

• Hemorrhage

  • the leaking of blood from blood vessels to spaces inside the body

  • yellowish/pink

  • uniform bloodiness

  • no clotting

• xanthochromia

  • yellowish discoloration 

Explain how RBCs are counted (when automated count is <1000 cells/uL). List the equation and be able to calculate total RBCs using a hemocytometer.

• RBCs initially counted by the sysmex

  • if <1000 then you use hemocytometer'

• Calculated RBCs = (average number of cells counted x dilution) / (squares counted x 0.1) = cells/uL

  • Ex: sample not diluted, first count was 22 RBCs and second count was 24 RBCs. answer ~ 26 cells/uL

• Hemocytometer

  • 10uL injected to each side

  • placed in humidity chamber 5-10min

  • both sides need to be counted and match within 10%

List the normal range of CSF protein. List causes of elevated and decreased total protein .

• 15-45 mg/dL

• Abnormal values may indicate

  • disruption or permeability to the blood-brain barrier

  • increased production or metabolism due to pathological conditions

• Elevated 

  • meningitis

  • hemorrhage

• Decreased

  • CSF leakage/trauma

  • recent puncture

Name an excellent indicator of the blood brain barrier.

• Albumin 

  • <9 = no impairment

Describe how glucose enters CSF and the normal values. List reasons for increased and decreased CSF glucose.

• enters CSF by selective transport across blood-brain barrier

• normal values

  • 60-70% of serum values

• Elevated glucose

  • increased serum glucose (hyperglycemia)

  • traumatic tap

• decreased glucose

  • alterations to the glucose transport mechanism across the blood-brain barrier or increased use of glucose in the brain

  • CNS infections (meningitis)

  • CNS damage

Correlate WBC count, differential results, and protein and glucose levels in bacterial, viral, tubercular and fungal meningitis.

Define serous body cavity, visceral membrane, parietal membrane.

• Serous Body Cavity

  • surrounds the heart, lungs, and abdomen

• Visceral membrane

  • serous membrane covering the organs contained within a cavity

• Parietal membrane

  • serous membrane that lines the walls of the lung, heart and abdomen cavities

Define effusion, transudate, exudate and list disease states for each.

• Effusion

  • an accumulation of fluid between the serous membranes

• Transudate

  • serous effusion produced as a result of systemic disruption of fluid production and regulation between the serous membranes 

    • congestive heart failure

    • hepatic cirrhosis

    • nephrotic syndrome

• Exudate 

  • serous fluid effusion caused by conditions producing damage to the serous membranes at the site of fluid production

    • infections

    • inflammation

    • hemorrhage

    • malignancy

Differentiate between transudates and exudates based on lab results.

• Transudates

  • pale yellow

  • clear

  • SG: <1.016

  • cell count: <1000

  • glucose: equal to serum

  • no clotting

  • LD: <200

  • protein: <3

• Exudates

  • abnormal color

  • bloody, cloudy, etc

  • SG: >1.016

  • cell counts: >1000

  • glucose: less than serum level

  • possible clotting

  • LD: >200

  • protein: >3

Define Chylous and Pseudochylous effusions

• Chylous

  • a milky lymphatic fluid that contains triglycerides and chylomicrons

• Pseudochylous

  • milky effusion that does not contain chylomicrons

List normal and abnormal cells found in serous fluid and what they may indicate.

• Normal

  • lymphocytes

  • macrophages

  • mesothelial cells: cavity lining cells

• Abnormal 

  • neutrophils

  • eosinophils/basophils

  • lupus erythematosus (LE) cells

  • malignant cells

Describe normal peritoneal fluid. List abnormal colors and clarity and what it may indicate.

• paracentesis

  • surgery to obtain fluid

• Normal

  • pale yellow, clear

• Abnormal 

  • turbid: infection

  • green: bile, gallbladder, pancreatic disorders

  • bloody: trauma, infection, or malignancy

  • milky: lymphatic trauma or blockage

List causes for transudates and exudates in peritoneal fluid and describe how albumin can be used to differentiate.

• Transudates

  • cirrhosis

  • hypoproteinemia

• Exudates 

  • Infections

  • neoplasms

  • pancreatitis

  • trauma

• Albumin can be used to help differentiate between transudates and exudates 

  • serum and fluid albumin is measured

    • serum albumin - fluid albumin

      • a difference of >1.1 = transudate

List the normal WBC count for peritoneal fluid and list causes for an increased count.

• Normal WBC counts

  • <350 cells/uL

• Increased count is seen in bacterial peritonitis and cirrhosis

  • an absolute neutrophil count >250 cells/uL or >50% of the total WBC count indicates infection

List what decreased glucose levels may indicate. (peritoneal fluid)

• glucose decreased below serum levels may indicate

  • bacterial and tubercular peritonitis

  • malignancy

Define pleural fluid and thoracentesis.

• Pleural fluid 

  • fluid around the lungs

• Thoracentesis

  • surgical puncture into the thoracic cavity to collect pleural fluid

Describe normal pleural fluid. List other colors and clarity and what it may indicate.

• Normal

  • pale yellow, clear

• Abnormal 

  • turbid, white: infection, tuberculosis

  • bloody: hemothorax, hemorrhagic effusion, pulmonary embolism, tuberculosis, malignancy

  • Milky: chylous material from thoracic duct leakage, pseudochylous material from chronic inflammation

  • Brown: rupture of amoebic liver abscess

  • black: aspergillus

  • Viscous: malignant mesothelioma

List causes for transudates and exudates in pleural fluid

• Transudates

  • hypoproteinemia

  • peritoneal dialysis

  • postoperative 

  • postpartum

  • venous obstruction

  • congestive heart failure

• Exudates

  • neoplasma

  • post myocardial infarct

  • pulmonary emboli or infarct

  • trauma

  • bile peritonitis

Describe what abnormal cell types in a pleural fluid may indicate.

• neutrophils are indicative of bacterial infection such as pneumonia

• leukocytes are normally present in transudates and exudates

• elevated lymphocyte counts are seen in effusions resulting from:

  • tuberculosis 

  • viral infections

  • malignancy

  • autoimmune disorders (RA and SLE)

• Eosinophil levels >10% may be associated with trauma resulting in a pneumothorax or hemothorax in the pleural cavity

Define pericardial fluid and pericardiocentesis.

• pericardial fluid

  • accumulation of fluid around the heart

• Pericardiocentesis

  • removal of fluid from pericardium

    • dangerous and rarely performed

    • done if infection or malignancy are suspected

Describe what pericardial effusions are caused by.

• Pericardial effusions are caused by damage to the mesothelium and not by mechanical factors, therefore they are usually exudate

• Transudate

  • metabolic and autoimmune disorders

• Exudate

  • cardiovascular disease

  • coagulation disorders

  • infections

  • metabolic diseases

  • neoplasma 

  • trauma

Describe normal pericardial fluid. List other colors and clarity and what they may indicate.

• Normal

  • pale yellow, clear

• Abnormal

  • blood-streaked: infection, malignancy

  • grossly bloody: cardiac puncture, anticoagulant, medications

  • milky: chylous or pseudochylous material 

List causes of transudates and exudates in pleural fluid.

• Transudates

  • metabolic and autoimmune disorders

• Exudates

  • cardiovascular disease

  • coagulation disorders

  • collagen vascular disorders

  • infections

  • metabolic diseases

  • neoplasms

  • trauma

Describe synovial fluid and arthrocentesis. What makes it viscous?

• Synovial fluid

  • viscous and mucinous and lines most joints

• Arthrocentesis 

  • the puncture of a joint to obtain synovial fluid

• Viscosity 

  • comes from the polymerization of the hyaluronic acid is essential for the proper lubrication of joints

Describe normal synovial fluid. List abnormal colors and clarity and what they may indicate.

• Normal 

  • colorless and clear

Abnormal

• Yellow/clear: non-inflammatory effusions

  • osteoarthritis

• Yellow/cloudy: inflammatory process

  • RA or SLE

• white/cloudy: inflammatory, may contain crystals 

  • gout or pseudogout

• green/cloudy: septic

  • infection

• Red/brown/xanthochromic: hemorrhage

  • trauma, tumors, hemophilia

List proteins synovial fluid does not contain. List causes for increased protein

• contains all except 

  • Fibrinogen

  • beta-2-macroglobulin

  • Alpha-2-macroglobulin

• Increased protein levels

  • Ankylosing spondylitis

  • arthritis

  • arthropathies that accompany Crohn disease, gout, psoriasis

Describe levels of synovial glucose and the correlation with serum glucose and what it indicates.

• synovial glucose levels should be interpreted using serum glucose levels

• synovial glucose levels should be <10 mg/dL lower than serum levels

• infectious joint disorders can cause synovial glucose to be 20 to 100 mg/dL lower than serum levels

• other joint disorders can cause a decrease of 20 mg/dL less than serum gllucose

List the normal percentages of cells in synovial fluid and list abnormal cells that can be seen and what they indicate.

• Normal synovial fluid may contain small amounts of lymphocytes and a few neutrophils

  • monocytes 48%

  • Lymphocytes 24%

  • Macrophages 10%

  • Neutrophils 7%

  • Synovial Lining Cells 4%

• Abnormal 

  • Eosinophils >2% may indicate arthritis, hemorrhagic joint effusions, lyme disease, parasitic arthritis, rheumatoid diseases and tubercular arthritis

  • septic arthritis exhibits high levels of neutrophils

  • LE cells can be seen in about 10% of patients with SLE and in some RA patients

  • plasma cells

Describe MSU, CCPD, and cholesterol crystals and what disease states they indicate.

• MSU

  • thin, needle like

  • negative bifringence

    • yellow when parallel

  • Gout

• CCPD

  • Smaller, rod-like or rhomboid

  • positive bifringence

    • blue when parallel

  • Pseudogout

• Cholesterol crystals

  • Large, flat, transparent plates with notched corners

  • exhibit a variety of colors under polarized light

  • may be present in chronic effusions with patients with osteoarthritis or RA

Identify crystals seen in synovial fluid.

Define bronchoalveolar Lavage (BAL).

• Not a natural occurring fluid, produced during procedure when warm saline is added to the lungs and then withdraw it

• laboratory receives the withdrawn specimen

  • used to determine types of organisms and cells present in areas of the lung that are inaccessible 

  • cell count must be performed within 1 hour

Describe possible colors and clarity and what they indicate. (BAL)

• bloody/pink/brown

  • could indicate an an alveolar hemorrhage

• Milky/white/brownish

  • could indicate pulmonary alveolar proteinosis

List normal cells seen in BAL fluid, and disease states that cause increased amounts of lymphocytes and eosinophils.

• Normal

  • ciliated columnar epis

  • squamous epis

  • alveolar macrophages

  • neutrophils (low numbers 

  • lymphocytes and eosinophils can be present in low numbers 

Describe collection requirements and indications for a seamen analysis.

• Indications

  • infertility

  • vasectomy effectiveness

  • forensic studies

  • sperm donor evaluation

  • paternity cases

• Must be collected through masturbation and the patient should be abstinent for at least 48-72 hours

• when transporting the specimen temp changes should be avoided

Describe how to check for viscosity (liquefaction) and list the normal time for liquefaction.

• normal semen is slightly viscous and will dispense drop by drop from a pipette

• increased viscosity will show a string of fluid when dispensed from a pipette 

• normal liquefaction time is 30 to 60 min

Describe normal seminal fluid. List abnormal seminal fluid color, what it may indicate and the cause. List normal volume for seminal fluid.

• semen is opaque and can have a variety of normal colors

  • gray

  • white

  • light yellow

• deep yellow color is associated with certain drugs brown or red colored may contain blood

• a turbid specimen usually contains leukocytes and may indicate a reproductive tract infection or inflammation

• normal volume is 2-5 mL

List normal sperm concentrations, the time frame to test for motility, and describe the grading for motility.

• normal 

  • between 20-250 million/mL

• Time frame

  • within 1 hr of collection

• grading 

  • progressive (straight line)

  • non-progressive (circled, vibrating)

  • non-motile

  • at least 80% should demonstrate forward progress in a normal sample

  • motility can be affected by temps and abys

Define viability. Describe how to read a viability slide. Explain why sperm is observed for agglutination.

• Viability

  • determines if the non-motile sperm are viable or non-viable

• Slide reading

  • eosin stain will make live sperm white and dead sperm pink

• agglutination may be normal 

  • if they are clumped head to head or tail to tail then it might indicate anti-sperm antibodies

Describe normal sperm morphology and list what areas of the sperm abnormalities could be seen.

• Normal morphology

  • flattened oval head and elongated tailpiece

  • contains nucleus that takes up 65% of the head

  • tailpiece varies in thickness

• Headpiece abnormalities

  • acrosomal abnormalities

  • constricted heads

  • enlarged or pinheads

  • nuclear abnormalities

• Tailpiece abnormalities

  • coiled tailpiece

  • cytoplasmic extrusion mass

  • multiple tails 

  • tail length

List other cells that can be found in seminal fluid and what each indicates