Synovial Fluid

Hyaluronic Acid

contributes to the viscosity of synovial fluid

Arthritis

• _{^{reduction of hyaluronic acid}}

Refers to the stiffness of joints

Arthrocentesis

Refer to the collection of synovial fluid

Syringe with heparin

What is used to collect synovial fluid (_{^{arthrocentesis}})?

NEVER REFRIGERATE

When analyzing for crystals, what should not be done to the specimen?

Colorless to Pale Yellow _{^{(Similar to Raw Egg White)}}

Normal color of Synovial Fluid

Bacterial Infection

Green Color =

Inflammatory or Non-inflammatory

Deeper Yellow =

Hemorrhagic Arthritis or Traumatic Aspiration

Red =

Presence of WBC _{^{(and/or Synovial Cells, Fibrin)}}

TURBID Clarity =

Presence of CRYSTALS

MILKY Clarity =

1. Ropes or Mucin clot test

2. 2-5% Acetic Acid

   • NORMAL: _{^{solid clot surrounded w/ clear fluid}}

   • ABNORMAL: _{^{less firm clor w/ turbid fluid}}

1. What test if performed to assess Synovial Fluid’s Viscocity?

2. What is added?

3. What are the Normal and Abnormal result?

WBC

Most common cell count performed for Synovial Fluid

1. NSS or 0.3% hypotonic saline w/ saponin

   • NEVER: Acetic Acid —_{^{only for CSF WBC count}}

2. Methylene blue (WBC nuclei)

WBC CELL COUNT:

1. Diluted sample is added with (diluent)

2. What stain is used?

Cytocentrifuged or Thinly Smeared Slides

Differential Counting should be performed in ?

• LE Cells _^—Lupus

• _{^{Reiter Cells —Reactive arthritis}}

• _{^{RA Cells (Ragocyte) —Rheumatoid Arthritis}}

• _{^{Cartilage Cells —Ostheoarthritis}}

• _{^{Rice Cells —-Tubercolusis or Rheumatoid Arthritis}}

• _{^{Fat Droplets —Injury or Chronic inflammation}}

• _{^{Hemosiderin —synovitis}}

SYNOVIAL CELLS:

• Neutrophil with ingested round body

• S: Lupus Erythematosus

• _{^{LE Cells —Lupus}}

• _{^{Reiter Cells —Reactive arthritis}}

• RA Cells (Ragocyte) _{^{—Rheumatoid Arthritis}}

• _{^{Cartilage Cells —Ostheoarthritis}}

• _{^{Rice Cells —-Tubercolusis or Rheumatoid Arthritis}}

• _{^{Fat Droplets —Injury or Chronic inflammation}}

• _{^{Hemosiderin —synovitis}}

SYNOVIAL CELLS:

• Neutrophil with DARK CYTOPLASMIC GRANULES

• S: RHEUMATOID ARTHRITIS

• _{^{LE Cells —Lupus}}

• Reiter Cells _{^{—Reactive arthritis}}

• _{^{RA Cells (Ragocyte) —Rheumatoid Arthritis}}

• _{^{Cartilage Cells —Ostheoarthritis}}

• _{^{Rice Cells —-Tubercolusis or Rheumatoid Arthritis}}

• _{^{Fat Droplets —Injury or Chronic inflammation}}

• _{^{Hemosiderin —synovitis}}

SYNOVIAL CELLS:

• Machrophage with ingested Neutrophil

• S: Reactive Arthritis

• _{^{LE Cells —Lupus}}

• _{^{Reiter Cells —Reactive arthritis}}

• _{^{RA Cells (Ragocyte) —Rheumatoid Arthritis}}

• Cartilage Cells _{^{—Ostheoarthritis}}

• _{^{Rice Cells —-Tubercolusis or Rheumatoid Arthritis}}

• _{^{Fat Droplets —Injury or Chronic inflammation}}

• _{^{Hemosiderin —synovitis}}

SYNOVIAL CELLS:

• Large, Multinucleated Cells

• S: Ostheoarthritis

• _{^{LE Cells —Lupus}}

• _{^{Reiter Cells —Reactive arthritis}}

• _{^{RA Cells (Ragocyte) —Rheumatoid Arthritis}}

• _{^{Cartilage Cells —Ostheoarthritis}}

• Rice Cells _{^{—-Tubercolusis or Rheumatoid Arthritis}}

• _{^{Fat Droplets —Injury or Chronic inflammation}}

• _{^{Hemosiderin —synovitis}}

SYNOVIAL CELLS:

• Polished Rice

• Shows collagen and fibrin

• S: Tuberculosis and Rheumatiod Arthristis _{^{[also in RA cells]}}

• _{^{LE Cells —Lupus}}

• _{^{Reiter Cells —Reactive arthritis}}

• _{^{RA Cells (Ragocyte) —Rheumatoid Arthritis}}

• _{^{Cartilage Cells —Ostheoarthritis}}

• _{^{Rice Cells —-Tubercolusis or Rheumatoid Arthritis}}

• Fat Droplets _{^{—Injury or Chronic inflammation}}

• _{^{Hemosiderin —synovitis}}

SYNOVIAL CELLS:

• Stained with Sudan Dye

• Refractile intracellular and extracellular globules

• S: Traumatic Injury _{^{[car accident]}} and CHRONIC INFLAMMATION

• _{^{LE Cells —Lupus}}

• _{^{Reiter Cells —Reactive arthritis}}

• _{^{RA Cells (Ragocyte) —Rheumatoid Arthritis}}

• _{^{Cartilage Cells —Ostheoarthritis}}

• _{^{Rice Cells —-Tubercolusis or Rheumatoid Arthritis}}

• _{^{Fat Droplets —Injury or Chronic inflammation}}

• Hemosiderin _{^—synovitis}

SYNOVIAL CELLS:

• Inclusions within cluster of synovial cells

• S: Pigmented Villonudular Synovitis

Monosodium Urate

SYNOVIAL CRYSTALS:

• Runs parallel to the long axis of crystals

Monosodium Urate

SYNOVIAL CRYSTALS:

• Yellow color

Monosodium Urate

SYNOVIAL CRYSTALS:

• more birefingent

Calcium Pyrophosphate Dihydrate (CPPD)

SYNOVIAL CRYSTALS:

• Perpendicular to the axis of crystlas

Calcium Pyrophosphate Dihydrate (CPPD)

SYNOVIAL CRYSTALS:

• Blue color

• Calcium Pyrophosphate Dihydrate (CPPD)

• Corticosteroid _{^{[negative and positive]}}

SYNOVIAL CRYSTALS:

• Positive Birefringent

Gout

Significance of MSU

Pseudogout

Significance of CPPD

Chronic Inflammation

Significance of Cholesterol

Injection

Significance of Corticosteroid

Renal Dialysis

Significance of Calcium Oxalate

Calcified Cartilage Degeneration

Significance of Calcium Phosphate (Apatite)

• Clear Yellow

• Good Viscocity

• WBC <1000 ul

• Neutrophil <30%

• Similar to Blood Glucose

Describe the Laboratory Findings: NONINFLAMMATORY

• Color:

• Viscocity:

• WBC:

• Neutrophil:

• Glucose:

• Cloudy, Yellow

• Poor Viscocity

• WBC 2,000 - 75,000 ul

• Neutrophil >50%

• DECREASE GLUCOSE

Describe the Laboratory Findings: INFLAMMATORY [Immuno]

• Color:

• Viscocity:

• WBC:

• Neutrophil:

• Glucose:

• Cloudy, MILKY

• Low Viscocity

• WBC 100,000 ul

• Neutrophil <70%

• DECREASED GLUCOSE

• crystals present (malamang)

Describe the Laboratory Findings: INFLAMMATORY [crystal]

• Color:

• Viscocity:

• WBC:

• Neutrophil:

• Glucose:

• Cloudy, YELLOW-GREEN

• Variable Viscocity

• WBC 50,000 - 100,000 ul

• Neutrophil >75%

• DECREASED Glucose

Describe the Laboratory Findings: Septic

• Color:

• Viscocity:

• WBC:

• Neutrophil:

• Glucose:

• Clear, RED

• Low Viscocity

• WBC equal to blood

• Neutrophil equal to blood

• NORMAL GLUCOSE

Describe the Laboratory Findings: Hemorrhagic

• Color:

• Viscocity:

• WBC:

• Neutrophil:

• Glucose:

• I - Non-inflammtory

• II - Inflammatory

  • Immunologic

  • Crystal-Induced

• III - Septic

• IV - Hemorrhagic

Classification (Group) of Joint Disorders