CCCC Synovial Fluids Review

normal synovial fluid appearance

colorless / pale yellow

clear

viscouos

should synovial fluid normally clot

no

if synovial fluid clots it may be caused by these things

traumatic taap

synovial membrane damage (inflammation)

what part of traumatic tap causes clots to synovial fluid

tissue and fibrinogen contamination

what causes the viscosity of synovial fluid

hyaluronate / hyaluronic acid

when the viscosity of synovial fluid is normal we see a string test with this result

> or = 5 cm

tests to analyze the viscosity of synovial fluid

string test

mucin test/ropes test

in the mucin/ropes test, we add _________ to ____________

acetic acid

synovial fluid

normal viscosity for the mucin test should result in

clotting

good clot

abnormal viscosity for the mucin test should result in

no clot

poor clot

causes of decreased viscosity

decreased hyaluronic acid

diluted hyaluronic acid

due to damage or inflammation of synovial membrane

what are the arthritis groups

group 1

group 2

group 3

group 4

what is group 1 arthritis caused by

non inflammatory

what is group 2 arthritis caused by

inflammation

immunologic response

crystal

what is group 3 arthritis caused by

infection

bacteria

what is group 4 arthritis caused by

hemorrhagic

homogenous bloody synovial fluid is caused by

hemorrhage

xanthochromic synovial fluid is caused by

hemorrhage

true internal bleed

blood streaked synovial fluid is caused by

traumatic tap

irritation

cloudy synovial fluid is caused by

increased WBC

microbes

crystals

rice bodies in synovial fluid are caused by

rheumatoid arthritis

black pepper in synovial fluid is caused by

prosthesis

synovial lining cells are called

serous lining cells

what do serous lining cells look like

fried eggs

reiter cells are

macrophages with ingested neutrophil nuclei

reiter cells are associated with this disease

rheumatoid arthritis

what should you never add to synovial fluid

albumin

what should we add to synovial fluid before prepping slides

hyaluronidase

what is the process to prep synovial fluid slide

add hyaluronidase

incubate at 37 degrees for 5 min

normal WBC count of synovial fluid

< 200 cells/uL

are RBCs counted for synovial fluid

no

what should we always assess synovial fluids for

crystals

what kind of microscope do we use to assess synovial fluid for crystals

compensating polarizing microscope

uric acid shape

needle

uric acid has a ____________ and _____________ birefringence

strong

negative

uric acid is ____________ when light is parallel and indicates ________/___________

yellow when parallel

MSU / Gout

calcium pyrophosphate has a _______________ and _________________ birefringence

weak

positive

calcium pyrophosphate is ____________ when light is parallel and indicates ___________/_____________

blue when parallel

CPPD / pseudogout

calcium pyrophosphate is this shape

rhomboid needle

cholesterol crystal is this shape

notched plate

cholesterol crystals in synovial fluid are associated with this disease

rheumatoid arthritis

calcium oxalate is this shape

envelope

calcium oxalate is associates with this disease

kidney disease

starch is this shape

maltese cross

starch in synovial fluid is associated with

contamination