Body Fluid Chapter 23

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Body Fluid Chapter 23
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Examination of body fluid

• Gross exam
• Total cell count
• Microscopic exam
• Any other special test (Chemistry, Microbiology,
  cytology, etc.)
• Test are performed in various areas of lab based
  on what the physician orders.
• Body fluids sterile vs. non-sterile

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Cerebrospinal Fluid

• Fluid surrounding brain and spinal cord
• Sterile
• Production by the plexus
• Specimen Lumbar puncture
• Collect 3-5 vials, each tube has a designated
  department.
• Gross exam Turbidity, Color, microscopic exam,
  cell count

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CSF cell differential

• Numerate and differentiate cells seen
• Lymphocytes usually see few , increase
  associated with viral, fungal, aseptic, bacterial
  meningitis, or nervous system disease (MS)
• Monocytes Less than 2 of normal CSF, increase
  associated with TB meningitis, syphilis, viral
  encephalitis, subarachnoid hemorrhage.
• Macrophages few in number associated with
  malignancy, hemorrhage, inflammation
• PMN very few, represent rapid disintegration,
  associated with Viral and acute diseases.

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• Eosinophils/Basophils not normally seen in CSF
• Plasma cells not normally present associated
  with viral disorders, Hodgkin's, and bleeds.
• Red Blood Cells Few to none present
• Mesothelial cells not present
• Malignant cells will see with malignant disease
  and infiltrate.
• Cells unique to CSFEpendymal resemble
  lymphocytes and Choroidal resemble lymphocytes,
  usually occur in clumps.

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• Pleural Fluid Lung fluid
• Effusion
• Transudate
• Exudates
• Lab analysis Gross exam, cell count, etc.
• Differential PMN, Lymph, Mono, etc.
• Cells unique to the lungs Mesothelial cells
• RBC and WBC is limited, if increase is seen in
  WBC and RBC without traumatic tap- indicates
  disease or infarct
• Cytology exam useful in identifying malignancy
  or abnormal morphological cells. (characteristics
  1-10, pg 289)

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Peritoneal Fluid

• Abnormal accumulation of fluid (effusion) in
  peritoneal cavity.
• A.K.A. ascites
• Removal procedure-paracentesis
• Lab analysis distinguish between transudate and
  exudates, gross exam, cell count, sedimentation,
  chemical analysis

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Physical CharacteristicsTable 23.9

• Peritoneal Fluid Appearance Color and clarity.
• Color and clarity can indicate certain infections
  and diseases.

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• Total Cell Count
• Assist in diagnosis of certain diseases by
  determining total RBC and WBC number.
• A total WBC gt0.3 X 109/L is considered abnormal.
  
• Differential Assist in diagnosis of infection
  and disease patterns
• Use Wrights stain Differentiate
• PMNgt25 in abnormal
• Eosingt50 (ruptured hydatid cyst, lymphoma, or
  vasculitis. Chronic peritoneal dialysis will see
  eosinophils.

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• Lymphocytes CHF, cirrhosis, nephrotic syndrome
• Mesothelial Cells Associated with tuberculosis
  peritoneal effusions
• Malignant cells seen with malignancy
• Ascites a condition which fluid accumulates
  within the peritoneal space. Must have an
  accumulation of at gt 100ml (several 100) before
  effusion can be detected on physical exam.

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• Pericardial Fluid accumulation of fluid of the
  lining of the heart (effusion)
• Cause neoplasm, infections, collagen disease,
  renal disease, Cardiovascular disease. (pg. 239-
  Table 23.12)
• Gross Exam Report appearance (bloody, clear,
  cloudy)
• Measure pH pH less than 7.0 associated with
  infection or rheumatoid disorder.
• Cell count see limited of RB and WBC
• Evaluate sedimentation

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• Seminal Fluid
• Examine physical, chemical and microscopic detail
• Quantitate number of sperm present , report
  morphology and motility
• Specimen must be a fresh collection-clean,
  sterile container.
• Gross Exam Color, pH, Volume, and viscosity.
• Agglutination study
• Table 21.14 pg 295

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• Synovial Fluid
• Joint Fluid normally clear, viscous
• Functions as a lubricate and transports nutrient
• Arthrocentesis aspirate of the joint fluid,
  aseptic technique
• Lab Assay Gross exam, microscopic exam, Gram
  stain, cultures, etc.
• Appearance clear, transparent, viscous
• Viscosity test String Test
• Mucin Clot test
• Note crystals (intracellular vs. extra cellular)
• Slide exam usually performed on concentration of
  the fluid using Wright-Giemsa or Papnicolaou