Joint Analysis and Cytology

Question 1

What is the colour of normal and infected synovial fluid?

Answer 1

Normal = clear or slightly yellow
Infected = clear, hemorrhagic or yellow

Question 2

What is the turbidity of normal and infected synovial fluid?

Answer 2

Normal = none
Infected = none, turbid or cloudy

Question 3

What is the viscosity of normal and infected synovial fluid?

Answer 3

Normal = less than 2cm between fingers
Infected = reduced viscosity/watery

Question 4

What is the total protein of normal and infected synovial fluid?

Answer 4

Normal = 10-20g/L
Infected = >40g/L

Question 5

What is the pH of normal and infected synovial fluid?

Answer 5

Normal = less than 6.9
Infected = greater than 6.9

Question 6

What is the WBC count of normal and infected synovial fluid

Answer 6

Normal = 0.2 x 109/L
Infected = >50 x 109/L

Question 7

What cell types are found in normal and infected synovial fluid?

Answer 7

Normal = <10% neutrophils
Some lymphocytes and mononuclear cells

Infected = >90% neutrophils
Degenerate / toxic neutrophils +/- bacteria

Question 8

What is degenerative vs non-denegerative and what cell types does this refer to?

Answer 8

Cell type: Neutrophils

Degenerative = a disease caused by the deterioration of the bodily structure and function (normally the cells dying in a ‘battle’ against bacteria).

Non-degenerative = sterile or autoimmune disease

Question 9

What are small mononuclear cells?

Answer 9

Lymphocytes

Non-reactive macrophages and synoviocytes

Question 10

What are large mononucelar cells?

Answer 10

Macrophages
Synoviocytes

Question 11

What are the typical tests for examining synoviocentesis?

Answer 11

Appearance (clarity + colour)
Viscosity (polymerisation of hyaluronic acid)
Mucin clot test (acetic acid)
Protein
Nucleated cell count
Cytology

Question 12

What are the 4 different types of neutrophils in this photo?

Answer 12

A. Normal mature neutrophil
B. Toxic neutrophil
C. Normal band neutrophil (left shift)
D. Toxic band neutrophil (lack of maturation)

Question 13

What cell type is this?

Answer 13

Lymphocyte

Question 14

What cell type is this?

Answer 14

Neutrophil

Question 15

What cell type is this?

Answer 15

Macrophage

Question 16

What is right shift (neutrophils)?

Answer 16

Increased number of hypersegmented neutrophils -> cells remain in circulation for longer than they should do.

Glucocorticoids can do this as they prevent apoptosis and decrease the rate of removal.

Question 17

What are the two types of left shift (neutrophils)?

Answer 17

Immature neutrophils are released from the bone.

Regenerative -> more segmented than immature

Degenerative -> immature more than segmented.

Question 18

What causes toxic neutrophils?

Answer 18

Toxic neutrophils exhibit a variety of nuclear and cytoplasmic abnormalities.

Chronic infections and bacterial sepsis.