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Flashcards in Synovial Fluid Analysis Deck (29)
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1

composition of synovial fluid

formed as an ultrafiltrate of plasma across the synovial membrane
mucopolysaccaride containing hyaluronic acid & a small amount of protein secreted by synoviocytes

2

function of synovial fluid

supply nutrients to cartilage
lubricant to surfaces of frequently moving joints

3

noninflammatory

degenerative joint disorders
osteoarthritis

4

inflammatory

immunological disordres
RA, SLE
crystal induced: gout & pseudogout

5

Septic

infection- bacterial, tubercular, fungal

6

Hemorrhagic

traumatic injury
hemophilia
coagulation disorders
anticoagulant overdose

7

collection

arthrocentesis (if possible fasting 4-6 hours)
blood sample collected at same time
3 tubes collected

8

3 tubes collected

1: non-anticoagulated tube - chemical & immunological
2. anticoagulated (Naheparin/liquid EDTA)- hematology
3. sterile (Na heparin/SPS) microbiology

9

transport & analysis

room temp
evaluate immedately

10

most helpful analysis on synovial fluid

WBC & differential
gram stain, culture & crystal examination

11

mucin clot test

performed if there are any concerns that fluid sample is not synovial fluid
normal synovial fluid shouldn't have fibrinogen & doesn't clot
dilute w/ 2% acetic acid- hyaluronate from joint will form a clot in acid

12

normal color & clarity

clear, pale yellow

13

yellow color/clarity

inflammation

14

greenish color/clarity

bacterial infection

15

bloody color/clarity

hemorrhagic arthritis/traumatic tap; joint fractures; tumors

16

milky color/clarity

SLE, tuberculous arthritis

17

substances that can affect synovial fluid clarity

WBCs, RBCs, & synoviocytes
crystals, fat droplets
fibrin, cellular debris, rice bodies

18

rice bodies

white, free-floating substances made up of collagen covered by fibrinous tissue; resemble polished, shiny grains of rice of various sizes; seen most commonly in rheumatoid arthritis

19

viscosity during inflammation

hyaluronate can be depolymerized by enzyme hyaluronidase present in bacteria & some neutrophils

20

severe inflammation in synovial fluid

>100,000 WBC/ul
pre-treatment w/ hyaluronidase permits proper mixing & accurate cell counts

21

increase in neutrophils

septic

22

increase in lymphocytes

non-septic inflammation

23

abnormal cells in synovial fluid

eosinophils
LE cells
reiter cells
RA cells (ragocytes)
malignant cells
lipids
hemosiderin granules

24

crystal ID

important microscopic exam
polarized microscopy

25

monosodium urate crystals

present in gouty arthritis
needle-like crystals w/ pointed ends
polarized :
strongly negative birefringent (bright against black background)
appear yellow when longitudinal axes are parallel to it & blue when perpendicular

26

Calcium pyrophosphate dihydrate crystals

degenerative arthritis
smaller & blunter than urate crystals
rodlike or rhomboid; display weak positive birefringence w/ their colors opposite of that to urate with red compensator

27

other crystals

cholesterol
hydroxyapatite
corticosteroids

28

glucose

not more than 10 mg/dl lower than blood
marked decrease: inflammatory or septic disorders

29

bacteria in synovial fluids

neisseria gonorrheae
staphylococcus aureus