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Lecture: Chemical Pathology > Body Fluids > Flashcards

Body Fluids Flashcards

1
Q

What are the major functions of cerebrospinal fluid?

A
  • physiological system to supply nutrients to central nervous system
  • remove metabolic waste
  • mechanical barrier to cushion brain and spinal cord from trauma
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2
Q

What is the normal volume of cerebrospinal fluid?

A

140 -170 mL

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3
Q

Where does the cerebrospinal fluid flow?

A

in the subarachnoid space between the pia mater and arachnoid

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4
Q

What is the purpose of the blood-brain barrier?

A

protects and restricts entry of macromolecular from blood to cerebrospinal fluid to brain

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5
Q

How is cerebrospinal fluid collected?

A

by lumbar puncture beneath third, fourth, or fifth vertebrae

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6
Q

What cerebrospinal fluid tubes belong to which department?

A

1: Chemistry/Serology
2: Microbiology
3: Hematology Cell Count
4: Cytology/Extra

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7
Q

How should you handle a cerebrospinal fluid collection if it cannot done be done STAT?

A

Hematology: Refrigerated
Chemistry: Frozen
Microbiology: Room Temperature

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8
Q

What does a clear cerebrospinal fluid indicate?

A

normal

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9
Q

What does a cloudy/turbid/milky cerebrospinal fluid indicate?

A
  • protein or lipid
  • WBC/Bacteria from Meningitis
  • RBC from Hemorrhage/Traumatic Tap
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10
Q

What does a xanthochromia cerebrospinal fluid indicate?

A
  • supernatant with pink/orange/yellow color
  • RBC Degradation
  • others: increased bilirubin or protein concentration, presence of carotene or melanoma pigment
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11
Q

How would a subarachnoid hemorrhage affect the cerebrospinal fluid?

A
  • xanthochromia present in all tubes
  • blood cerebrospinal fluid caused by intracranial hemorrhage does not contain enough fibrinogen to clot
  • presence of macrophages containing ingested RBCs or hemosiderin granules
  • positive D-Dimer indicates formation of fibrin at hemorrhage site
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12
Q

How would a traumatic tap affect the cerebrospinal fluid?

A
  • uneven distribution of blood between four tubes
  • clot formation from plasma fibrinogen leaking into cerebrospinal fluid
  • supernatant usually clear
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13
Q

What are the normal cell counts for cerebrospinal fluid?

A
  • 0-5 WBC/uL in adults
  • 0-30 mononuclear cells/uL in neonates
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14
Q

Why do you need to perform cerebrospinal fluid immediately?

A

WBC/RBC begin to lyse in less than an hour, 40% of granulocytes disintegrate after two hours

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15
Q

What is the hemocytometer calculation equation?

A

(cells counted x dilution)/(# of squares x 0.1 uL)

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16
Q

What are the normal findings in cerebrospinal fluid?

A

no RBC, 0-5 lymphocytes and/or monocytes, ependymal cells

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17
Q

What are the abnormal findings in cerebrospinal fluid?

A

any RBCs, RBCs ingested in macrophages, WBC>5, neutrophils, blasts, malignant cells, plasma cells, reactive lymphocytes, eosinophils, bacteria, fungi, hemosiderin

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18
Q

What disease states are associated with increased lymphocytes?

A

HIV & AIDS, multiple sclerosis, viral infections

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19
Q

What disease states are associated with increased eosinophils?

A

parasitic infections, fungal infections

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20
Q

What disease states are associated with increased neutrophils?

A

meningitis, repeated lumbar punctures, injection of medications/dyes

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21
Q

What disease states are associated with increased macrophages?

A

appear 2-4 hours after RBCs enter cerebrospinal fluid, previous hemorrhage

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22
Q

What is a normal protein level in cerebrospinal fluid?

A

15-45 mg/dL in adults; higher in infant/elderly

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23
Q

What is the most abundant protein found in cerebrospinal fluid?

A

albumin

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24
Q

What does decreased protein in cerebrospinal fluid?

A

fluid leaking from central nervous system

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25
Q

What does increased protein in cerebrospinal fluid?

A
  • damage to blood-brain barrier (meningitis, hemorrhage)
  • immunoglobulin production in central nervous system
  • decreased clearance of normal protein
  • degradation of neural tissue
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26
Q

What is considered a normal value for plasma glucose?

A

60-70% of plasma glucose (plasma glucose of 1000 mg/dL would have a normal cerebrospinal fluid glucose of 65 mg/dL)

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27
Q

What does an elevated serum glucose indicate?

A

elevated cerebrospinal fluid glucose

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28
Q

What does a decreased cerebrospinal fluid glucose help determine?

A

causative agent of meningitis

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29
Q

What does a decreased glucose, increased leukocytes with neutrophils in cerebrospinal fluid indicate?

A

bacterial

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30
Q

What does a decreased glucose, increased leukocytes with lymphocytes in cerebrospinal fluid indicate?

A

tubercular

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31
Q

What does a normal glucose with increased leukocyte with lymphocytes in cerebrospinal fluid indicate?

A

viral

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32
Q

What significant values show up in bacterial meningitis?

A

increase in neutrophils, low cerebrospinal fluid glucose, high cerebrospinal fluid lactate, high cerebrospinal fluid protein

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33
Q

What significant values show up in viral meningitis?

A

increase in lymphocytes and monocytes, normal cerebrospinal fluid glucose, normal cerebrospinal fluid lactate

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34
Q

What are serous fluids?

A

closed cavities of body lined with two serous membranes; serous fluid beneath membranes provide lubrication as surfaces move

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35
Q

What is parietal fluid?

A

fluid that lines cavity wall

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36
Q

What is visceral fluid?

A

fluid that covers organs within cavity

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37
Q

How is serous fluid formed?

A

ultrafiltrates of plasma; production and reabsorption subject to hydrostatic and oncotic pressure from capillaries serving the cavity

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38
Q

What is effusion?

A

increase in fluid beneath membranes due to disruption in serous fluid formation and reabsorption

39
Q

What causes effusion?

A

increased hydrostatic pressure, increased capillary permeability (inflammation/infection), decreased oncotic pressure (hypoproteinemia in nephrotic syndrome), lymphatic obstructions (tumors)

40
Q

Where is pleural fluid?

A

lungs/chest

41
Q

Where is peritoneal fluid?

A

abdominal

42
Q

Where is pericardial fluid?

A

heart

43
Q

What preservatives are used for serous fluid?

A

EDTA and heparin

44
Q

What are transudates?

A
  • effusion due to change in hydrostatic pressure
  • fluid leaks out of blood vessels into body cavities
45
Q

What are exudates?

A
  • effusion due to inflammation
  • enlarged vessels allow fluid and protein to leak out into body cavities
46
Q

What helps determine if a fluid is a transudate or exudate?

A
  • serum total protein ratio
  • serum LD ratio
47
Q

What results do transudates present?

A

clear, low cell count, low LDH

48
Q

What results do exudates present?

A

cloudy/bloody, high cell count, high LDH

49
Q

What does normal and transudative fluid look like?

A

clear to pale yellow

50
Q

Why could pleural fluid be turbid?

A

WBCs indicating infection, tuberculosis, immunological disorder

51
Q

What does a bloody pleural fluid indicate?

A

signifies trauma, membrane damage (malignancy), traumatic draw

52
Q

What does a milky pleural fluid indicate?

A

chylous material from thoracic duct leakage or pseudochylous material from chronic inflammatory conditions

53
Q

What does it mean when lymphocytes are found in pleural fluid?

A

normal in transudates and exudates, increase in tuberculosis, viral infections, malignancy, autoimmune disorder (lupus)

54
Q

What does it mean when neutrophils are found in pleural fluid?

A

increased bacterial infection (pneumonia), pancreatitis, pulmonary infarction

55
Q

What does it mean when eosinophils are found in pleural fluid?

A

trauma, allergy, parasitic infections

56
Q

What does a decreased glucose in pleural fluid indicate?

A

rheumatoid inflammation or purulent infection

57
Q

What does a pH <7.3 in pleural fluid indicate?

A

need to chest-tube drainage, antibiotics for pneumonia

58
Q

What does a pH <6.0 in pleural fluid indicate?

A

esophageal rupture with influx of gastric fluid

59
Q

What does an increase in amylase in pleural fluid indicate?

A

pancreatitis, esophageal rupture, malignancy

60
Q

What are the common bacteria in pleural effusions?

A

Staphylococcus aureus, Enterobacteriaceae, Anaerobes, Mycobacterium tuberculosis

61
Q

What are some common tests used for pleural fluid?

A

gram stain, acid-fast stains, anaerobic/aerobic cultures, mycobacterium cultures

62
Q

What is the normal amount for pericardial fluid?

A

10-50 mL

63
Q

What are pericardial effusions caused by?

A

pericarditis, malignancy, trauma, metabolic disorders (uremia)

64
Q

What does a normal pericardial fluid look like?

A

clear to pale yellow

65
Q

What does a turbid pericardial fluid indicate?

A

infections or malignancy (with blood)

66
Q

What does a grossly bloody pericardial fluid indicate?

A

cardiac puncture, anticoagulant misuse

67
Q

What does a milky pericardial fluid indicate?

A

chylous/pseudochylous effusion

68
Q

What is the normal appearance of peritoneal fluid?

A

clear to pale-yellow

69
Q

What does a decrease in glucose of peritoneal fluid indicate?

A

tubercular peritonitis, malignancy

70
Q

What does an increase in amylase of peritoneal fluid indicate?

A

pancreatitis

71
Q

What does an increase in alkaline phosphatase of peritoneal fluid indicate?

A

intestinal perforation

72
Q

What are normal cell types found in peritoneal fluid?

A

abundant mesothelial cells, macrophages, lipophages, leukocytes

73
Q

What does peritoneal fluid in malignancy of gastrointestinal or ovarian origin look like?

A

WBCs with mucin-filled vacuoles, psammoma bodies of collagen-like material

74
Q

What is synovial fluid?

A

found in all moveable joints beneath articular cartilage lining bones

75
Q

What are the functions of synovial fluid?

A

lubrication of joints, lessen bone compression during walking/jogging, provide nutrients to articular cartilage

76
Q

What happens in arthritis?

A

damage to articular membranes producing pain or stiffness

77
Q

What is arthritis caused by?

A

infection, inflammation, metabolic disorders, trauma, stress

78
Q

What are the four classification groups of arthritis?

A

noninflammatory, inflammatory, septic, hemorrhagic

79
Q

What is associated with noninflammatory arthritis?

A

degenerative joint disorders

80
Q

What is associated with inflammatory arthritis?

A

rheumatoid arthritis, lupus erythematosus, crystal-induced gout, pseudogout

81
Q

What is associated with septic arthritis?

A

microbial infection

82
Q

What is associated with hemorrhagic arthritis?

A

traumatic injury, coagulation deficiencies

83
Q

What happens in osteoarthritis?

A

bone ends rub together and thinned cartilage

84
Q

What happens in rheumatoid arthritis?

A

swollen inflamed synovial membrane and bone erosion

85
Q

How is synovial fluid collected?

A

by needle aspiration called arthrocentesis

86
Q

How is synovial fluid distributed?

A

into three tubes
- heparinized for microbiology
- EDTA for hematology
- nonanticoagulated - crystal (no powdered anticoagulants) for chemical/serological testing

87
Q

What is the normal appearance of synovial fluid?

A

pale yellow and clear; deeper yellow seen in inflammation

88
Q

What causes a bloody appearance to synovial fluid?

A

traumatic aspiration versus hemorrhagic arthritis (uneven distribution)

89
Q

What causes synovial fluid to appear turbid?

A

WBCs, synovial debris, fibirn

90
Q

What is the normal viscosity of synovial fluid?

A

4-6 cm string

91
Q

What happens to the viscosity of synovial fluid in arthritis?

A

decreased viscosity

92
Q

What is the normal leukocyte count of synovial fluid?

A

<200 cells/uL; primarily mononuclear cells with <20% PMNs and <15% lymphocytes

93
Q

If there are increased PMNs in synovial fluid, what does that indicate?

A

septic condition

94
Q

If there is an increased lymphocytes in synovial fluid, what does that indicate?

A

nonseptic inflammation

Lecture: Chemical Pathology (9 decks)

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