Synovial fluid

Synovial fluid

is a viscous liquid found in the cavities of the movable joints

Articular cartilage

the bones in the synovial joints are lined with

Diathroses

movable joints

Synoviocytes

The synovial membrane contains specialized cells called

Type A cells

are macrophage-like cells located in the superficial layer of the synovial membrane and play an important role in phagocytosis.

Type b cells

are fibroblast-like cells with prominent endoplasmic reticulum located in a deeper layer of the synovial membrane

hyaluronic acid, fibronectin, and collagen

Type b cell produce

Synovial fluid

is formed as an ultrafiltrate of plasma across the synovial membrane

Lubrication

Provide Nutrients

Lessen shock

Importance of synovial fluid

Nonselective

Filtration of synovial fluid yes [selective or non selective]

Hyaluronic acid

contribute the noticeable viscosity to synovial fluid

Arthritis

Damage to the articular membranes produces pain and stiffness in the joints, collectively referred to as

Arthritis

Laboratory results of synovial fluid analysis can be used to determine the pathological origin of

white blood cell (WBC) count, differential, Gram stain, culture, and crystal examination

The beneficial tests performed most frequently on synovial fluid are the

Arthricentesis

Synovial fluid is collected from a joint by needle aspiration called

less than 3.5 mL

the normal amount of fluid in the adult knee cavity is

Heparin

fluid is collected in a syringe that has been moistened with

collorless list to pale yellow

Normal color of synovial fluid

Clear

Normal clarity of SF

High; Able to form a string 4—6 cm long

Normal viscosity of SF

<200 cell/ul

Normal leukocyte count of SF

<25%

Normal neutrophils

No

Is it normal to find crystals in SF

<10 mg/dL lower than the blood glucose level

Normal Glucose:plasma difference of SF

<3 g/dL

Normal total protein of SF

<25.0 mg/dL

Normal lactate of SF

Degenerative joint disorders, osteoarthritis

Non inflammatory joint disorders

Immunologic disorders, rheumatoid arthritis, systemic lupus erythematosus, scleroderma, polymyositis, ankylosing spondylitis, rheumatic fever, Lyme arthritis Crystal-induced gout, pseudogout

Inflammatory joint disorders

Microbial infection

Septic joint disorders

Traumatic injury, tumors, hemophilia, other coagulation disorders Anticoagulant overdose

Hemorrhagic disorders

Red tube

The first 4 to 5 mL of the synovial fluid obtained should be placed into what tube

4 to 5 milliliter

Milliliter for the obtained synovial fluid

sodium heparin per mL (green stopper) , ethylenediaminetetraacetic acid (EDTA) tube

The next 4 to 5 mL is collected into a tube to which 25 units (U) of _____is added or to a ____

sterile tube, sodium polyanethol sulfonate (yellow stopper) tube

The last 4 to 5 mL is placed into a ___ to which 25 U per mL heparin is added (green stopper) or to a ___ for microbiological studies.

Powdered

What anticoagulants should not be used because they may produce artifacts that interfere with crystal analysis.

False

True or false.

Specimens for crystal analysis should be refrigerated

egg white

Normal viscous synovial fluid resembles

Egg or ovum

The word "synovial" comes from the Latin word for

Clear, yellow fluid

Good viscosity

WBCs <1000 µL Neutrophils <30% Similar to blood glucose

Noninflammatory lab findings

Cloudy, yellow fluid

Poor viscosity

WBCs 2,000—75,000 µL

Neutrophils >50%

Decreased glucose level

Possible autoantibodies present

Immunologic origin laboratory findings

Cloudy or milky fluid

Low viscosity

WBCs up to 100,000 µL

Neutrophils <70%

Decreased glucose level Crystals present

Crystal induced origin, laboratory findings

Cloudy, yellow-green fluid Variable viscosity WBCs 50,000 to 100,000 µL Neutrophils >75% Decreased glucose level Positive culture and Gram stain

Septic laboratory findings

Cloudy, red fluid Low viscosity WBCs equal to blood Neutrophils equal to blood Normal glucose level

Hemorrhagic laboratory findings

Sterile sodium heparin or sodium polyanethol sulfonate

Required tube for a Gram stain and culture

Sodium heparin or liquid ethylenediaminetetraacetic acid

Tube for cell count

Sodium fluoride or nonanticoagulated

Tube for Glucose analysis

deeper yellow

The color becomes a ____in the presence of noninflammatory and inflammatory effusions

greenish tinge

Color may have a ___with bacterial infection.

Traumatic aspiration

the uneven distribution of blood or even a single blood streak in the specimens are obtained from a

Clarity

is determined by the presence of WBCs, red blood cells (RBCs), synoviocytes, crystals, fat droplets, fibrin, and cellular debris in the synovial fluid

Turbidity

is associated frequently with the presence of WBCs and synovial cell debris and fibrin

milky

The fluid may appear __ when crystals are present

WBCs, red blood cells (RBCs), synoviocytes, crystals, fat droplets, fibrin, and cellular debris in the synovial fluid

Clarity is determined by the presence of

Arthritis

affects both the production of hyaluronate and its ability to polymerize, thus decreasing the fluid viscosity.

fluid's ability to form a string from the tip of a syringe

Several methods are available to measure the synovial fluid viscosity, the simplest being to observe the

Ropes, or mucin clot, test

Hyaluronate polymerization can be measured using a

mucin clot

Formation of a ___after adding acetic acid can be used to identify a questionable fluid as synovial fluid.

False

True or false

The mucin clot test is performed routinely because all forms of arthritis decrease viscosity and little diagnostic information is obtained.

2% to 5% acetic acid

When added to a solution of ___, normal synovial fluid forms a solid clot surrounded by clear fluid.

Leukocyte count

is the cell count performed most frequently on synovial fluid

one drop of 0.05% hyaluronidase; phosphate buffer; milliliter; 37°C for 5 minutes

Very viscous fluid may need to be pretreated by adding ___ in ___per __ of fluid and incubating at ___

Neubauer counting chamber

Manual counts on specimens that have been mixed thoroughly are done using the

True

True or false

clear fluids can be counted undiluted

acetic acid

traditional WBC diluting fluid cannot be used because it contains ___ that causes the formation of mucin clots

Normal saline

can be used as a diluent when counting abc

hypotonic saline (0.3%); saponinj

If it is necessary to lyse the RBCs, __ or saline that contains ___ is a suitable diluent

Methylene blue

stains the WBC nuclei, permitting separation of the RBCs and WBCs during counts performed on mixed specimens.

9 large square

For counts less than 200 WBCs/µL, count

4 corner squares

For counts greater than 200 WBCs/µL in the previous count, count

five small squares

For counts greater than 200 WBCs/µL in the previous count, count the ___used for a RBC count.

less than 200 WBCs/µL

For counts ___, count all nine large squares.

greater than 200 WBCs/µL

For counts ___ in the previous count, count the four corner squares

monocytes, macrophages, and synovial tissue cells

are the primary cells seen in normal synovial fluid

septic condition

Increased neutrophils indicate a

nonseptic inflammation

elevated cell count with a predominance of lymphocytes suggests a

Less than 15%

Normal lymphocyte count

crystals

Microscopic examination of synovial fluid for the presence of ___ is an important diagnostic test in evaluating arthritis.

Monosodium urate and calcium's pyrophosphate dihydrate

The primary crystals seen in synovial fluid are

• Increased serum uric acid resulting from impaired metabolism of purines • Increased consumption of high-purine-content foods, alcohol, and fructose

• Chemotherapy treatment of leukemias

• Decreased renal excretion of uric acid

The most frequent causes of gout include

Pseudogout, calcium

is associated most often with degenerative arthritis, producing cartilage calcification, and endocrine disorders that produce elevated serum ___ levels

hydroxyapatite

crystal associated with calcified cartilage degeneration

Cholesterol

Crystal associated with chronic inflammation and seen in RA

Corticosteroids

Crystals after injection

calcium oxalate crystals

crystals in patients on renal dialysis

Monosodium urate

Crystals associated with gout

Calsium pyrophosphate

Crystals associated with pseudogout

Neutrophil

Polymorphonuclear leukocyte

Lymphocyte

Mononuclear leukocyte

Macrophage

Large mononuclear leukocyte, may be vacuolated

Synovial lining cell

Similar to macrophage, but may be multinucleated, resembling a mesothelial cell

LE cell

Neutrophil containing characteristic ingested "round body"

Reiter cell

Vacuolated macrophage with ingested neutrophils

RA cell (ragocyte)

Neutrophil with dark cytoplasmic granules containing immune complexes

Cartilage cells

Large, multinucleated cells

Rice bodies

Macroscopically resemble polished rice and Microscopically show collagen and fibrin

Fat droplets

Refractile intracellular and extracellular globules

Hemosiderin

Inclusions within clusters of synovial cells

Hemosiderin

Pigmented villonodular synovitis

Fat bodies

Associated with Traumatic injury Chronic inflammation

Rice bodies

Associated with Tuberculosis and Septic and rheumatoid arthritis