Body fluids Final

List reasons to analyze CSF

1. meningitis

2. hemorrhage

3. leukemia/lymphoma/tumor

4. multiple sclerosis

5. hydrocephalus/shunt

6. maybe when doing x-ray dye

Where is CSF created?

Choroid plexus in ventricles

What is the purpose of CSF?

-to cushion brain and spinal cord

-exchange nutirents/waste

What controls the amount of cells, protein, and glucose in the CSF?

Blood Brain Barrier

CSF normal WBC

0-5 WBC/uL

CSF normal RBC

0-10

CSF normal protein

15-45 mg/dL

CSF normal glucose

60-70% of plasma glucose

CSF Tube 1

-chemistry

-for protein, glucose

-If not analyzed within 2 hours: freeze

CSF Tube 2

-microbiology

-culture and gram stain

-if not analyzed in 2 hrs: Room temp

CSF Tube 3

-hematology

-diff and cell count

-if not analyzed in 2 hrs: fridge

CSF Tube 4

-extra tests

-serology/special tests

-if not analyzed in 2 hrs: fridge

Normal CSF appearance

Clear/colorless

Meningitis CSF appearance

cloudy

Bad tap

bloody w/ clear supernatant

Cerebral Hemorrhage

bloody and when centrifuged will be yellow (xanthochromia)

Ways to distinguish cerebral hemorrhage from bad tap

1. clot

2. In bad tap, blood will be diluted after each tube

3. xanthochromia: yellowish/pinkish (hemorrhage)

Basic formula for CSF cell count

[# of cells] X [dilution factor] / [Area] X [depth factor 0.1]

What is the diagnosis?

WBC: High

CSF Protein: incr

CSF Glucose: decr

CSF Lactate: incr

Bacterial Meningitis

What is the diagnosis?

WBC: incr

Diff: Lymphs/ variant

CSF Protein: norm- slight incr

CSF Glucose: norm

Viral meningitis

What is the diagnosis?

WBC: incr

Diff: erythrophages

CSF Protein: incr

CSF glucose: normal

Cerebral hemorrhage

Erythrophage

What is present in the cell and when does this usually happpen?

-Orange: Hematin crystal

-Black: Hemosiderin

-Happens during cerebral hemorrhage

What are these cells and when would we see them?

-lympblasts

-seen in acute leukemia

If lymphoblasts are seen in the CSF, what should be done?

Chemotherapy directly to spinal to overcome BBB

What do these cells indicate?

Lining cells

What do these cells indicate?

BM contamination

What do these cells indicate?

malignancy

How to asses damage to BBB

calculate ratio of CSF albumin to serum albumin

<9 normal

>9 damage

Diagnosis of MS

• oligoclonal bands

• prescsnec of myelin basic protein

• calculation of IgG index: ratio high

Calculate IgG index

[ CSF IgG/serum IgG]

[CSF albumin/serum albumin]

What are TAU proteins?

tubulin associated unit that help stabilize internal structures of neurons

What happens with TAU proteins in Alzheimers and Parkinsons disease?

TAU proteins become hyperphosphorylated and tangle up

-this blocks neural communication= dysfunction

Where else are high amounts of TAU proteins seen?

chronic traumatic encephalopathy

Effusion

Buildup of fluid between two serous membranes

Transudate

Buildup of fluid due to pooling between membranes

Exudate

Buildup of fluid due to disruption of membranes

Transudate vs Exudate cell counts

Transudate

• pleural: <1000

• Peritoneal + ascites: <500

Exudate

• pleura: >1000

• peritoneal: >500

Transudate vs Exudate ratio

Transudate

• Fluid serum protein ratio: <0.5

• Fluid serum LD ratio: <0.6

Exudate

• Fluid serum protein ratio: >0.5

• Fluid serum LD ratio: >0.6

Paracentesis

Procedure to remove fluid from the abdominal cavity

Thoracentesis

Procedure to remove fluid surrounding the heart and lungs

Arthrocentesis

remove joint fluid

Pericardiocentesis

withdraw fluid around the heart

Chylous

milky fluid due to increased triglyceride and chylomicrons

Pseudo-chylous

milky fluid due to incr cholesterol

Transudates caused by:

1. congestive heart failure

2. liver disease

3. kidney disease

Exudate caused by:

anything else: malignancy, infection, peritonitis, trauma, etc

Appearance of transudate vs exudate

-transudate is clear and yellow

-exudate is cloudy and bloody

Macrophage

Mesothelial

Malignant

What is synovial fluid?

clear liquid that lubricates joints

Why is snyovial fluid viscous?

Hylauronic acid

How is synovial fluid made less viscous?

pre-treatment with hylaurodinase

Mixing synovial fluid with acetic acid causes?

makes it become gel and difficult to work with

List the categories of joint disorders

1. hemorrhagic:RBCs

2. Septic: bacteria

3. Crystal induced: uric and calcium pyrophosphate

4. Autoimmune: high WBC’s

5. Degenerative: Low WBC

Cholesterol crystals

starch from gloves

What disease and how can you tell?

Pseudo-gout

• calcium pyrophosphate crystals-blue when parallel to axis

• (+) birefringence

What disease and how can you tell?

Gout

• uric acid crystals-yellow when parallel to axis

• (-) birefringence

Semen must be analyzed within___hr

1 hr

Why can’t condoms be used for semen anaysis?

Some contain spermicides

Why must all sperm be collected?

If the first part is lost, it will mess up the count since it is highest

What temp is semen kept at?

RT or 37C

What other tests may be done on sperm sample?

-fructose to asses seminal vesicles

-sperm viability (redheads are dead)

Semen: Measure____,___, if liquefaction happens in 30-60 min.

Measure ___

volume, viscosity, pH

Semen: At 40x look for___, ____, and ____

agglutination, round cells (immature sperm), motility

Immobilize sperm in ___to count

formalin/phosphate buffer

What area should be counted for sperm?

5 RBC squares

How to calculate sperm concentration?

number X 1 million

Absolute sperm count

number X volume (mL)

Post Vas sperm count

-2 months post procedure for 2 months of no sperm present

Why must centrifugation be done for post vas sperm

to concentrate and double check that there is no sperm

Amniocentesis

obtain amniotic fluid

Normal appearance and handling and storage of amniotic fluid

-colorless/hazy

-protect from light (bilirubin)

What condition is amniotic fluid tested for?

1. open neural tube defects

2. hemolytic diseases

3. fetal lung maturity

Spina Bifida: elevated levels of ____can be found in amniotic fluid and maternal serum

alpha fetoprotein (AFP)

How to monitor hemolytic diseases of fetus

OD 450 for bilirubin —> Liley graph(24 weeks) OR Queenan graph (17 week)

Prediction of fetal lung maturity:

1. L/S ratio____(lectin to sphingomyelin ;secreted by alveoli cells)

2. Presence of _____in amniotic fluid

3. ____count >50

1. L/S ratio_>2.5_(lectin to sphingomyelin)

2. Presence of __phosphatidyl_in amniotic fluid

3. Lamellar_count >50

Fetal fibronectin (“glue-leak” )presence can signal _____ could happen

preterm labor

APT test- hemolysis mixed with NaOH, adult hgb ______/fetal hgb _____

adult: denatures and turns green

fetal: remains pink

ROM test

cartridge test to determine if vaginal fluid is amniotic or not

Fern test

bedside test to determine if vaginal fluid is amniotic or not

Materenal serum quad test

Neural defects: high AFP

Down’s: Low estriol + trisomy 18

Down’s and Edwards: High DIA

Down’s and multiple babies: HCG

Sweat chloride is used to diagnose

Cystic fibrosis

High levels of chlroide in sweat test obtained by_____

pilocarpine iontorphoresis

Pancreatic insufficiency

fecal fat measurement where pt is unable to break down fats due to pancreatic enzyme deficiency

What do eosinophils in urine indicate

drug induced instersitial nephritis

Steatorrhea

high levels of fat in stool

-normal 21g in 72 hrs

How will synovial fluid with crystals appear?

Very cloudy