Synovial Fluid Flashcards by Kyra Catedral

SYNOVIAL FLUID
-Present in the areas of the skeleton where_____ develops

friction

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•Functions:

•Bathes and lubricates the joint

• Source of nutrients of the metabolically active articular cartilage

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«Formed from ______a across the synovial membrane and from secretions of____

ultrafiltration of plasm

synoviocytes

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Ultrafiltration of plasma:
• Blood plasma (the liquid part of blood) passes through the_________, which filters out cells and large proteins.
• This filtered plasma becomes part of the synovial fluid.

synovial membrane

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Synoviocytes, especially fibroblast-like synoviocytes (FLS) in the synovial lining, produce key components like:
• _________– gives the fluid its thick, slippery texture.
• Proteins and lubricating molecules like________ – helps reduce friction even more.

Hyaluronic acid (HA)

PRG4 (Proteoglycan 4 or lubricin)

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Anatomy of a Synovial Joint

Bine
Cartilage
Articular capsule
Synovial membrane
Synovial fluid

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• A tough outer layer that surrounds the joint.

• Protects the joint and keeps the synovial fluid inside.

Articular Capsule

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• Inner lining of the joint capsule that produces synovial fluid.

Synovial Membrane

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• Synovial lining layer – contains FLS (Fibroblast-like Synoviocytes) that produce (2)

HA and PRG4.

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– contains blood vessels (vasculature) and lymphatics, supporting nutrient exchange and waste removal

Synovial subintima

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Synovial lining layer – contains_______that produce HA and PRG4.

FLS (Fibroblast-like Synoviocytes)

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Synovial Fluid Contents

• ______– for nutrition and repair.
• ______– for viscosity (thickness).
• ______– for lubrication and protection of cartilage.

Proteins

HA (Hyaluronic Acid)

PRG4 (Lubricin)

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Test

Volume, mL
Color
Viscosity
WBC count, cells/uL
Neutrophils
Glucose concentration
Glucose: P-SF* difference
Culture
Associated diseases

Normal*

<3.5
Pale yellow
High
<200 cells/ uL
<25%
Approximately equal to plasma level
≤10 mg/dL
Negative

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Test

Volume, mL
Color
Viscosity
WBC count, cells/uL
Neutrophils
Glucose concentration
Glucose: P-SF* difference
Culture
Associated diseases

Group I Noninflammatory

> 3.5
Yellow
High
<3000
<25%
Approximately equal to plasma level
<20 mg/dL
Negative

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G1 Non inflammatory Diseases

Osteoarthritis
Osteochondritis
Osteochondromatosis
Traumatic arthritis
Neuroarthropathy

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Test

Volume, mL
Color
Viscosity
WBC count, cells/uL
Neutrophils
Glucose concentration
Glucose: P-SF* difference
Culture
Associated diseases

Group Il Inflammatory

> 3.5
Yellow-white
Low
2000 to 100,000’’
50%
Less than plasma level
20 mg/dL (range, 0 to 80)
Negative

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Test

Volume, mL
Color
Viscosity
WBC count, cells/uL
Neutrophils
Glucose concentration
Glucose: P-SF* difference
Culture
Associated diseases

Group Ill Septic

> 3.5
Yellow-green
Low
10,000 to >100,000’’ >75%
Less than plasma level
40 mg/dL (range, 20 to 100)
Positive

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Test

Volume, mL
Color
Viscosity
WBC count, cells/uL
Neutrophils
Glucose concentration
Glucose: P-SF* difference
Culture
Associated diseases

Group IV Hemorrhagic

> 3.5
Red-brown Decreased >5000’1
25%
Approximately equal to plasma level
<20 mg/dL
Negative

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G2 Inflammatory diseases

Crystal synovitis (gout, pseudogout)
Rheumatoid arthritis
Reactive arthritis
Systemic lupus erythematosus

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G3 Septic Diseases

Bacterial infection
Fungal infection
Mycobacterial infection

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G4 Hemorrhagic Diseases

Trauma
Blood disease (e.g., hemophilia, sickle cell disease)
Tumor
Joint prosthesis

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SOX COLLECTION

•If possible, patients should have been fasting for_____

-If glucose is requested….

4-6 hours

collect blood simultaneously

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SPX COLLECTION

•Normal volume:______
‘dry tap’ if there is no effusion

0.1 to 3.5 ml

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SPX COLLECTION

-Transport and analyze____ at____
‘Don’t______!!!

ASAP; RT

refrigerate

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SPECIMEN COLLECTION -Tube 1:_______ for chemical and serological tests -Tube 2: ______for microscopic examination -Tube 3:______ for microbiologic tests

plain red top tube sodium heparin or liquid EDTA sodium polyanethol sulfonate

•Test done to determine if the collected fluid is synovial fluid

MUCIN CLOT TEST

MUCIN CLOT TEST -Dilute the fluid (____) with____ •_______(normal component of SF)______: positive result

1:4; 2% acetic acid Hyaluronic acid will form a clot

MUCIN CLOT TEST •Alternative:______

staining with toluidine blue

Toluidine blue - procedure: _____+_____ •If the fluid stains blue: positive result

Fluid in filter paper + 0.2% toluidine blue

Toluidine blue •______samples should not be used!!!

Heparinized

PHYSICAL EXAMINATION •Color: NORMAL

colorless to pale yellow; clear

PHYSICAL EXAM: COLOR • Red or brown: •Traumatic tap: •Greenish or purulent: • Milky:

trauma or damaged synovial membrane uneven blood distribution; blood-streaked infections tuberculous arthritis, SLE

PHYSICAL EXAM •Clarity -The components that modify SF clarity are typically identified in microscopy •Rice bodies in_____ • Ochronotic shards in___ and ____

rheumatoid arthritis alkaptonuria and ochronosis

PHYSICAL EXAMINATION •Normally viscous due to the presence of_______, a joint lubricant secreted by______

hyaluronic acid ; synoviocytes

-Decreased viscosity in_____ conditions (neutrophils and some bacteria have______) •Assess viscosity by observing the fluid as it leaves the syringe

inflammatory hyaluronidase

VISCOSITY -Normal: formation of a string_____ before breaking

4 cm long

•Low viscosity: early breakage of string or if______ form

water-like droplets

•Clot formation: abnormal • Caused by…

Damaged synovial membrane or traumatic tap

-_______if clear

Undiluted

• If turbid,_______ -DO NOT USE!!!: _______can cause cell clumping and clot formation

dilute with 0.85% saline Acetic acid

•Differential Count •______is the ideal concentration method

Cytocentrifugation

•Normal: _____monocytes/macrophages, _____lymphocytes, _____neutrophils

60% 30% 10%

: vacuolated macrophage with ingested neutrophils

-Reiter cell

«Present in reactive arthritis

Reiter cells

: neutrophils with dark, cytoplasmic granules containing immune complexes

•RA cell or ragocyte

-Present in rheumatoid arthritis or immunologic inflammations

RA Cells

•Crystal Identification •CLINICALLY SIGNIFICANT! -Better examined using____ or _____ microscopy

direct or compensated polarizing

•______substances appear as bright objects against a black background •_______enables the identification and differentiation of positively and negatively birefringent substances

birefringent compensated polarizing microscopy (using a red compensator plate)

Crystal Type Condition Birefringence Color Seen ***Monosodium urate (MSU)***

Gout Negative birefringence Yellow when parallel Blue when perpendicular

Crystal Type Condition Birefringence Color Seen *** Calcium pyrophosphate dihydrate (CPPD)***

Pseudogout Positive birefringence Blue when parallel Yellow when perpendicular

-Indicates gouty arthritis

-Monosodium urate

-Needle-like crystals with pointed ends •Direct polarizing microscopy: bright against black background

MSU

•Compensated PM: negatively birefringent (yellow when parallel, blue when perpendicular)

MSU

-Pseudogout conditions (calcification of articular cartilages)

•Calcium pyrophosphate dihydrate

Smaller, blunter, rodlike, or rhomboid

•Calcium pyrophosphate dihydrate

Weak positive birefringence (Blue when parallel, yellow when perpendicular)

CPPD

: better viewed in unstained specimens • Present in chronic effusions like rheumatoid arthritis

Cholesterol crystals

: present intracellularly in WBCs

• Hydroxyapatite crystals

• Requires electron microscope • Tiny, needle-like; not birefringent • Present in calcific depositions

• Hydroxyapatite crystals

: present a few months after intra-articular injection • Looks like CPPD but with same birefringence as MSU

• Corticosteroid crystals

•Glucose •Blood collection along with arthrocentesis -Fasting patient: ______difference

< 10 mg/dl

GLUCOSE • Decreased in joint disorders • ______ noninflammatory and hemorrhagic • ______ septic or inflammatory

< 20 mg/dl difference > 20 mg/dl difference

GLUCOSE •Process within_____ •If not, store sample in a tube with_____

1 hour sodium fluoride

•Total protein - _____that of plasma •High protein: increased permeability or increased synthesis

1/3

•Equivalent to plasma • Increased in gout (look for MSU crystals)

•Uric acid

• Increased in inflammatory conditions that cause anaerobic glycolysis leading to tissue hypoxia

•Lactate

•Gram stain * ______, Gram-negative bacteria

Streptococcus

***•Culture and molecular methods*** •Must be done even if Gram stain is______

negative

PCR methods for

Borrela burgdorter (Lyme arthritis) Mycobacterium tuberculosis (osteoarticular tuberculosis)

Synovial Fluid Flashcards

(69 cards)