BF

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what fluids are studied

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209 Terms

1

what fluids are studied

  • cerebrospinal (brain + spine)

  • synovial (surrounds joints)

  • serous

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2

what does serous fluid consist of

  • pleural (chest cavity and lungs)

  • peritoneal (fluid between abdomen and organs)

  • pericardial (around heart)

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3

routine analysis of BF

  • gross examination

  • total cell count

  • differential count

  • microbiologic examination

  • chemical analysis

  • cytology examination

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4

function CSF

  • cushion

  • waste collection

  • nutrient circulation

  • lubrication

  • regulate volume of intracranial pressure

  • chemical environment

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5

where does CSF circulate between

pia and arcahnoid layer

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6

what processes if CSF involved in

  • active secretion

  • transport

  • ultrafiltration from plasma

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7

csf three membranes and meanings

  • dura matter = outer

  • arachnoid = middle

  • pia = inner

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8

normal CSF volume in adults

90-150 mL

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9

normal CSF volume neonate

10-60 mL

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10

turnover of CSF per day and hour

500-600 mL/day

20 mL/hour

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11

what is increased CSF called

hydrocephalus

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12

when does hydrocephalus occur

circulation is blocked or reabsorption is impaired

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13

how is CSF collected , and where

how much can be safely removed

lumbar puncture

  • L3 and L4 lumbar space

  • L4 and L5 for neonates

  • 10-20 mL of fluid

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14

what would you record for CSF collection

total volume of the tap in all tubes

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15

how many tubes of CSF is collected, where do they go

3

  • chemistry

  • micro

  • hematology

w

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16

what would a 4th tube of CSF be used for

observation of a pellicle

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17

when is CSF stable

within an hour , no clots

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18

do you refrigerate CSF

NO

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19

what does it mean when CSF exhibits xanthochromia

contains bilirubin

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20

what is xanthochromia

yellow discoloration

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21

what is cell count performed on

hemacytometer

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22

what can CSf indicate

  • infection of meninges

  • subarachnoid hemorrhage

  • CNS malignancies

  • demyelinating disorders

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23

example of menginges infection

bacterial meningitis

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24

example of CNS malignancy

acute leukemia

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25

example of demyelinating disorder

multiple sclerosis

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26

what does CSF lab analysis involve

  • gross examination

  • microscopic examination

  • chemical analysis

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27

whats involved in CSF gross examination

color, clarity, clotting ← bleed or poorly drawn

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28

whats involved in CSF microscopic examination

RBC, WBC counts, differentials

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29

what is involved in CSF chemical analysis

glucose and protein

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30

what do you do to distinguish a traumatic tap from an intracranial hemorrhage

observe clearing from tube to tube

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31

what indicates a traumatic puncture

first tube contains blood , but remaining are clear

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32

what does it mean for CSF if all tubes are uniformly bloody

subarachnoid hemorrhage present

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33

what does it mean if CSF (supernatant?) is clear

traumatic tap

  • blood at bottom

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34

what does it mean if CSF (supernatant?)is yellow or pink- what does each color mean

hemorrhage

  • yellow = bilirubin broken down, OLD BLOOD

  • pink = fresh NEW blood

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35

what does it mean if CSF after centrifugation is clear

bacteria

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36

what should you observe for in CSF after centrifugation

xanthochromia

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37

what does subarachnoid hemorrhage sample look like in 1-4 hours , what does it contain

pale pink ← oxyhemoglobin

  • erythrocyte

  • neutrophils

  • lymphocytes

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38

what does subarachnoid hemorrhage sample look like in 12 hours , what does it contain

yellow xanthochromia (bilirubin)

  • peaks 2-4 weeks

  • macrophages englufed with RBCs OR stored iron (hemosiderin)

  • 1-8 weeks siderophages

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39

should CSF clot? why?

no, CSF does not contain fibrinogen

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40

characteristics of traumatic tap

  • blood decreasing amounts

  • clot formation

  • colorless supernatant

  • negative D dimer

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41

characteristics of subarachnoid hemorrhage

  • blood is in equal amounts

  • does not clot

  • xanthrochromic

  • positive D dimer

  • hemosiderin

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42

what is normal for CSF gross examination

CSf should be clear

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43

what is normal cell count for CSF

adult 0-5 uL

neonate 0-30 uL

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44

what is CSF normal differential

lymphocytes and monocytes normal

lymph 60%, mono 30%, poly 2%

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45

what is CSF normal chemical examination

glucose : 50-80 mg/dL

protein 15-45 mg/dL

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46

where is cell counts performed

chamber with undiluted fluid

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47

equation for cell count

(#of cells counted ) x (dilution)

__________________________________

(#of squares counted) x (volume of 1 sq)

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48

when is protein count in CSF higher

  • neonates have higher count that adults

  • after the age of 40 it increases as well

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49

what does increased CSF protein indicate

  • traumatic tap

  • increased permeability of blood CSF barrier

  • infections

  • subarachnoid hemorrhage

  • increased synthesis of IgG, neurosyphilis, MS

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50

what do CSF glucose values need to be compared to

serum glucose values

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51

what is the normal adult CSF glucose levels

60-70% of plasma levels

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52

what is an increased CSF glucose related to

plasma elevations w

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53

what is a decreased CSF glucose value related to

  • impaired glucose transport

  • increased glycolytic activity

  • increased glucose utilization by bacteria

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54

what in CSF aids in diagnosing and managing meningitis

CSF lactacte

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55

what are the causes of an incease in CSF lactate levels, and what are their values

  • bacteria : <35 mg/dL

  • viral 25 mg/dL

w

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56

what can CSF lactate also be used to monitor

head injuries , tissue destruction

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57

what is pleocytosis

increased amount of WBCs in body fluid

  • type of WBC correlates with condition or disorder

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58

what do neutrophils indicate

bacterial infection

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59

what do lymphs indicate

  • viral

  • Guillain Barre (own immune system attacks nerves)

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60

what do plasmacytes indicate

multiple sclerosis

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61

what do eosinophils indicate

allergic reactions

  • rare

  • example: shunt

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62

what do monocytes/macrophages indicate

phagocytized

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63

what can b seen in CSF

  • WBC, RBC

  • ependymal

  • macrophage

  • malignant cells

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64

what do WBCs indicate in CSF

inflammatory or infectious process in CNS

  • meningitis → increase in WBC

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65

what do RBCs indicate in CSF

  • subarachnoid hemorrhage

  • intracranial bleeding

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66

what produces CSF into brain ventricles

the choroid plexus

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67

what do germinal matrix cells have to do with CSF

give rise to various cell types in CNS

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68

what do macrophages indicate in CSF

inflammatory response or immune reaction in CNS

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69
<p>what is this cell</p>

what is this cell

lymphocyte

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70
<p>what is seen in the picture </p>

what is seen in the picture

segs, monos, and nRBCs

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71
<p>what is pictured</p>

what is pictured

the choroid plexus

  • eccentric nucleus

  • lining cells

  • waxy cytoplasm

  • clustered together

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72
term image

signet ring

  • monocyte phagocytizing vacuole

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73
<p>what is pictured</p>

what is pictured

subarachnoid hemorrhage

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74

what are WBC levels / findings in Bacterial Meningitis

  • >50k WBC/uL

  • 90% neutrophils

  • INC protein

  • DEC glucose

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75

what can cause bacterial meningitis

  • H influenzae

  • S pneumonia

  • N meningitis

  • GBS

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76

what is seen in viral meningitis

mild - severe leukocytosis

  • predomiately lymphs → large and reactive

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77

what causes viral meningitis

enteroviruses

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78

what are the types of acute leukemia

  • lymphoblastic

  • myeloblastic

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79

what causes fungal meningitis

  • cryptococcus neoformans (india ink)

  • low or normal glucose

  • elevated protein

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80

what is seen with intracranial shunts for hydrocephalus

  • increased monocytes

  • iINC macrophages

    • INC eos

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81

where are malignant cells more common

  • lung

  • breast

  • GI

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82
term image

neutrophils with bacteria

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83
term image

bacteria and yeast

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84
term image

acute leukemia

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85
term image

intracranial hemorrhage

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86

what is synovial fluid? where is it found

  • supplied nutrients to cartilage

  • lubricant to surface joints

  • removes debris

    • found in joint cavities

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87

what is general normal chemical composition of synovial fluid like? why

  • same as plasma

    • it is ultra-filtrate of plasma

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88

what are some properties of synovial fluid

  • straw color

  • viscous

    • essential to proper lubrication

  • hyaluronic acid

    • hyaluronate = mucopolysaccharide for viscosity

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89

what is the normal volume for synovial fluid,where is it found

1-4 mL

  • knee, hip, elbow

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90

what does a large amount of synovial fluid volume mean

disease process

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91

what are normal WBC value for synovial fluid ? what composes that

<200 uL

  • lymphs are majority (mononuclear)

  • <25% neutrophils

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92

what is normal for synovial fluid in terms of RBCs and crystals

there should be none seen

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93

how is synovial fluid collected? how many tubes?

arthrocentesis with a heparinized needle

  • three tubes

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94

should there be clots in synovial fluid? why?

NO

  • does not contain fibrinogen

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95

what should the patient do before synovial fluid collection

fasting for 6 hours

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96

what are the tubes used for in synovial fluid

1: sterile for micro

2: heparin/EDTA for microscopy

3: plain tube for clot formation, gross examination, chemical examination

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97

what is preferred for the 2nd tube in synovial fluid

heparin

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98

what is involved in routine examination of synovial fluid

  • physical appearance

  • cell count

  • differential

  • crystal exam

  • chemical

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99

physical appearance for synovial fluid

color viscosity, clarity

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100

cell count for synovial

RBC and WBC

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