Body Fluid Analysis Study Guide

Pleural

lungs

pericardial

heart

peritoneal

abdomical organs

plasma ultrafiltrate

Hydrostatic pressure forces ________ to form in cavity

oncotic pressure

At the same time, plasma proteins in capillaries produce ___________ opposing this filtration

fluid formaton

permeability of capillary endothelium regulates rate of ultrafiltrate formation and its protein composition

Effusion

accumulation of fluid in a body cavity indicating an abnormal or pathologic process

paracentesis

percutaneous puncture of a body cavity for aspiration of fluid

thoracentesis

to obtain pleural fluid

pericardiocentesis

for pericardial fluid

peritoneocentesis

for peritoneal fluid

transudate

results from systemic disease that causes an increase in hydrostatic pressure or a decrease in plasma oncotic pressure

exudate

results from inflammatory processes that increase permeability of capillary endothelium or a decrease in absorption by lymphatic system

Transudate (Chemical examination)

-clear

-WBC

Exudate (chemical examination)

-cloudy

-WBC >1000/uL

-Fluid: serum protein and LD ratios (>0.5; >0.6)

-spontaneous clotting possible

-generally associated with infection, inflammation, or malignancy

Transudate (physical examination)

clear, pale yellow

viscosity similar to serum

do not clot (no fibrinogen)

Exudates (physical examination)

-Usually cloudy

-Various colors (Yellow, green, or pink to red)

-May have shimmer or sheen

-Can form clots

Cloudy paracentesis fluid

large number of WBCs, other cells, chyle, and/or lipids; milky after centrifugation indicates chyle

chylous effusions

caused by obstruction of or damage to lymphatic system

pseudochylous effusions

chronic effusions can be differentiated from chylous effusions by their lipid content

chylous

high triglycerides and chylomicrons present

pseudochylous

low triglycerides and no chylomicrons present

glucose chemistry testing

-only low-fluid glucose significant

-associated with RA; also infection, TB and malignant neoplasm

Amylase chemistry testing

high pleural or peritoneal fluid associated with:

-pancreatitis

-esophageal rupture

-gastric duodenal perforation

-metastatic disease

lipid chemistry testing

used to identify chylous effusions

pH chemistry testing

abnormally low pH helps identify pleural exudates caused by pneumonia or lung abscess

dura mater

outer layer next to bone

arachnoid mater

middle layer resembling a spiderweb

pia mater

innermost layer adhering to surface of neural tissues

Function of CSF

bathes and protects brain and spinal cord

85-150 mL

normal adult volume of CSF

10-60 mL

CSF volume in neonates

electrolytes, albumin, IgG, glucose, and lactate

Substances that can cross blood-brain barrier

lumbar puncture

collected by aseptic lumbar puncture in third or fourth lumbar interspace with local anesthesia

xanthochromia

abnormal color of CSF, usually yellow, orange, or pink due to various conditions

pleocytosis

increased number of cells in CSF

WBC counts

-increased in diseases of CNS and variety of other conditions

-All WBCs are counted

-differential performed on cytospin slide stained with Wright's stain

Neutrophils

-in bacterial meningitis, up to 90% of WBCs can be neutrophils

-early viral, fungal, tuberculosis (TB), or parasitic infections

-some noninfectious conditions

lymphocytes

-increased in viral, TB, fungal, or syphilitic meningitis particularly in later stages

plasma cells

-are abnormal; seen in multiple sclerosis and acute viral and chronic inflammatory conditions

monocytes

may be increased in a mixed cell pattern such as TB or fungal meningitis, chronic bacterial meningitis, or rupture of cerebral abscess

eosinophils

-10% or greater with parasitic, fungal, or allergic reactions

-following injection or radiographic contrast media or medications

-can also result from an allergic reaction to malfunctioning intracranial shunts

macrophages

often found after hemorrhage of phagocytic ability

15 to 45 mg/dL

Normal levels of total protein in CSF

CSF/Serum Albumin index

used to assess permeability of blood-brain barrier

multiple sclerosis

Where is oligoclonal bands seen?

transthyretin, albumin, two transferrin bands

Four bands that are predominate in CSF

Glucose CSF tests

Value reflects plasma value 30 to 90 minutes before CSF collection; decreased value is associated with many conditions including meningitis

Lactate CSF tests

Increased conditions impairing blood supply or transport of oxygen to the CNS; viral meningitis normal; other elevated

gram stain

for bacteria and fungi

india ink

for cryptococcus neoformans

acid-fast stain

for tb meningitis

wright's stain

for ameba Naegleria fowleri

culture

to detect bacterial cause

detection of microbial antigens

immunological tests to assist in identifying bacterial and fungal antigens in CSF

synovial fluid

-bathes and lubricates joints

-present in areas where friction can develop, such as joints, bursae, and tendon sheats

Hyaluronic acid

_______ causes synovial fluid to be vicious

Formation of synovial fluid

formed by ultrafiltration of plasma across synovial membrane and from secretions by synoviocytes

arthrocentesis

percutaneous aspiration from a joint using aseptic technique and disposable sterile equipment

-patient should be fasting a minimum of 4 to 6 hours

-blood sample should be collected at the same time

Collection and handling of synovial fluid

best anticoagulant is sodium heparin or liquid EDTA, since they do not form crystals (or SPS)

Transport of Synovial fluid

transport and analyze at room temperature; evaluate immediately

(refrigeration causes decreased microorganism viability and cause crystal formation)

Physical examination of synovial fluid

-pale yellow

-colorless and clear

Red or brown synovial fluid

associated with trauma during collection procedure or disorders that disrupt synovial membrane allowing blood to enter joint cavity

greenish or purulent synovial fluid

associated with infections and milky in others (tuberculous, arthritis, systemic lupus erythematosus)

Rice bodies

white, free-floating substances made up of collagen covered by fibrous tissue

-Seen in many arthritic conditions: Rheumatoid arthritis

mucoprotein hyaluronate

high viscosity due to high concentrations of ___________________

Inflammatory conditions

hyaluronate can be depolymerized by enzyme hyaluronidase present in bacteria and some neutrophils

Assessing viscosity

expelling fluid from collection syringe and observing a normal string formation, at least 4 cm long before breaking

clot formation synovial fluid

-normal synovial fluid does not clot

-spontaneous clot formation indicates abnormal presence of fibrinogen

monosodium urate crystals

-present in gouty arthritis

-needle-like crystals with pointed ends that can distend the cytoplasm of WBCs

-polarizing microscopy

calcium pyrophosphate dihydrate crystals (CPP)- pseudogout

-seen in degenerative arthritis and arthritis accompanying metabolic diseases

-smaller and blunter than MSU crystals

-are rodlike or rhomboid; display weak positive birefringence with their colors opposite of that of MSU

Cholesterol crystals (synovial fluid)

-observe on wet preparation or unstained cytospin slide

-flat, rectangular plates with notched corners

-seen in chronic inflammation

hydroxyapatite crystals (synovial fluid)

-observe intracellularly but only using electron microscope

-tiny, needle-like crystals

-can induce an acute inflammatory reaction similar to that caused by MSU and CPPD crystals

corticosteroid crystals (synovial fluid)

-seen for months after steroid injection

-of no clinical significance

-look like MSU or CPPD but yield conflicting results based on their birefringence

glucose chemical examination (synovial fluid)

some diseases cause decreased glucose in fluid, 1/2 that present in the patient's plasma

total protein chemical examination (synovial fluid)

-increased protein as a result of variety of joint diseases

-only indicates inflammatory process

uric acid chemical examination (synovial fluid)

-same levels as plasma

-increased levels in fluid may cause MSU crystals

lactate chemical examination (synovial fluid)

-increased from anaerobic glycolysis in the synovium

-clinical value not yet established

sperm production

_______ regulated by Sertoli cells in seminiferous tubules of testes

Testes

function controlled by FSH and LH

Secretion of sperm (exocrine)

regulated by sertoli cells in seminiferous tubules

Secretion of testosterone (endocrine)

regulated by interstitial cells of Leydig

Epididymis

-sperm undergo final stages of maturation

-concentrates sperm by removing lumen fluid

vas deferens

muscular tube which transports sperm to the ejaculatory duct

seminal vesicles (accessory gland)

-secretions account for about 70% of fluid volume

-adds flavin, fructose, proteins, and prostaglandins

prostate (accessory gland)

-secretions account of about 25% of fluid volume

-adds citric acid, enzymes (acid phosphatase and proteolytic enzymes), other proteins, zinc

bulbourethral glands

provides a small amount of fluid to semen

Sperm specimen collection notes

-entire ejaculate is collected in appropriate sterile container

-samples delivered to lab within 1 hour; maintained between 20 C and 40 C

-lubricants and normal condoms cannot be used

-the collection container should be kept at room temperature or warmed to approximately body temperature prior to collection

-note time of specimen collection

appearance of sperm

-normal: gray-white and opalescent

-immediately coagulates but should liquefy within 30 minutes

-normal volume: 2 to 5 mL

-viscosity: after liquefaction, normal specimen is watery and forms discrete droplets

Sperm motility

50% or more should show moderate to strong linear or forward progression

0 (sperm motility)

immotile

1 (sperm motility)

motile, without forward progression

2 (sperm motility)

motile, with slow nonlinear or meandering progression

3 (sperm motility)

motile, with moderate linear (forward) progression

4 (sperm motility)

motile, with strong linear (forward) progression

20 to 250 million/mL

Normal sperm concentration

vitality

vital staining differentiates between live and dead sperm, dead sperm take up stain; live ones do not

agglutination

presence of motile sperm sticking together

pH of sperm

-normal ranges from 7.2 to 7.8

-below 7.2 is abnormalities of epididymis, vas deferens or seminal vesicles

-above 7.8 suggests infection

fructose (sperm)

-produced and secreted by seminal vesicles

-most often measured when no sperm seen on count

-normal levels greater than or equal to 13 umol per ejaculate