108.6

Briefly describe the formation, circulation, and composition of spinal fluid.

Clear, colorless, sterile fluid that circulates in the ventricles of the brain, the subrachnoid spaces and spinal cord

List the four main functions of CSF.

Mechanical buffer that prevents trauma

Regulates the volume of the intercranial contents

Provides nutrient medium for CNS

Act as a excretory channel for metabolic products of the CNS

Explain the indication of CSF analysis.

Meningitis

Cerebral hemorrhage

Neurological disease

Suspected malignancy

Introduction of drugs, radio contrast media, and anesthesia

Describe the collection of CSF and special handling.

Collected by needle aspiration between 3rd and 4th lumbar vertebra

Must be handled carefully and tested immediately

Distribute the three specimen tubes to their appropriate laboratory sections.

Tube 1: Chemical tests

Tube 2: Micrbiology

Tube 3: Total and differential cell count/ Hemotology

List three chemistry tests performed on CSF and normal reference ranges.

Protein: 15-45 mg/dL

Glucose: 60-70% of plasma

40-70 mg/dL

Lactate: 10-24 mg/dL

Why would gram stains and microbiology cultures be included in a CSF lab workup?

ID of bacteria meningitis

Discuss the clinical significance of different types of protein found in CSF.

Disorders affecting the blood brain barrier

What tests should be performed at the same time as measuring CSF glucose and why?

A blood glucose test

For comparison to the levels found in the CSF

What would be the clinical significance of a decreased CSF glucose?

Meningitis

Why is CSF Lactate a good test to monitor meningitis?

Levels fall rapidly if treatment is successful

Describe the appearance of normal, infectious, and hemorrhagic bleed CSF.

Normal: colorless, clear

Infectious: Xanthrochromatic, hazy

Hemorrhagic: Red, cloudy

Define xanthochromia and relate to CSF appearance.

Yellowish discoloration of the CSF

Shows there's a degradation or excess of cells

Describe three characteristics used to distinguish an intracerebral hemorrhage from a traumatic tap.

Discoloration will be more prominent in tube 1

Traumatic Tap may clot

Intracerebral hemorrhage is significant and discolors all tubes

What is a pellicle formation and which meningitis could be indicated?

Web like clots in the sample

Tubercular meningitis

Describe the principle of manual wbc counts using hemacytometers.

Body fluid is diluted, counted, the the number of cells counted is reported

Name the type of wbc associated with bacterial meningitis.

Neutrophils

Name the type of wbc associated with viral meningitis.

Lymphocytes

Monocytes

Name the type of wbc associated with tubercular meningitis.

Lymphocytes

Monocytes

Plasma cells

Name the type of wbc associated with parasitic meningitis.

Eosinophils

Plasma cells

Describe two differences in identifying Choroidal cells and Ependymal cells.

Choroidal cells do not contain a nucleus

Ependymal cells are found in the ventricle and neural canal linings

List one hematologic origin abnormal cell in CSF and one nonhematologic cell in CSF.

Hematologic: Lymphoma cells

Nonhematologic: Metastatic Carcinoma cells

List 5 origins of seminal fluid.

Testes

Epididymes

Seminal Vesicles

Prostate gland

Bulbourethral glands

List 8 parameters that are analyzed in a semen analysis

Appearance

Liquefaction

Volume

Viscosity

pH

Sperm concentration and count

Sperm motility

Sperm morphology

What would be a reason for analyzing semen?

Fertility services

Describe synovial fluid and its origin and function.

Straw colored and viscous

Every large joint of the skeleton

Proper lubrication of joints

List two functions of synovial fluid.

Provides lubrication to the joints

Provides nutrients to the articular cartilage

Briefly describe the routine examination of synovial fluid and the appearance of normal synovial fluid.

Gross appearance

Viscosity

Red and white blood cell count

Morphologic examination

Microscopic examination for crystals

Clear to straw color with the viscosity of egg whites

List the four classifications of Joint Disorders.

1. Noninflammatory

2. Inflammatory

3. Septic

4. Hemorrhagic

List the pathologic significance associated with each of the four classifications of Joint Disorders.

1. Noninflammatory: Degenerative joint disorders

Osteoarthritis

2. Inflammatory: Immunological disorders

Crystal-induced gout

3. Septic: Microbial infections

4. Hemorrhagic: Traumatic injuries

Tumors

List the abnormal laboratory values associated with each of the four classifications of Joint Disorders.

1. Noninflammatory: Higher WBCs

Higher glucose

2. Inflammatory: Cloudy

Poor viscosity

Higher WBCs

High neutrophils

Low glucose

Antibodies or crystals present

3. Septic: Yellow-Green fluid

Variable viscosity

High WBCs

High neutrophils

Low glucose

Positive culture and strain

4. Hemorrhagic: Cloudy

Red fluid

Low viscosity

WBCs and Neutrophils

List 3 wbcs that may be seen in synovial fluid.

Neutrophil

Lymphocyte

Macrophage (monocyte)

List a synovial lining cell that may be found in synovial fluid.

Mesothelial cell

What are two significant crystals that be found in synovial fluid associated with gout and inflammation?

Monosodium Urate

Calcium Pyrophosphate

Which microscopic technique may be used in identifying the crystals?

Polarizing microscope

Explain the origin of serous fluid and its location in the body.

Pleural: lung

Pericardial: heart

Peritoneal: abdomen

How is serous fluid collected and what is the procedure called according to body cavity?

Needle aspirate

Thoracentesis: lung

Pericardiocentesis: heart

Paracentesis: abdominal

Explain the significance between a transudate and an exudate.

Transudates are caused by an imbalance between hydrostatic and oncotic pressure

Exudates are caused by an increase in cell membrane permeability

List 6 reasons to perform test on amniotic fluid.

Hemolytic disease of the newborn (antibody)

Chromosome abnormalities

Neural tube defects

Fetal Lung Maturity (FLM)

Metabolic disorders

Gestational age

List 6 early disease detections performed on feces.

GI bleed

Liver and Biliary duct disorders

Maldigestion/Malabsorption syndromes

Pancreatic diseases

Inflammation

Causes of diarrhea amd Steatorrhea

What is occult blood in the stool and what laboratory test can be performed to detect it'spresence?

A common guaiac based test that looks for hidden blood in the stool

Why are vaginal secretions analyzed in the laboratory?

Diagnosing vaginal infections

Pregnancy testing

Forensic testing

STDs

List the microscopic elements seen in a vaginal secretion that suggest bacterial vaginitis.

Thin, homogenous, white-to-grey vaginal discharge

pH: >4.5

Amine test: positive

Clue cell: >20%

Increase in small curved bacilli, coccobacilli, and plemorphic bacilli