OTHER BODY FLUIDS LRH

hcg is secreted by the

Trophoblast of the developing embryo that rapidly increase in urine and serum

in normal pregnancy, detectable amount of

25 mIU/ml / 5 IU/L detectable 2-3 days after implantation, 8 to 10 days after conception or fertilization

peak level of HCG

2-3 months after last menstrual period

formation of hemorrhagic follicles and corpora lutea

ascheim-zondek use immature female mice

hyperemic uterus and corpora hemorrhagica

Friedman Mature virgin femal rabbit marginal ear vein

mode of injection is intraperitoneal

kupperman female rat

urine samples for pregnancy testing should have a specific gravity of

1.015

product of fetal metabolism, the constituents that are present in the fluid provide information about the metabolic processes taking place during and progress of fetal maturation

Amniotic fluid

During the first trimester, approximately ____ derived from _____

35 ml, maternal circulation

After the first trimester. ____ is the major contributor to AF volume

Fetal urine

normal amniotic fluid volume

800-1200 ml

quadruple screening test for amniocentesis

AHUI

Alpha feto protein

HCG

Unconjugated estriol UE3

Inhibin A

amniocentesis is safe to do at

14th week gestation

Second trimester amniocentesis is done for ___ at ___

chromosomal abnormalities at 16th week of gestation

third trimester amniocentesis is done for

tests for fetal distress and maturity

maximum volume for AF collection

30 mL

AMINOCENTESIS INDICATED AT 20 TO 42 WEEK

Fetal lung maturity

Fetal distress

HDN

Infecttion

colors disappear with ferric chloride causing black urine

ARGYROL (ANTISEPTIC)

reliable way to distinguish maternal urine and amniotic fluid

creatinine and urea

urea AF <30 mg/dl MU >300 mg/dl

Creatinine <3.5 mg/dl MU >10 mg/dl

lless reliable way to distinguish Amniotic fluid and maternal urine

protein and glucose

fern like crystals are due to the

protein and sodium chloride content of AF

DETECT THE PRESENCE OF THE PLACENTAL ALPHA MICROGLOBULIN (PAMG-1)

Amnisure ROM test

Detects INSULIN LIKE GROWTH FACTOR BINDING PROTEIN FACTOR, also referred to as Placental protein 12

Actim PROMT

Detects both ALPHA FETO PROTEIN AND IGFBP-1

ROM PLUS

yellow amniotic fluid

HDN

STORAGE FOR AF

Bilirubin

cytogenestic studies or microbial

fetal lung maturity

Covered with light

Room temp or incubated at 37C

Transported in ice and kept refrigerated

normal amniotic fluid OD

Highest is 365 nm and decreases linearlty to 500 nm

blood from Amniotic fluid for bilirubin is removed by ____ because blood can ___

removed by chloroform

can cause oxyhemoglobin occurs at 410 nm interfering the OD 450 of bilirubin

zone 1 of liley graph

MILDLY affected fetus

Sone 2 liley graph

MODERATE hemolysis and may require careful monitoring

Zone 3 liley graph

Severe hemolysis, Intervention through indication of labor or intrauterine exchange transfusion must be considered

screening test for Neural tube defects

confirmatory test for neural tube defects

Alphe fetoprotein

Acetylcholinesterase

Alpha-fetoprotein is REPORTED in both serum and amniotic fluid in terms of ___

Value of ____ the median value is considered ABNORMAL

MULTIPLES OF THE MEDIAN (MoM)

2 times or greater than 2 MoM

Increase AFP

Decrease AFP

Increase - Spina bifida, anencephaly

Decrease - Down syndrome

seventh most common cause of morbidity and mortality in the premature infant

Respiratory Distress Syndrome

low surfactant causing alveoli to collapsed

Respiratory distress syndrome

Primary component of the surfactants

Lecithin

can serve as control on which to the base the rise in lecithin

Sphingomyelin

during respiratory distress syndrome the L/S ratio will rise

2.0 or higher as the lecithin production increases to prevent alveolar collapse

immunologic agglutination test for phosphatidyglycerol

Amniostat FLM

thin layer chromatography

Lecithin-spingomylin ratio

production of phosphatidylglycerol normally parallels that of lecithin, but its production is delayed in cases of

MATERNAL DIABETES

More rapid and easy to perform method for assessment of fetal maturity that does not require a laboratory ro be equipped to perform THIN LAYER CHROMATOGRAPHY

AMNIOSTAT FLM

uses antisera containing polyclonal anti-PG antibodies that are specific for PG-containing lamellar bodies in the amniotic fluid

AMNIOSTAT FLM

Not affected by specimen contamination with blood and meconium

Amniostat flm

foam or shake test of amniotic fluid is mixed with

95% ethanol (ANTI-FOAMING AGENT), shake for 15 seconds, undisturbed for 15 minutes

positive with continuous line of bubbles around the outside edge

VALUES OF EQUAL OR GRATER THAN 47 in foam stability index indicates

fetal lung maturity

lamella bodies are produced by ___ diameter is similar to ____

type II pneumocytes, SIMILAR TO SMALL PLATELETS

Lamellas body count

FETAL LUNG MATURITY

IMMATURE LUNG

Lamellas body count

FETAL LUNG MATURITY >50,000/uL OR 32,000/uL

IMMATURE LUNG <15,000/ uL

Can be obtain using the platelet channel of automated hematology analyzers using either optical or impedance methods for counting

Lamella body counting

Presence of lamellar bodies increases the OD of the amniotic fluid

OD 650 nm

Lamellar bodies measure in Optical Density is prepared by

Centrifuged at 2000 g for 10 minutes and examined of 650 nm

OD 0.150 for lamellar bodies

Fetal lung maturity

Lamellar bodies OD 650 nm

estimate of fetal age

creatinine >2 mg/dL indicates a fetal age of approximately 36 WEEKS

THIRD MAJOR BODY FLUID

CEREBROSPINAL FLUID

csf is first recognized by

catugno in 1764

csf is produced approximately ____ in the CHOROID PLEXUS and reabsorbed by the ____

20 mL/hour, arachnoid villi

capillary networks that produce CSF from plasma by mechanism of ____

Selective filtration under hydrostatic and active transport protein

rate of production and reabsorption of CSF is

EQUAL

REABSORBED CSF BACK

Arachnoid villi or granulations

CSF VOLUME

Adult

Neonate

90 to 150 ml

10 to 60 mL

1 csf tube only

Micro, Hema, CSF

CSF WBC AND RBC should be tested within 1 hour because it begins to lyse

Within 1 year. and 40% of the leukocytes disintegrate after 3 hours

CSF Specimen that cannot be annalyzed immediately should be

refrigerated

Normal adult CSF

Normal neonates CSF

Adult: 0-5 WBC/ul

Neonates: 30 Mononuclear cells/uL

CSF TOTAL CELL COUNT DILUENTS

Normal Saline (0.85% NaCl)

CSF WBC COUNT Diluent

3% Acetic Acid with Methylene Blue

CSF RBC count

Total Cell count minus WBC count

CSF Corrections for contamination

Subtract 1 WBC for every 700 RBCs

Subtract 8 WBC for every 10,000 RBCs/uL

CSF Specimen concentration include

Sedimentation

Filtration

centrifugation

cytocentrifugation

In cytocentrifuge, as the specimen is centrifuged, cells present in fluid are forced into a monolayer within a ____ on the slide

6 mm diameter

csf specimen

increase cell yield or recovery

decreases cellular distortion

0.1 ml csf + 1 drop of 30% albumin

csf specimen

Daily control slide for bacteria

0.2 ml csf + 2 drop of 30% albumin

increased in number of normal cells in CSF

PLEOCYTOSIS

all stages of development may be found

Lymphocytes

found mixed with lymphocytes

monocytes

granules may be less prominent than in blood

cells disintegrate rapidly

neutrophils

may contain phagocytized RBCs appearing as empty vacuoles or ghost cells, hemosiderin granules, and hematoidin crystals

macrophages

resemble lymphocytes with cleft nuclei

lymphoma cells

traditional and classic forms seen

reactive lymphocytes

plasma cells

seen in clusters with distinct nuclei and distinct cell walls

ependymal, choroidal, and spindle shaped cells CES

Seen in clusters with fusing of cell borders and nuclei

malignant cells

resemble lymphocytes with cleft nuclei

lymphoma cell

may resemble neutrophils with pyknotic nuclei

nucleated RBC

csf protein normal value

15 to 45 mg/dl

rapid CSF production

DECREASED PROTEIN

major csf protein

albumin

2nd csf protein found

pre albumin

CSF alpha globulin

haptoglobin, ceruloplasmin

beta globulin in csf

transferrin

gamma globulin

primarily IgG, some IgA

NOT FOUND IN NORMAL CSF

FIB

Fibrinogen

IgM

Beta Lipoprotein

reagent of choice because it will precipitate both albumin and globulin equally

trichloroacetic acid (TCA)

unless SSA is combined with sodium sulfate, albumin will contribute more to the tubidity than globulin

Sulfosalicylic Acid (SSA)

TURBIDIMETRIC for total CSF Protein

Trichloroacetic acid

Sulfosalicylic acid

total protein CSF in dye binding

Coomassie brilliant blue

evaluate the integrity of the blood brain barrier

CSF/Serum albumin Index

CSF/Serum albumin index

Intact bloood brain barrier

an index value <9 represents an intact blood brain barrier

Index increases relative to the amount of damage to the barrier

measure IgG synthesis within the CNS

IgG index

normal IgG index

values greater than 0.70 indicate IgG production within the CNS