2nd prt jul last other body fluids

Cerebrospinal Fluid (CSF)

Is essential of infection such as meningitis, encephalitis, subarachnoid hemorrhage, multiple sclerosis, malignancies and autoimmune disorders

between L3 to L4 or L4 to L5 vertebrae

Cerebrospinal Fluid (CSF) Collection Method

Collected using lumbar puncture which is also called spinal tap, typically in:

Tube identification number (1,2,3,4) indicating order of collection

CSF Order of Collection Labeling

Microbiology, Hematology, And then Chemistry

CSF Order of Collection (3 tubes)

CSF Tube 1 (4 tubes order)

For chemistry and serology - less prone for contamination from blood. If delayed processing refrigerate

CSF Tube 2 (4 tubes order)

For microbiology - for microbiology, this is for gram stain, blood culture, etc. keep at room temperature. Do not refrigerate

CSF Tube 3 (4 tubes order)

For hematology - CBC, differential count, should be handled quickly to prevent cell lysis

CSF Tube 4 (4 tubes order)

Cytology analysis - Hemoglobin pigments in CSF

Xanthochromia

Two most common reasons for hemoglobin pigments (Xanthochromia) in CSF: 1. Traumatic tap 2. Subarachnoid hemorrhage (SAH)

Traumatic tap (CSF)

accidental puncture of blood vessels during lumbar puncture. Blood presents in later tube (tube 2) tube 1 can be bloody but clearer in tube 3 or 4.

Subarachnoid hemorrhage (SAH) (CSF)

blood present in CSF due to a bleed in a subarachnoid base. Blood is evenly distributed across all tubes from tube 1 to 4. It can also show a bit of xanthochromia where there is a yellowish discoloration due to hemoglobin breakdown.

Urine

It is critical in clinical chemistry for diagnosing and monitoring a wide range of conditions such as renal function, electrolyte balance, metabolic disorders and endocrine abnormalities.

Types of urine specimen: Random specimen

collected anytime of the day without any preparation. In CC, dipstick testing or spot check for glucose or protein

Types of urine specimen: First voided specimen

also called first morning specimen. It is typically concentrated. It is usually for pregnancy testing or testing of analytes that are low in concentration such microalbumin, ketones, and bilirubin

Types of urine specimen: Timed specimen

these are specimens that are collected over a specified time interval. In CC, 24-hour creatinine clearance, protein calcium urea, hormone, and heavy metal testing.

Types of urine specimen: Clean-catch midstream specimen

AUBF urinalysis, to prevent contamination from skin flora collected after cleaning the genital area and capturing the midstream urine.

Types of urine specimen: Catheterized specimen

this is performed by medical personnel under sterile conditions. This is obtained by insertion of a sterile catheter into the bladder. This is an accurate test for electrolytes or protein for non ambulatory patients. This is highly sterile and suitable for patients when the person cannot avoid it voluntarily.

Pleural Cavity Specimen Collection Method

Diagnostic thoracentesis - is collected via a thoracentesis needle that punctures in the lung cavity in order to get the pleural fluid.

Pleural Cavity Specimen Required Volume

Between 20 to 40 mL of pleural fluid is needed for a complete analysis - You will need 20-40mL of pleural fluid in order to get a complete panel such as chemical analysis, cytology, microbiology and cell count and differential count.

Pleural Cavity Anticoagulant

EDTA or heparin - The usual anticoagulant is EDTA (for cell count and cytology) or heparin (upper venting clotting for biochemical test) for no additive for culture and chemistry

Pleural Cavity Transport Temperature

Transported to the laboratory at ambient temperature -room temperature for short duration

2hrs

Pleural Cavity Maximum Acceptable Time Delay

The maximum acceptable time delay - ___. Critical for glucose, lactate dehydrogenase (LGH)

Pleural Cavity Delay Storage (>2 hrs)

If a longer delay is expected - store in the ref at 4°C except for microbiological cultures. Because refrigeration can inhibit pathogen recovery

48 hrs

Pleural Cavity Refrigerated Storage

Refrigerated storage for up to ___ valid for chemistry, cytology but not suitable for blood cultures

Pericardial Fluid Purpose

In the heart cavity, it helps identify the cause of pericardial effusion which may result from infection, malignancy, autoimmune condition, post-myocardial infarction syndrome, trauma or post-surgical complication

pericardiocentesis or open surgical drainage

Pericardial Fluid Collection Method

Collected via ___

2-8°C

Pericardial Fluid Cytopathological Study

Cytopathological study send to lab ASAP fresh state or refrigerated at ___

2ml

Pericardial Fluid Volume Required

Volume - __ For each laboratory test

Abdominal cavity

Peritoneal Fluid Location

Found in ____ between membrane line in abdomen

Peritoneal Fluid Collection Method paracentesis

Peritoneal Fluid Collection Method

Collection method is

Clear and pale Yellow

Peritoneal Fluid Color for Normal

Cloudy/turbid

Peritoneal Fluid Color for infection

Green

Peritoneal Fluid Color for Bile, pancreatitis, cholecystitis (inflammation of gall bladder)

Bloody

Peritoneal Fluid Color for Malignancy, traumatic tap, tuberculosis

Milky

Peritoneal Fluid Color for Lymphatic trauma and blockage

Glucose

Chemical Analysis of Peritoneal Fluid: decrease in tuberculosis and malignancy. Normally present in peritoneal fluid similar to blood glucose level

LDH (Lactate dehydrogenase)

Chemical Analysis of Peritoneal Fluid Enzymes: elevated in malignancy

AMS

Chemical Analysis of Peritoneal Fluid Enzymes: elevated in pancreatitis, GIT perforation, intestinal necrosis

ALP

Chemical Analysis of Peritoneal Fluid Enzymes: indicates intestinal perforation, meaning there is damage in the intestine.

Lactate

Chemical Analysis of Peritoneal Fluid: indicates anaerobic metabolism due to tissue hypoxia or infection elevated in spontaneous bacterial peritonitis, malignancy and tuberculosis. - If you have inflammation or infection in the peritoneal cavity, lactate serves as a marker of infection.

Chemical Analysis of Peritoneal Fluid: BUN and Creatinine

if elevated there is a indicate ruptured bladder or urinary tract leakage

Ammonia

Chemical Analysis of Peritoneal Fluid: if increased this can indicate bowel perforation or intestinal ischemia or necrosis. Produced by bacteria and damage tissue therefore it could be a useful marker for GASTROINTESTINAL complication

Serum ascites-albumin gradient (SAAG)

Chemical Analysis of Peritoneal Fluid: it helps differentiate between types of acetic fluid based on the albumin gradient between serum and acetic fluid.

SAAG Exudate

Chemical Analysis of Peritoneal Fluid: Tumor markers

CEA elevated in malignancy such gastrointestinal colorectal and pancreatic cancer and CA125 often raise in ovarian cancer

Synovial Fluid

It is viscous fluid or liquid found in the cavities of synovial joints. With access to a lubricant and nutrient carrier for the cartilage and joint tissue.

Arthrocentesis

Synovial Fluid Collection Method

Collection method by an

for microbiology

Synovial Fluid Collection Tubes: Sterile heparin

Liquid EDTA and Na heparin

Synovial Fluid Collection Tubes: microscope cell count to help preserve cell morphology

glucose analysis

Synovial Fluid Collection Tubes: Sodium fluoride

for other extra tests

Synovial Fluid Collection Tubes: Plain tube

Synovial Fluid Gross Contamination Parameters

Total volume: <3mL Color: colorless to pale yellow Clarity: clear Consistency: viscous and non-clotting

Chemical Analysis of Synovial Fluid: Glucose

Normal value: 0-10mg/dL lower than serum levels. Ratio of synovial fluid to serum glucose: 0.9:1. Decreased glucose is seen in septic arthritis

<3g/dL

Chemical Analysis of Synovial Fluid: Protein

Normal value:

<25 mg/dL

>250 mg/dL up to 1000mg/dL

Chemical Analysis of Synovial Fluid: Lactate/Lactic Acid

Normal value:

Septic arthritis:

6mg/dL

Chemical Analysis of Synovial Fluid: Uric Acid

Normal value:

Used for diagnosis of gout, in cases wherein crystal examination is not available

Lactate dehydrogenase (LDH)

Chemical Analysis of Synovial Fluid: Increased in cases of rheumatoid arthritis, infectious arthritis and gout. In case of RA: LDH is abnormal in synovial fluid but normal in serum. Making the synovial fluid LDH a useful diagnosis marker for rheumatoid arthritis.

Amniocentesis

Amniotic Fluid Collection Method

This is collected by___. By pregnant women, this procedure is done to assess the health and development of the fetus.

30mL

Amniotic Fluid Maximum Volume

low speed 500-1000g for 5minutes

Amniotic Fluid Centrifugation

Fetal Lung maturity

Amniotic Fluid Preservation: keep on ice or refrigerated

Cytogenetic analysis

Amniotic Fluid Preservation: room temp 37C

HDN

Amniotic Fluid Preservation: must be protected from light to avoid degradation

Colorless

Amniotic Fluid Color: Normal

Traumatic tap or hemorrhage (hit blood vessels)

Amniotic Fluid Color: Blood-streaked

Hemolytic Disease of the Newborn (a condition where the mother immune system attacks the RBC of the fetus, leading to anemia)

Amniotic Fluid Color: Yellow

Meconium (the fetus first feces which can be a sign of fetal distress or maturity, can increase the risk of complication in pregnancy)

Amniotic Fluid Color: Dark Green

Fetal Death

Amniotic Fluid Color: Dark Red Brown

Pre-examination

The stage before the actual testing of specimens

Pre-examination

Examples include patient client prep, sample collection, personnel competency test evaluations, sample receipt and accessioning, and sample transport.

Pre-examination

Examples include personnel professionalism, patient consent, patient preparation, infection control, standard precautions, patient identification, preparation for venipuncture, venipuncture procedure and other specimen collection, proper use of anticoagulant and preservatives, specimen handling and processing, transport specimens, and delivery time limits.

Examination

The actual laboratory testing process where errors are less common but still possible if protocols are not followed

Examination

Examples include quality control testing.

Examination

Examples include analytic techniques and instrumentation, quality control, interferences with the methods, specific reagents, and knowledge of the analyte, analytic parameters, methodology and instrumentation and management of all study variables.

Post-examination

This stage begins after the tests are completed focusing on results interpretation and validation.

Post-examination

Examples include reporting and record keeping.

Post-examination

Examples include Laboratory Information System (LIS) and Hospital Information System (HIS).

Pre-analytical, Analytical, Post-analytical

These the three major stages in the total testing process

Report should include

6. Other pertinent information for proper test interpretation