Body Fluids exam 4

Mesothelial cells

Thin single layer of connective tissue that is covered by these cells that line the serous membrane

Effusion

Accumulation of fluid in a body cavity indicating an abnormal or pathological process

Paracentesis

Percutaneous puncture of a body cavity for aspiration of fluid

Thoracentesis

To obtain pleural fluid

Pericardiocentesis

To obtain pericardial fluid

Ascites

An effusion in peritoneal cavity

Sterile tube with anticoagulant EDTA

microscopic exam

non anti-coagulant red top tube

chemistry studies

What temp do the tubes stay

Room temperature

What do you use to compare serous fluid with?

Blood sample and plasma

Transudate

Fluid pushed through the capillary due to high presser within the capillary, noninflammatory.

Exudate

Fluid that leaks around the cells of the capillaries caused by inflammation.

Neoplasm

Exudate

Hepatic cirrhosis

Transudate

Infection

Exudate

Rheumatoid arthritis

Exudate

Trauma

Exudate

Nephrotic syndrome

Transudate

Congestive heart failure

Transudate

Systemic lupus

Exudate

Pancreatitis

Exudate

Transudate: Physical exam

Clear, pale yellow, no clots

Exudate: Physical Exam

Cloudy, yellow, greenish, pink, red, often clots

Transudate Microscopic exam

WBC less than 1000 /uL (Pleural)
WBC less than 300 /uL (Pritoneal)

Differential- mononuclear cells predominate

Exudate: Microscopic exam

WBC greater than 1000 /uL (pleural)
WBC greater than 500 /uL (peritoneal)

Differential- early, neutrophils predominate, mononuclear cells

Transudate: Chemical exam (Fluid to serum)

Bilirubin                ≤0.6
Glucose                Equal to serum level
TP concentrate     <50% of serum
TP ratio                 ≤0.5
LD activity             <60% of serum”
LD ratio                 ≤0.6
cholesterol ratio    ≤0.3

Exudate: Chemical exam (Fluid to serum)

Bilirubin                >0.6
Glucose               Less than or equal to serum level
TP concentrate     >50% of serum
TP ratio                 >0.5
LD activity             >60% of serum
LD ratio                 >0.6
cholesterol ratio    >0.3

Which of the following statements regarding serous fluid is true?

Mesothelial cells, PMNs, lymphocytes, and macrophages may be present in normal fluids

Which of the following laboratory results on a serous fluid is most likely to be caused by a traumatic tap?

An RBC count of 8,000/uL

Which of the following conditions is commonly associated with an exudative effusion?

Malignancy

Which of the following conditions is associated with a chylous effusion?

Lymphatic obstruction 

A glucose concentration difference greater than 30 mg/dL between the serum and an effusion is associated with

Rheumatoid arthritis

A pleural or peritoneal fluid amylase level two times higher than the serum amylase level can be found in effusions resulting from

Pancreatitis

Chylous and pseudochylous effusions are differentiated by their

Lipid content

Chylous lipid content

high triglycerides and chylomicrons

Pseudochylous lipid content

low triglycerides and no chylomicrons

Plural transudates differ from pleural exudates in that transudates have:

Transudates less than 1000 WBC/uL and exudates more than 1000 WBC/uL 

Pleural Fluid from a patient with congestive heart failure would be expected to:

transudate, clear and pale yellow 

A fluid sample was collected by thoracentesis. A serum sample was collected immediately afterward.  The LD fluid to serum ratio was 0.9.  There were 5,000 WBC/uL, with 75% PMNs (segs).  Which of the following describes the fluid?

Pleural effusion exudate

Is effusion and edema the same thing

Effusion is in the cavities and edema is widespread in tissues

Is ascites fluid the same as peritoneal fluid?

Peritoneal fluid is the normal amount of fluid and ascites is excessive accumulation of peritoneal fluid that indicates a pathological condition.

Synovial fluid formation

ultrafiltrate of plasma across synovial membrane

What do synoviocytes do in synovial fluid?

secrete hyaluronic acid that makes the fluid visccous

Synovial fluid: Physical exam

Total volume      0.1-3.5 mL
Color                  Pale yellow
Clarity                Clear
Viscosity            High, strings 4-6 cm long
clot formation     No

Synovial fluid: Microscopic exam

Erythrocyte count      Less than 2000 cell/ uL
Leukocyte count        Less than 200 cells/ uL

Synovial fluid: Differential count

Monocytes/macrophages       about 60%
Lymphocytes                          about 30%
Neutrophils                             about 10%
Crystals                                  none

Synovial fluid: Chemical exam

Glucose                                                   Equivalent to plasma
Glucose (plasma to SF difference)         <10 mg/dLb
Uric Acid                                                  Equivalent to plasma
Total Protein                                            1-3 g/dL
Lactate                                                     9-33 mg/dL
Hyaluronate                                             0.3-0.4 g/dL

Synovial: Group I noninflammatory

volume greater than 3.5
yellow color
more than 3000 WBC
glucose equal to plasma
glucose Plasma- SF greater than 20 gm/dL
negative culture

Synovial: Conditions that are group 1 non inflammatory

Osteoarthritis, osteochondritis, osteochondromatosis

Synovial: group II inflammatory

volume greater than 3.5
yellow-white color
low viscosity
2000-100,000 WBC
over 50% neutrophils
glucose less than plasma
glucose plasma- SF is >20mg/dL
negative culture

Synovial: conditions that are group II inflammatory

gout, pseudogout, rheumatoid arthritis, reactive arthritis, systemic lupus

Synovial: Group III septic

volume greater than 3.5
yellow-green color
low viscosity
10,000- greater than 100,000 WBC
greater than 75% neutrophils
glucose less than plasma
glucose plasma- SF >40 mg/dL
positive culture

Synovial: conditions that are group III septic

bacterial infection, fungal infection, mycobacterial infection

Synovial: group IV hemorrhagic

volume greater than 3.5
red-brown color
decreased viscosity
more than 5000 WBC
glucose equal to plasma
glucose plasma- SF is >20mg/dL
culture negative

Synovial: conditions that are group IV hemorrhagic

trauma, blood disease like hemophilia or sickle cell, tumor, joint prosthesis

Arthrocentesis

Percutaneous aspiration of fluid from joint using aseptic technique

Why do you need an anticoagulant for synovial fluid sample?

Because inflammation can cause clotting and lead to inaccurate cell counts

In synovial fluid samples what temperature do you handle it and why?

Room temperature to obtain accurate cell counts and avoid lysis and changes in crystals

Synovial sample collection tubes

Tube 1 no anticoagulant for chem and immuno
Tube 2 liquid EDTA (not powder) for microscopic exam
Tube 3 sterile tube no anticoagulant for microbiology

What is a rice body?

White free floating substances made up of collagen covered by fibrinous tissue, seen in arthritic conditions most common RA

MSU crystals

impaired purine metabolism, high purine foods, leukemia chemotherapy, decreased renal excretion of uric acid, mainly seen in gout. long thin needles

CPPD crystal

degenerative arthritis, disorders causing elevated calcium levels, mainly seen in pseudo gout. crystal shape

What clinical significance are apatite crystals?

Osteoarthritis

What clinical significance are Calcium pyrophosphate (CPPD) crystals?

Pseudo gout

What clinical significance are corticosteroid crystals?

Injections

What clinical significance are monosodium urate (MSU) crystals?

Gout

Which of the following characteristics is higher for synovial fluid than for the serous fluid?

viscosity

What type of cell is a “ragocyte”

A PMN cell with inclusion formed by immune complexes 

Which of the following crystals is the cause of pseudogout?

calcium pyrophosphate (CPPD)

Which of the following crystals is the cause of gout?

monosodium urate (MSU)

A synovial fluid sample is examined using a polarizing microscope with a red compensating filter.  Crystals are seen that are yellow when the long axis of the crystal is parallel to the slow vibrating light.  When the long axis of the crystal is perpendicular to the slow vibrating light, the crystals appear blue.  What type of crystal is present?

Uric Acid, MSU crystals 

The mucin clot test determines the presence of synovial fluid ___________.

Hyaluronic acid

What is added to the synovial fluid to determine the viscosity?

Acetic acid

Crystals that appear needle-shaped under polarized light and are yellow when aligned with the slow vibration of compensated polarized light are

monosodium urate (MSU)

A physician attempts to aspirate a knee joint and obtains XXX mL of slightly bloody fluid. Addition of 
acetic acid results in turbidity and a clot. This indicates that;

It is synovial fluid

In an examination of synovial fluid under compensated polarized light, rhombic-shaped crystals are observed. What color would these crystals be when aligned parallel to the slow vibration?

Blue

In which type of arthritis is the synovial WBC count likely to be greater than 50,000 /uL?

Septic

A paired fasting plasm specimen was collected at the same time an arthrocentesis was performed. The difference in glucose concentrations between the two fluids was reported as >50 mg/dL. Which of the following is the best explanation of the condition?

Septic group III

Which of the following organisms account for the majority of septic arthritis cases in YOUNG and MIDDLE age ADULTS?

Staphylococcus aureus

Which of the following components is not normally present in synovial fluid?

Fibrinogen

Which of the following substances will not increase the turbidity of synovial fluid?

Hyaluronate 

A synovial fluid specimen has a high cell count and requires dilution to be counted. Which of the following diluents should be used?

Normal Saline

In synovial fluid, which of the following crystals in not birefringent?

Hydroxyapatite crystals

Seminal Fluid: Physical exam

Color                                  Grey-white, opalescent, opaque
Volume                               1.5-5 mL
Viscosity/Liquification         Discrete droplets, watery within 1 hour

Seminal Fluid: Microscopic exam

Motility                      50% or more forward motility
Concentration           20-250×10^6 sperm/ mL (15 lowest)
Morphology             >50% normal (>14%) strict
Vitality                      75% or more alive
Leukocytes               less than 1×10^6/mL

Seminal Fluid: Chemical exam

pH                                        7.2-7.8
Acid phosphatase (total)     ≥200 U per ejaculate at 37°C
Citric acid (total)                  ≥52 μmol per ejaculate 
Fructose (total)                    ≥13 μmol per ejaculate
Zinc (total)                           ≥2.4 μmol per ejaculate

A repeat semen analysis for fertility testing is reported as follows: 

VOLUME: 3.5 mL SPERM CONCENTRATION: 6 million/mL 

VISCOSITY: Normal SPERM MOTILITY: 30%—grade 1.0 

PH: 7.5 MORPHOLOGY: <30% normal-forms—30 spermatids/100 sperm 

The results correspond with the first analysis. 

 

Which of the following test results are abnormal?  

Morphology, motility, concentration

A repeat semen analysis for fertility testing is reported as follows: 

VOLUME: 3.5 mL SPERM CONCENTRATION: 6 million/mL 

VISCOSITY: Normal SPERM MOTILITY: 30%—grade 1.0 

PH: 7.5 MORPHOLOGY: <30% normal-forms—30 spermatids/100 sperm 

The results correspond with the first analysis. 

What is the sperm count on this specimen? 

6 million x 3.5 mL= 21,000,000

A repeat semen analysis for fertility testing is reported as follows: 

VOLUME: 3.5 mL SPERM CONCENTRATION: 6 million/mL 

VISCOSITY: Normal SPERM MOTILITY: 30%—grade 1.0 

PH: 7.5 MORPHOLOGY: <30% normal-forms—30 spermatids/100 sperm 

The results correspond with the first analysis. 

What is the spermatid count? 

1,800,000 no

Which of the following results would be considered abnormal for seminal fluid?

Liquification time greater than 60 min

Which of the following studies is performed by aspirating seminal fluid with a Pasteur pipette and observing the formation of droplets as it is allowed to fall under only the influence of gravity?

Viscosity

Evaluation of sperm morphology is performed by staining an air-dried smear with Wright, Giemsa, or Papanicolaou stain and evaluating 200 sperm using: 

100x oil immersion

Which of the following sample preparations is appropriate to use for evaluation of sperm agglutination?

Wet prep

Which of the following would be evidence of a successful vasectomy?

Azoospermia- no sperm present

Which stain is used to measure sperm viability?

Eosin-nigrosin

Maturation of spermatozoa takes place in the

Epididymis

Enzymes for the coagulation and liquidation of semen are produced by the

Prostate gland

The major component of seminal fluid is

Fructose

Failure of laboratory personnel to document the time a semen sample is collected primarily affects the interpretation of semen:

Viscosity

The percentage of sperm showing average motility that is considered normal is

50%