Synovial Fluid Flashcards by Kyla Salgado

“Joint fluid”
Cavities of the movable joints (diarthroses) and synovial joints

synovial fluid

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Joint are lined by __________that contains synoviocytes

synovial membrane

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➔ Superficial level
➔ Macrophage-like cells involved in phagocytosis

Type A Synoviocytes

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➔ Deeper layer
➔ Abundant rough endoplasmic reticulum

Type B Synoviocytes

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Type B synoviocytes produce?

● Hyaluronic acid
● Fibronectin
● Collagen

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● Responsible for the viscosity
● Absence leads to and increased friction between joints

Hyaluronic acid

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role of synovial fluid

➔ Lubrication between joints
➔ Provides nutrients to the articular cartilage
➔ Acts as a cushion

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Composition of synovial fluid

a. Products of type B cells
b. Elements from plasma

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Damages to membrane =

inflammation, pain and stiffness (arthritis)

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normal volume of synovial fluid

less than 3.5 mL

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normal COLOR of synovial fluid

COLORLESS TO PALE YELLOW

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normal VISCOSITY of synovial fluid

HIHLY VISCOUS; FORM A 4-6 CM LONG STRING

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normal LEUKOCYTE COUNT of synovial fluid

TOTAL WBC COUNT: <200 CELLS/UL
MAJORITY: MONOCYTES & MACROPHAGES
<25% NEUTROPHILS
<15% LYMPHOCYTES

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PRESENCE OF CRYSTALS of synovial fluid

NONE

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normal PROTEIN of synovial fluid

LESS THAN 3 g/dL

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normal GLUCOSE of synovial fluid

<10 mg/dL LOWER THAN PLASMA GLUCOSE

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normal LACTATE of synovial fluid

<25 mg/dL

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SYNOVIAL FLUID IS classified into four types:

Type 1: Non-inflammatory
Type 2: Inflammatory
Type 3: Septic
Type 4: Hemorrhagic

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synovial fluid is collected via needle aspiration called

arthrocentesis

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Inflammation (arthritis) =

up to 25 mL

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Normal synovial fluid does not clot (T/F)

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Moisten the syringe with________ to prevent clotting

heparin

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iN SYNOVIAL FLUID Fluid must be collected in how many tubes?

3 tubes

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First 4-5 mL of fluid should be collected in a tube with
no anticoagulant to observe for clotting
Tube → centrifuged → chemistry or serology tests

tube 1

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Glucose testing =

fluoride tube

* Tubes with sodium heparin or liquid EDTA * Cell count, differential count and crystal identification

Tube 2

* Crystal identification =

tubes should not be refrigerated

* Tubes with a sterile sodium heparin or SPS for microbial studies

Tube 3

Normal appearance of synovial fluid

Clear, highly viscous, colorless to pale yellow in color

Synovial comes from a latin word for

egg/ovum

is associated with effusions from inflammatory and non-inflammatory arthritis

Darker yellow

= septic arthritis

Green-tinge

= increased leukocytes

Turbid

= presence of crystals

Milky

= Arthritis

Decreased viscosity

➔ Ropes or mucin clot test ➔ To evaluate the normal function of hyaluronic acid

Hyaluronic acid polymerization test

Hyaluronic acid polymerization test ➔ Reported as:

● Good (solid clot) ● Fair (soft clot) ● Low (friable clot) ● Poor (no clot)

Used to confirm if specimen is synovial fluid (not to screen for arthritis)

Hyaluronic acid polymerization test

→ solid clot with clear fluid

Synovial fluid + 2-5% acetic acid

Routinely performed in synovial fluid

Total WBC Count

Too viscous fluid cannot be loaded to counting chamber, what to do?

Pre-treat using 1 drop of drop 0.05% hyaluronidase in phosphate buffer per milliliter of fluid collected and incubate @ 37 degrees for 5 minutes

Clear specimens =

undiluted

Abnormal appearance =

diluted

Diluting agents in cell counting in synovial fluid

a. Normal saline b. Hypotonic saline or saline w/ saponin → lyse RBCs

Initial count

If WBC is < 200/uL, count all large nine square

Second count

If WBC count is > 200/uL in the initial count, use the four corner squares

Third count

If WBC count is still >200/uL in the 2rd count, use the five small squares used for RBC count

Normal cell count in synovial fluid

less than 200 WBCs/uL

Inflammation and infection

may reach up to 100,000 WBCs/uL

In cell differential count, should be performed from

cytocentrifuge and 0.05% hyaluronidase treated synovial fluid

Primary cells of synovial fluid

monocytes & macrophages

<25% of neutrophils are normal

● Increased in arthritis ● Marked increased in septic arthritis

<15% of lymphocytes are normal

Increased non-septic arthritis

parasitic, allergic, or drug related complications leading to arthritis

eosinophils

lupus erythematosus

LE CELLS

Reactive arthritis

reiter cells

rheumatoid arthritis and immunologic inflammation

RA cell

normal; may be sloughed off during arthrocentesis

synovial lining cell

osteoarthritis

cartilige cells

septic and rheumatoid arthritis

rice bodies

crush injury

fat droplets

pigmented villonodular synovitis

hemosedirin granules

Presence of _________ is important in evaluating crystal-induced arthritis

crystals

* Gouty arthritis * common causes of gout: * Needle shaped crystals * Negative birefringence (yellow on parallel slow light) * Intracellular (within the cytoplasm of neutrophils)

1. Monosodium Urate (MSU) or Uric Acid

* Pseudogout * Rhomboid-shaped or square but may appear as short rods * Positive birefringence (blue on parallel slow light) * Located within vacuoles of the neutrophils

Calcium Pyrophosphate (CPP)

associated with calcifies cartilage degeneration; non-birefringement

hydroxyapatite

chronic inflammation; negative birefringence and extracellular

cholesterol crystals

after injections; both positive and negative birefringence

corticosteroids

patients on renal dialysis; negative birefringence

calcium oxalate

* Most frequently requested chemical test

1. Glucose test

* Normal: less than 3 g/dL protein (approximately one third of the serum value) * Protein increases in all types of arthritis except for noninflammatory type

Total Protein

* Aids in the diagnosis for gouty arthritis * confirmatory test when crystals cannot be demonstrated in the fluid

Uric Acid

* Increase in septic arthritis caused by gram-positive cocci and gram-negative bacilli, except for N.gonorrhoeae. * N.gonorrhoeae = normal or low * >9 mmol/L (81 mg/dL) indicate septic arthritis

Lactic acid

Done to confirm for autoimmune diseases RA and systemic _______________ by the demonstration of autoantibodies

lupus erythematosus

➔ Arthritis is a frequent complication ➔ Antibodies to the causative agent B. burgdorferi in the patient's serum can confirm the cause of the arthritis

Lyme Disease

Synovial Fluid Flashcards

(77 cards)