Synovial Fluid Flashcards by Gay Amor Tipolo Gacang

Q

Synovium refers to the

A

tissue lining synovial tendon sheaths
bursae
diarthrodial joints

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Q

Synovium is composed of one to three cell layers that form a discontinuous surface overlying

A

fatty, fibrous, or periosteal joint tissue

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Q

An ultrafiltrate of plasma combined with hyaluronic acid produced by the synovial cells or synoviocytes

A

Synovial fluid

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Q

Synovial fluids findings by disease category:

Clarity: Transparent

A

Normal

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Q

Synovial fluids findings by disease category:

Clarity: Transparent

A

Group I: Noninflammatory

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Q

Synovial fluids findings by disease category:

Clarity: Transparent/opaque

A

Group II: Inflammatory

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Q

Synovial fluids findings by disease category:

Clarity: Opaque

A

Group III: Infectious and Group IV: Hemorrhagic

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Q

Synovial fluids findings by disease category:

Color: Clear to pale yellow

A

Normal

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Q

Synovial fluids findings by disease category:

Color: Xanthochromic

A

Group I: Noninflammatory

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Q

Synovial fluids findings by disease category:

Color: Xanthochromic to white/bloody

A

Group II: Inflammatory

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Q

Synovial fluids findings by disease category:

Color: White

A

Group III: Infectious

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Q

Synovial fluids findings by disease category:

Color: Red-brown or xanthrochromic

A

Group IV: Hemorrhagic

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Q

Synovial fluids findings by disease category:

WBCs/mL: 0-150

A

Normal

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Q

Synovial fluids findings by disease category:

WBCs/mL: <3000

A

Group I: Noninflammatory

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Q

Synovial fluids findings by disease category:

WBCs/mL: 3000-75,000

A

Group II: Inflammatory

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Q

Synovial fluids findings by disease category:

WBCs/mL: 50,000-200,000

A

Group III: Infectious

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Q

Synovial fluids findings by disease category:

WBCs/mL: 50-10,000

A

Group IV: Hemorrhagic

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Q

Synovial fluids findings by disease category:

PMNs, %: <25

A

Normal

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Q

Synovial fluids findings by disease category:

PMNs, %: <30

A

Group I: Noninflammatory

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Q

Synovial fluids findings by disease category:

PMNs, %: >50

A

Group II: Inflammatory

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Q

Synovial fluids findings by disease category:

PMNs, %: >90

A

Group III: Infectious

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Q

Synovial fluids findings by disease category:

PMNs, %: <50

A

Group IV: Hemorrhagic

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Q

Synovial fluids findings by disease category:

RBCs present:

A

Group III: Infectious
Group IV: Hemorrhagic

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Q

Synovial fluids findings by disease category:

RBCs absent:

A

Normal
Group I: Noninflammatory
Group II: Inflammatory

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Synovial fluids findings by disease category: Glucose (blood/SF difference, mg/dL): 0-10 (0-0.56 mmol/L)

Normal Group I: Noninflammatory

Synovial fluids findings by disease category: Glucose (blood/SF difference, mg/dL): 0-40 (0-2.2 mmol/L)

Group II: Inflammatory

Synovial fluids findings by disease category: Glucose (blood/SF difference, mg/dL): 20-100 (1.11-5.5 mmol/L)

Group III: Infectious

Synovial fluids findings by disease category: Glucose (blood/SF difference, mg/dL): 0-20 (0-1.11 mmol/L)

Group IV: Hemorrhagic

Little inflammatory response in Group I: Noninflammatory

Osteoarthritis Traumatic arthritis Neuropathic osteoarthropathy Pigmented villonodular synovitis Early rheumatoid arthritis

Present in noninflammatory effusions

Early rheumatoid arthritis Early bacterial infection Viral arthritis

Examples of reaction group in Group II: Inflammatory

Rheumatoid arthritis Systemic lupus erythematosus (SLE) Reiter syndrome Rheumatic fever Acute crystal-induced arthritis Arthritis associated with inflammatory bowel disease Psoriatic arthritis Fat droplet synovitis

Infections that constitutes Purulent (Infectious) Effusions (Group III)

Bacterial, fungal, and tuberculosis joint infections

Diseases associated with Hemorrhagic effusions (Group IV)

Traumatic arthritis Pigmented villonodular synovitis Synovial hemangioma Neuropathic osteoarthropathy Joint prostheses Hematologic disorders)

Joint fluid aspiration

Arthrocentesis

Caution is necessary to avoid aspirating a sterile joint in someone with ______ into a sterile joint

bacteremia through a cutaneous or periarticular soft tissue infection

Large joints such as the knee normally contain no more than

4.0 mL of SF

Synovial fluid must be collected with a ____, ____, and ____ to avoid contamination by birefringent particulates

sterile, disposable needs, and plastic syringes

In routine arthrocentesis, the syringe may be heparinized with

25 U of sodium heparin/mL of SF

These should be avoided because they form crystal artifacts that may be misleading during the microscopic examination

Oxalate Lithium heparin Powdered ethylene-diaminetetraacetic acid (EDTA) anticoagulants

The SF specimen should be separated into three groups:

1) 3 to 10 mL into a sterile heparinized tube or syringe for MICROBIOLOGICAL STUDIES 2) 2 to 5 mL in an anticoagulant tube (sodium heparin or liquid EDTA) for MICROSCOPIC EXAMINATIONS 3) 5 mL into a plain (no anticoagulant) tube for CHEMICAL ANALYSIS

It has an inhibitory effect on some pathogenic bacteria

Heparin concentrations greater than 125 U/mL

Specimens for culture should be at least:

1 to 2 mL in volume submitted in green-top sodium heparin tubes containing 143 U/tube of heparin Submitted in recapped syringes after removal of the needle and excess air

Sufficient for the most critical test

Dry tap

Effective in collecting SF following a dry tap

Saline injection Reaspiration

Infectious organism

Staphylococcus aureus

Under gross examination:

Total volume Color Clarity

Part of gross examination where it should be recorded at the bedside, especially if the sample is to be divided for submission to different laboratory sections

Total volume

Color should be evaluated in a

clear glass tube against a white background

Normal SF color

colorless

Disorders that impart a straw to yellow color (xanthocrhromia) specimen

Noninflammatory and inflammatory disorders

Color of Septic fluid depending on the chromogens produced by the offending organisms and the host response, including the presence of WBCs and RBCs

Yellow, brown, or green

Produces an uneven distribution of blood during arthrocentesis or streaking in the syringe

Traumatic tap

A red-brown color following centrifugation is good evidence of

pathologic hemarthrosis

Relates to the number and type of particles within the SF

Clarity

Clarity of normal SF

Transparent

Clarity of the fluid that completely obscures the background

Opaque

Most commonly responsible for the changes in clarity

Leukocytes

Produces an opaque, milky, opalescent fluid without leukocytes

very large number of crystals

A shimmering, oily-appearing specimen suggests ____, which may grossly resemble pus

cholesterol crystals

Increased turbidity is less often due to:

concentrations of fibrins free-floating rice bodies metal and plastic particles from patients with joint prostheses Cartilage fragments in osteoarthritis

It is fragments of degenerating proliferative synovial cells or microinfarcted synovium

Free-floating rice bodies

Appearance from pigmented cartilage fragments that may be a result of metabolic disorders (i.e., ochronosis)

Ground pepper appearance