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CLS426 Body Fluid Powerpoint Serous Fluid Handout

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SEROUS FLUIDS: PLEURAL, PERITONEAL, PERICARDIAL FLUID ANALYSIS

Pleural, peritoneal and pericardial spaces normally contain

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Cell count (RBC and WBC) and differentiala. The cell counts are often performed on an automated cell counter IF the specimen is

both bacteria-free AND clot-free. If these conditions are not met, the cell counts areperformed on a hemocytometer.

b. Normal (benign) cells that can be seen include polymorphonuclear (PMN) cells(includes both segmented and band neutrophils), mesothelial (lining) cells,lymphocytes, monocyte/macrophage/histiocytes (lymphs and monos are sometimes

called mononuclear cells), benign signet ring cells, eosinophils, basophils, mast cells,pyknotic cells

c. Abnormal (benign) findings include erythrophages, hemosiderin-laden macrophages,LE cells, and infectious agents such as bacteria and yeast (eg. Cryptococcus).Infectious agents require an immediate pathologist review at many institutions.

d. Abnormal cells are often malignantand include plasma cells, leukemic blast cells,lymphoma cells, metastatic cancer tumor cells and signet ring carcinoma cells. Theserequire a pathologist review at many institutions.

e. The entire cytospin slide should be scanned on low power (10x) to look for thepresence of malignant cells. Differential is performed on 100x (oil).

SEROUS FLUID ANALYSIS PERITONEAL CASE

A 48-year old woman presents with ascites and pleural effusion. Blood is drawn and 30 mLof peritoneal fluid specimen is obtained by paracentesis and sent to the laboratory for evaluation.

PERITONEAL FLUID RESULTS

Physical Exam Microscopic Exam Chemical ExamColor: yellow Leukocyte count: 23 cells/L Total protein: 2.9 g/dLTurbidity: clear PMNs 100% LD: 125 U/LClots present: no Glucose: 67 mg/dL

Gram stain: no organisms seen

BLOOD CHEMISTRY RESULTS:

Total protein: 6.5 g/dL (Reference range: 6.0 to 8.3 g/dL)Lactate dehydrogenase (LD): 300 U/L (Reference range: 275 to 645 U/L)Glucose, fasting: 82 mg/dL (Reference range: 70 to 110 mg/dL)Liver function tests

(ALT, AST, GGT, ALP): normal

Cytology examination performed on peritoneal fluid: no malignant cells seen***********************************************************************************

1. Calculate the fluid-to-serum total protein ratio.

2. Calculate the fluid-to-serum lactate dehydrogenase ratio.

3. Use all information provided to classify this peritoneal fluid specimen as a transudate or an exudate.

4. Identify three conditions known to cause this type of effusion.

5. ____T/F Formation of the effusion in this patient could be caused by an increase in hydrostaticpressure or a decrease in oncotic pressure.

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SEROUS FLUID ANALYSIS PLEURAL CASE

A 51-year old man with a history of tuberculosis presents with a unilateral pleural effusion. Apleural fluid specimen is obtained by thoracentesis and 1200 mL is sent to the laboratory forevaluation.

PLEURAL FLUID RESULTS

Physical Exam Microscopic Exam Chemical ExamColor: yellow Leukocyte count: 1535 cells/L Total protein: 4.2 g/dLTurbidity: cloudy Differential count: LD: 345 U/LClots present: yes Monocytes: 57% Glucose: 55 mg/dL

Lymphocytes 40%PMNs: 3%

Gram stain: no organisms seen; leukocytes present

BLOOD CHEMISTRY RESULTS

Total protein: 7.0 g/dL (Reference range: 6.0 to 8.3 g/dL)Lactate dehydrogenase (LD): 520 U/L (Reference range: 275 to 645 U/L)Glucose, fasting: 75 mg/dL (Reference range: 70 to 110 mg/dL)

***********************************************************************************1. Would you perform the cell counts on this pleural fluid on an automated cell counter or on a

hemocytometer? Explain.

2. Calculate the fluid-to-serum total protein ratio.

3. Calculate the fluid-to-serum lactate dehydrogenase ratio.

4. Are clots in a specimen more suggestive of transudates or exudates?

5. Use all information provided to classify this pleural fluid specimen as a transudate or an exudate.

6. Identify four conditions known to cause this type of effusion.

7. Of what significance is the differential count and gram stain in this particular case?