Body fluids Final review

Reasons to analyze CSF

• Meningitis

• CVA

• MS

• Leukemia, tumors, lymphoma

• hydrocephalus

• X-ray dye

CSF is created by the

Choroid plexus

Purpose of the CSF

to cushion and exchange nutrients and wastes

In CSF, the amount of cells, protein, and glucose is controlled by the

Blood brain barrier

Normal WBC in CSF

0-5

Normal RBC in CSF

none

Normal protein in CSF

15-45mg/dL

Normal glucose in CSF

2/3 of blood glucose

Tube 1 of CSf goes to ____ for ______. if it can’t be analyzed w/in 2 hrs you _______ it

chem

protein/glucose

freeze

Tube 2 of CSF goes to ____ for ______. if it can’t be analyzed w/in 2 hrs you _______

micro

culture and gram stain

leave it at rm temp

Tube 3 of CSF goes to ____ for ______. if it can’t be analyzed w/in 2 hrs you _______

heme

Diif/cell count

put it in the fridge

Tube 4 of CSF goes to ____ for ______. if it can’t be analyzed w/in 2 hrs you _______

extra

serology/special tests

put in the fridge

Normal CSF looks

like water

CSF from a meningitis patient is

cloudy

CSF from a CVA patient is

bloody/yellow

CSF from a bad tap is

bloody but clear

How doe you distinguish CVA from a bad tap

• RBC in 1 vs 3 (Bad tap)

• Xanthochromia (CVA)

• clot (CVA)

Meningitis has what CSF results

inc. WBC

inc. CSF protein

dec. CSF glucose

inc. CSF lactate

Viral meningitis has what CSF results

inc WBC

Inc. lymphs

CSF protein norm

CSF glucose norm

What cell type is found in CSF for a CVA pt.

Erythrophage

expected CSF results for a CVA

inc. WBC

Inc. macrophages and RBC

inc CSF protein (damage from blood brain barrier)

norm CSF glucose

What two things are in this macrophage and when does this happens?

• Hematoidin crystal and hemosiderin

• CVA

What will happen if someone sees blasts in a CSF

Chemo to the (spinal) cord

what does it mean when lymphoblasts are seen in CSF

leukemia metastisized

What do these cells indicate

inflammation of the pleural lining (mesothelial cells)

What do these cells indicate in a body fluid

Bone marrow contamination (b/c nucleated RBCs)

What do these cells indicate?

malignancy

When the ratio of CSF albumin to serum albumin is <9, indicates

normal CSF

When the ratio of CSF albumin to serum albumin is >9, indicates

damage to the BBB

the Presence of oligoclonal bands in CSF means

MS

MS has the presence of what protein in CSF

Myelin basic protein

Calculation of Ig index

[CSF IgG/serum IgG] / [CSF albumin/serum albumin]

hyperphosphorylated tau proteins in the CSF indicate

Alzheimers, parkinsons, or encephalopathy

Tau proteins are good for

stabilizing the internal structure of neurons

Effusion

build up of fluid btw 2 serous membranes

Transudate

Build up of fluid due to pooling btw membranes

Exudate

build up of fluid due to disruption of membranes

Chylous

milky fluid due to increased triglycerides

Pseudo-chylous

Milky fluid due to an increased cholesterol

Transudates are caused by:

• CHF

• chronic kidney failure

• liver failure

transudates look like

clear yellow

cell count of pleural fluid is

<1000

Cell count of ascites and peritoneal is

<500

Transudates fluid:serum protein ratio is

<0.5

Transudates fluid:serum LD ratio

<0.6

Exudates are caused by

• malignancy

• trauma

• infection

Exudates appear

yellow cloudy/bloody

Fluid:serum protein ratio of exudate is

>0.5

Fluid: serum LD ratio of exudates is

>0.6

The viscosity of synovial fluid is due to

hyaluronic acid

How do you pre treat synovial fluid

Hylauronidase

Mixing synovial fluid with acetic acid causes he fluid to

gell as it lyses RBC

What are the three M’s too look for in body fluids

• macrophage

• Mesothelial

• Malignant cells

What are the five categories of joint disorders

1. Hemmorhagic, RBC

2. Septic, bacteria

3. crystal induced, urate/calciumphosphatedehydrogenase

4. Atoimmune related

5. degenerative disorders, decreased WBC

____ has ____ birefringence and is blue when parrallel; yellow when perpendicular

CPPD, +

______ has ____ birefringence and is yellow when parallel; blue when perpendicular

Gout, -

Semen analysis should be done within

1 hrs

the first part of the ejaculate has

the most sperm

semen sample should be kept at

room temp

what are other tests you can do on semen

fructose and spermviability

preliminary info for sperm

volume

viscosity

ph

if liquefaction occurs with in 30-60 min

40x sperm

• look for agglutination, round cells, motility

• grading is different btw WHO 4th and 5th

sperm dilution on 20x

• immobolize sperm in fomalin/phos to count

• count 5 RBC squares

• number counted is multiplied by 1 million, is the serm concentrated

• multiply number x volume in ml to get absolute count

how long is a sperm count needed post vas

2 months post vas and isnt called clear until 2 months in a row

to be sure no sperm are present what do you do to the specimen

centrifuge

Amniotic fluid must be

kept from light

Amniotic appears

colorless and hazy

What conditions are tested for in amniotic fluid

• open neural tube defects

• hemolytic disease

• fetal lung maturity

Nueral tube defects are indicated by what in amniotic fluid and maternal serum

AFP

How do you monitor hemolytic disease of a fetus

OD 450 Scan

liley graph (23wks on)

Queenan graph for early pregnancy

What are indicators of fetal lung maturity

• Lecithin to sphingomyelin >2.5

• Phosphatidyl glycerol in amniotic fluid

• Lamellar body count >50

Fetal fibronectin can signal

pre-term labor

APT test hemolysate mixed with NaOH adult hgb _____/ fetal hgb ______

• denatures

• remains pink

What is a ROM test

to see if fluid is amniotic or not

Fern test

bedside test to see if fluid is vaginal or amniotic

Maternal serum quad scree screens for birth deects by looking for

• high AFP (neural tube defects)

• Low estriol (downs)

• High DIA (downs and edwards)

• High HCG (in downs and multiple babies)

Sweat chloride is used to diagnose

CF

High levels of chloride in sweat obtained by

pilocarpine iontophoresis

Steatorrhea means

fatty feces

Fecal fat measurement done to assess pancreatic enzyme deficiency where patient is unable to break down fats; condition is called

pancreatic insufficiency

Eosinophils in the urine detect

drug induced interstitial nephritis