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Mercy CLS 7/8: Coagulation/Body Fluids > Body fluids—Chemistry, serous, synovial > Flashcards

Body fluids—Chemistry, serous, synovial Flashcards

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1
Q

most common chemical tests performed on CSF

A
  • glucose
  • protein
  • IgG
  • CSF electrophoresis
  • myelin basic proteins
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2
Q

CSF protein RR

A

15-45 mg/dL
0.6% concentration of serum

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3
Q

—– protein identifies fluid as CSF

A

TAU

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4
Q

major Ig in CSF

A

IgG

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5
Q

3 proteins absent from CSF

A

IgM
fibrinogen
beta lipoprotein

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6
Q

causes of ↓ CSF protein

A
  • leakage/trauma
  • water intoxication
  • rapid CSF production
  • recent puncture
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7
Q

causes of ↑ CSF protein

A
  • damage or inflammation of meninges
  • infection
  • trauma
  • neoplasms
  • cerebral infarction
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8
Q

CSF protein >500 mg/dL

A

bacterial meningitis

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9
Q

volume CSF taken depends on…

A

patient volume
opening pressure

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10
Q

CJD testing CSF sample handling

A

-80° freezer

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11
Q

primary and secondary CSF proteins

A

albumin
prealbumin

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12
Q

major CSF beta globulin

A

transferrin

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13
Q

TAU

A

carbohydrate-deficient transferrin
seen in CSF, not in blood
used to identify CSF

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14
Q

higher CSF protein values found in…

A

infants
people over 40

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15
Q

2 major techniques for measuring CSF protein

A

turbidity production
dye-binding ability

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16
Q

CSF/serum albumin index is used for…

A

BBB integrity
<9: intact BBB

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17
Q

CSF/serum albumin index

A

CSF albumin (mg/dL)/serum albumin (g/dL)

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18
Q

2 causes of elevated IgG in CSF

A
  • increased production (MS)
  • leakage (damaged BBB)
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19
Q

IgG index RR

A

0.25-0.85

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20
Q

IgG index

A

(CSF IgG)(serum albumin)/(serum IgG)(CSF albumin)

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21
Q

↑ IgG index

A

local production of IgG
MS

BBB is not damaged

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22
Q

↓ IgG index

A

strokes
tumors
meningitis

BBB is damaged

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23
Q

IgG index values >—— indicate IgG production within the CNS

A

0.70

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24
Q

bands in the gamma region of CSF electrophoresis

derived from clones of immunocompetent cells

A

oligoclonal bands

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25
oligoclonal bands in CSF no bands in serum
MS
26
oligoclonal bands in CSF and serum
- leukemia/lymphoma - HIV - viral infection
27
represent inflammation in the CNS
oligoclonal bands
28
Presence in CSF indicates recent demyelination
myelin basic proteins (MBPs)
29
used to monitor MS course/tx
MBP
30
↑ gamma globulins in CSF due to Bence Jones proteins crossing BBB
MM
31
CSF glucose RR
60-70% plasma glucose around 40-70 mg/dL
32
CSF glucose procedure
draw plasma glucose 2 hours prior for comparison
33
pellicle
a delicate cobweb clot in CSF seen in tubercular meningitis
34
Decreased CSF glucose values are caused primarily by...
- alterations in the mechanisms of glucose transport across thee BBB - increased use of glucose by the brain cells
35
normal CSF WBCs
0-5/uL
36
CSF lactic acid RR
10-24 mg/dL
37
pellicle formation due to...
marked increase of proteins
38
use of CSF lactic acid
- Diagnosis and management of meningitis - Monitor head injuries
39
CSF --------- will fall rapidly when meningitis tx is successful
lactic acid
40
false increase of CSF lactic acid
hemorrhagic specimens or traumatic tap RBCs have lactate
41
- markedly ↓ CSF glucose - lactate >35 - WBC >50 - ↑ % neuts
bacterial meningitis
42
- normal CSF glucose - normal lactate - WBC >50 - ↑ % lymphs
viral meningitis
43
- ↓ CSF glucose - lactate >25 - WBC >50 - ↑ % lymphs
tubercular meningitis
44
- normal CSF glucose - lactate >25 - WBC >50 - ↑ % lymphs
fungal meningitis
45
if CSF has <50 WBCs...
think about degenerative neurologic disorders
46
CSF glutamine RR
8-18 mg/dL
47
function of glutamine
produced by brain cells from ammonia + 𝛼-ketoglutarate serves to remove toxic ammonia from CNS
48
glutamine preferred over ammonia because...
ammonia is volatile
49
CSF glutamine > ------ correlates with coma
35
50
causes of ↑ CSF glutamine
- Reye's syndrome - liver disease - disturbance of consciousness
51
3 serous cavities of body
- pleural - pericardial - peritoneal
52
2 serous membranes
parietal visceral
53
fluid buildup in serous cavities
effusion
54
main causes of effusions
- CHF increasing BP - hypoproteinemia decreasing oncotic pressure - inflammation increasing capillary permeability - infection - malignancy - lymphatic obstruction
55
2 types of effusions
transudate exudate
56
fluid accumulation due to a systemic disease affecting filtration/reabsorption balance
transudate
57
fluid accumulation due to disorders involving the membrane surfaces
exudate
58
characteristics of transudates
**Transudates** - transparent - fluid:serum protein <0.5 - WBC <1000 - no spontaneous clotting - serum-ascites albumin gradient >1.1
59
characteristics of exudates
**Exudates** - cloudy - fluid:serum protein >0.5 - WBC >1000 - spontaneous clotting possible - serum-ascites albumin gradient <1.1
60
(transudates/exudates) usually require less testing
transudates
61
3 types of needle aspirations of serous fluid
- thoracentesis - pericardiocentesis - paracentesis
62
types of tubes of serous fluid drawn
- EDTA: hematology - sterile heparinized/SPS: micro, cytology - clotted/heparin: chemistry, serology
63
--------- fluid specimens for pH are STAT and should be maintained anaerobically
serous
64
the -------- cavity is not a true cavity but becomes one when a disease state is present
pleural
65
causes of PE transudates
- CHF - nephrotic syndrome - cirrhosis
66
causes of PE exudates
- infection - pulmonary infarction - pancreatitis - SLE - RA - cancer - trauma
67
2 types of milky PE and their causes
- **chylous**: triglycerides; thoracic duct leaking; stain with sudan III - **psudeochylous**: cholesterol; chronic inflammatory condition
68
how to differentiate 2 causes of bloody PE
- **Hemothorax** (trauma): Hct >50% or >blood Hct - **Hemorrhagic effusion** (membrane damage): Hct <50% or similar to blood Hct
69
brown PE
rupture of amoebic liver abscess
70
black PE
aspergillus
71
viscous PE
malignant mesothelioma (↑ hyaluronic acid)
72
↓ glucose in PE
- RA - purulent infection
73
↑ lactate in PE
bacterial infection
74
↓ pH in PE
- pneumonia not responding to antibiotics - esophageal rupture (pH <6.0)
75
↑ ADA in PE
- tuberculosis - malignancy
76
↑ amylase in PE
- pancreatitis - esophageal rupture - malignancy
77
pH of PE <7.0 indicates...
need for chest tubes
78
Carcinoembryonic antigen
GI malignancy
79
CA125
uterine and ovarian malignancy
80
causes of pericardial transudates
- autoimmune disorders - uremia - hypothyroidism
81
causes of pericardial exudates
- infection - MI - cancer - trauma
82
amount of pericardial serous fluid
10-50 mL
83
causes of bloody pericardial fluid
- accidental puncture - misuse of anticoags
84
suspected when cardiac tamponade (compression) is heard by physician
pericardial effusion
85
WBC >1000 and high % neuts in pericardial fluid
bacterial endocarditis
86
acid fast stain and adenosine deaminase
tubercular effusion
87
peritoneal effusion
ascites
88
causes of peritoneal transudates
- CHF - nephrotic syndrome - cirrhosis
89
causes of peritoneal exudates
- peritonitis (infection) - neoplasms - pancreatitis - trauma
90
recommended over fluid:serum protein and LD ratios to detect peritoneal transudates of hepatic origin
serum-ascites albumin gradient (SAAG)
91
SAAG >1.1
peritoneal transudate of hepatic origin
92
SAAG <1.1
exudative peritoneal effusions
93
normal saline introduced into peritoneal cavity detect abdominal injuries
peritoneal lavage
94
SAAG =
serum albumin - fluid albumin
95
RBC count >--------- from peritoneal lavage indicates blunt trauma
100,000
96
eos in peritoneal lavage
allergic reactions to equipment air in the cavity
97
normal WBC in peritoneal fluid
<500
98
green peritoneal fluid
bile, gallbladder, pancreatic disorders
99
↑ BUN/creatinine in peritoneal fluid
ruptured or punctured bladder
100
↑ ALP in peritoneal fluid
intestinal perforation
101
movable joints
diarthroses/synovial
102
functions of synovial fluid
- prevents friction - absorbs shock of joint compression - provides nutrients to cartilage
103
excluded from synovial fluid
HMW proteins
104
cells that secrete synovial fluid
synoviocytes
105
contribute to viscosity of synovial fluid
polymerization of hyaluronic acid some protein
106
4 classifications of arthritis
1. **Noninflammatory**: degenerative, osteoarthritis 2. **Inflammatory**: immunologic, lupus erythematosus (LE), rheumatoid arthritis (RA), Lyme disease, crystal-induced (gout and pseudogout) 3. **Septic**: microbial infection 4. **Hemorrhagic**: trauma, tumors, coagulation deficiencies
107
normal viscosity of synovial fluid
able to form a 4-6 cm string
108
normal synovial fluid WBC
<200
109
normal synovial fluid neuts
<25%
110
normal synovial fluid glucose
<10 mg/dL lower than BG
111
normal synovial fluid total protein
<3 g/dL
112
needle aspiration of synovial fluid
arthrocentesis
113
normal amount of knee synovial fluid collected
3.5 mL
114
tubes collected for synovial fluid
- sterile heparinized/SPS: micro - liquid EDTA (no powdered): hematology - heparinized/clotted: other tests - sodium fluoride: glucose (ideally)
115
test synovial fluid STAT to avoid...
cellular lysis changes in crystals
116
used to assess hyaluronate polymerization in synovial fluid
Ropes/mucin clot test add 2-5% acetic acid normal fluid forms a solid clot
117
Ropes test results
- good - solid clot - fair - soft clot - low - friable clot - poor - no clot
118
can ID fluid as synovial
add acetic acid normally forms a clot
119
main crystals found in synovial fluid
- monosodium urate (**MSU**) in **gout** - calcium pyrophosphate dihydrate (**CPPD**) in **pseudogout**
120
causes of MSU crystals in synovial fluid
- impaired purine metabolism - high purine foods - leukemia chemo - decreased renal excretion of uric acid
121
causes of CPPD in synovial fluid
- degenerative arthritis - elevated Ca++
122
crystals from calcified cartilage degeneration
hydroxyapatite calcium phosphate
123
crystals from RA, SLE
cholesterol
124
crystals following knee injections
corticosteroid
125
crystals in renal dialysis pts
CaOx
126
artifacts that may be found in synovial fluid
- starch - powdered anticoags - dust - scratches - polyethylene fragments from artificial joints
127
where can crystals be found in synovial fluid?
extracellular, intracellular, or both
128
ability to refract light in 2 directions
birefringent
129
magnified birefringent images appear bright or colored against black background
polarizing microscopy
130
MSU crystal characteristics
- needle shaped - intracellular and extracellular - negative birefringence - **slow vibration**: yellow; more intense than CPPD - **fast vibration**: blue; more intense than CPPD
131
CPPD crystal characteristics
- rod, needle or rhombic shaped - intracellular and extracellular - positive birefringence - **slow vibration**: blue; less intense than MSU - **fast vibration**: yellow; less intense than MSU
132
used to observe birefringence of crystals separates light ray into fast and slow moving vibrations
red compensator crystal
133
the compensator aligns crystals with the ------ vibration
slow
134
cholesterol crystals characteristics
- notched rhombic plates - extracellular - negative birefringence unless stacked
135
corticosteroid crystal characteristics
- flat, variably shaped plates - primarily intracellular
136
MSU molecules run -------- to the long axis, aligned with slow vibration; fast light is impeded, producing a --------- color (negative birefringence)
parallel yellow
137
CPPD molecules run --------- to long axis and impede the slow light producing a -------- color (positive birefringence)
perpendicular blue
138
why is chemical testing not considered clinically important on synovial fliud?
ultrafiltrate of plasma -- approximately the same chemically
139
↑ lactic acid in synovial fluid
septic arthritis caused by GPC and GNR
140
↓ lactic acid in synovial fluid
arthritis caused by Ngon
141
synovial fluid lactic acid >------ mmol/L (---- mg/dL) indicate an immediate tx onset
9 81
142
used to monitor severity and prognosis of RA
enzymes in synovial fluid
143
used to monitor extent of joint inflammation
CRP and fibrinogen in synovial fluid
144
Borrelia Ab in synovial fluid
Lyme
145
ultrafiltrate of serum
no additional material from membrane cells serous fluid
146
serous fluid production through -------- membrane reabsorption into lymphatic system through ----------- membrane
parietal visceral
147
148
blood sample should be drawn at the same time as ------- fluid
serous
149
most significant test on pleural fluid
diff
150
normal cells in pleural fluid
- lymphs - mesothelial cells
151
large round with round nucleii blue cytoplasm, dark chromatin may resemble lymphs, plasmas and malignants
mesothelials
152
mesothelials can become...
macros
153
eos in pleural fluid
- trauma (air or blood in cavity) - allergic reaction - parasitic infection
154
characteristics of reactive mesothelials
- clusters - varying amounts of cytoplasm - eccentric nuclei - prominent nucleoli - can be giant and multinucleated
155
characteristics of malignant cells that differentiate them from mesothelials
- nuclear irregularities - vacuoles in cytoplasm, nucleus - hyperchromatic nucleoli - clumps with cytoplasmic molding - high N:C ratio
156
important exam for pericardial fluid
cytologic exam for malignant cells
157
frequently encountered malignant cells in pericardial fluid
- metastatic lung carcinoma - breast carcinoma
158
most common cause of ascitic transudate
hepatic disorders
159
origins of peritonitis
- perforation of intestine - ruptured appendix
160
special macrophages that may be found in peritoneal fluid
lipophages
161
contain concentric striations of collagen-like material
psammoma bodies
162
↑ Ca++ in fluid seen in benign conditions, and ovarian and thyroid cancer
psammoma bodies
163
used to thin synovial fluid for analyzer
hyaluronidase
164
no additives in synovial fluid for...
crystal analysis
165
never used as diluent for synovial fluid used instead
acetic acid (clots) saline
166
when to dilute synovial fluid for cell count
when it is not transparent
167
normal WBC in synvoial fluid
<200
168
normal cells in synovial fluid
- monos/macros - synovial lining cells (same as mesothelials)
169
indicates septic arthritis
↑ neuts in synovial fluid often pyknotic
170
indicates non-septic inflammation in joints
↑ lymphs in synovial fluid
171
neutrophils in synovial fluid with cytoplasmic blue granules filled with RF immune complexes
ragocytes found in RA
172
macrophages in synovial fluid with ingested neutrophil
Reiter cells Reiter syndrome, nonspecific inflammation
173
3 signs of Reiter syndrome
- red eyes - urinary tract problems - arthritic (overactive macros)
174
very dark pink cells in synovial fluid
chondrocytes
175
many chondrocytes
osteoarthritis
176
neutrophil in synovial fluid with ingested "round body"
LE cell found in SLE, RA
177
how to count cells on amniotic fluid
count all nucleated cells (WBCs + SECs)
178
normal cell to see in amniotic fluid
SEC

Mercy CLS 7/8: Coagulation/Body Fluids (9 decks)

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