synovial, serous, amniotic fluids Flashcards
(207 cards)
1
Q
Joint fluid
A
SYNOVIAL FLUID
2
Q
a highly viscous fluid found in the cavities of the movable joint (diathroses)
A
SYNOVIAL FLUID
3
Q
Formed as an ultrafiltrate of plasma across the synovial membrane.
A
SYNOVIAL FLUID
4
Q
Lubricates joints
A
SYNOVIAL FLUID
5
Q
Reduces friction between bones
A
SYNOVIAL FLUID
6
Q
Provides nutrient to the articular cartilage
A
SYNOVIAL FLUID
7
Q
Lessens shock of joint compression during activities
A
SYNOVIAL FLUID
8
Q
Method collected be needle aspiration
A
Arthrocentesis
9
Q
Arthrocentesis
> 25 mL indicate
A
inflammation or infection
10
Q
Arthrocentesis Volume
A
< 3.5 mL
11
Q
1st tube
A
MICROBIOLOGY
12
Q
2nd tube
A
CELL COUNT
13
Q
3rd tube
A
CHEMISTRY
14
Q
4th tube
A
GLUCOSE DETERMINATION
15
Q
type of tube used for 1st tube
A
HEPARINIZED TUBE
Sodium heparin
16
Q
type of tube on 2nd tube
A
EDTA tube
Heparin
17
Q
type of tube on 3rd tube
A
Nonanticoagulated tube
18
Q
type of tube on 4th tube
A
Sodium fluoride tube
19
Q
Color and Clarity:
➢ Clear to Pale Yellow
➢ Resembles egg white
A
NORMAL
20
Q
Color and Clarity:
➢ inflammation
A
DEEPER YELLOW
21
Q
Color and Clarity:
➢ Bacterial infection
A
GREENISH TINGE
22
Q
Color and Clarity:
➢ Trauma, hemorrhagic arthritis
A
RED
23
Q
Color and Clarity:
➢ Presence of crystals
A
MILKY
24
Q
Color and Clarity:
➢ Presence of WBCs, Rice bodies
A
TURBID
25
Color and Clarity:
➢ Pigmented cartilage fragments
GROUND PEPPER APPEARANCE
26
DETERMINATION of SOLID CLOT
GOOD
27
DETERMINATION of Soft clot
FAIR
28
DETERMINATION of Friable clot
LOW
29
DETERMINATION of No clot
POOR
30
STRING TEST: string
4 – 6 cm
31
Hyaluronate polymerization test
ROPES or MUCIN CLOT TEST
32
ROPES or MUCIN CLOT TEST % acetic acid
2 – 5%
33
TOTAL CELL COUNT Diluting fluid:
NSS with methylene blue or hypotonic saline or saline with saponin
34
Total cell count is most frequently performed using
liquid EDTA
35
Concentration of the specimen
TOTAL CELL COUNT
36
TOTAL CELL COUNT WBCs
< 200 cells/ uL
37
TOTAL CELL COUNT RBCs
< 2000 cells/ L
38
Performed on cytocentrifuged preparations or on thinly smeared slides
DIFFERENTIAL COUNT
39
Synovial fluid should be incubated with ___________ prior slide preparation
hyaluronidase
40
Synovial fluid DIFFERENTIAL COUNT % Monocytes and macrophages
65%
41
Synovial fluid DIFFERENTIAL COUNT %Neutrophils
< 25%
42
Synovial fluid DIFFERENTIAL COUNT %Lymphocytes
<15%
43
PMN
NEUTROPHIL
44
Bacterial sepsis Crystal-induced inflammation
NEUTROPHIL
45
Mononuclear leukocytes
LYMPHOCYTE
46
Nonseptic inflammation
LYMPHOCYTE
47
Large mononuclear leukocyte, may be multinucleated, resemble Mesothelial cell
MACROPHAGE
48
Normal Viral infection
MACROPHAGE
49
Similar tomacrophage, may be multinucleated, resemble Mesothelial cell
SYNOVIAL LINING CELL
50
Normal
SYNOVIAL LINING CELL
51
Neutrophil containing ingested round body
LE CELL
52
Vacuolated macrophage with ingested neutrophils
REITER CELL
53
Reiter’s syndrome
Nonseptic inflammation
REITER CELL
54
Neutrophil with dark cytoplasmic granules containing immune complexes
RA CELL (RAGOCYTE)
55
RA
Immunologic inflammation
RA CELL (RAGOCYTE)
56
Large multinucleate cells
CARTILAGE
57
Osteoarthritis
CARTILAGE
58
Macroscopic: re. Polished rice
Microscopic: show collagen and fibrin
RICE BODIES
59
TB, septic and RA
RICE BODIES
60
Refractile intracellular and extracellular gobbles Stain with Sudan dyes
FAT DROPLETS
61
Traumatic injury
FAT DROPLETS
62
Inclusions within clusters of synovial cells
HEMOSIDERIN
63
Pigmented villonodular synovitis
HEMOSIDERIN
64
Examined unstained under polarized and compensated polarized light for detection of MSU and CPPD crystals
CRYSTAL IDENTIFICATION
65
Red compensator is placed between
crystal and analyte
66
COMPENSATED POLARIZING MICROSCOPE(–)
yellow
67
COMPENSATED POLARIZING MICROSCOPE (+)
blue
68
CAUSES OF CRYSTAL FORMATION
▪ Metabolic disorder
▪ Decreased renal excretion that produce elevated blood levels of crystallizing chemicals
▪ Degeneration of cartilage and bones
▪ Injection of medication (corticosteroids)
69
• Needle shape
• Seen in Gout
• Strongly birefringence
MONOSODIUM URATE
70
• Rhombic square, rods
• Pseudogout
• Weakly birefringence
CALCIUM PYROPHOSPHATE
71
• APATITE
• Small particles, require electron microscopy
• Osteoarthritis
• No birefringence
CALCIUM PHOSPHATE
72
Notched, rhomboid plates
(-) birefringence
CHOLESTEROL
73
• Envelope shape
• Renal dialysis
• (-) birefringence
CALCIUM OXALATE
74
• Flat, variable-shaped plates
• Injections, medications
• (+) and (-) birefringence
CORTICOSTEROIDS
75
CHEMISTRY TESTS
glucose
protein
lactate
uric acid
76
N. V for glucose chemistry test
<10 mg/dl
77
N. V protein chemistry test
<3 g/dl
78
SEROLOGICAL TESTS
Autoantibody Detection
Antibody detection
79
Common organisms that infect synovial fluid
S. aureus
Streptococcus
Haemophilus
Neisseria gonorrhea
80
predominant pathogen in adult joint infection (most common).
S. aureus
81
• WBCs: < 1000/uL
• Neutrophils: <30%
• Normal Glucose
Noninflammatory
82
WBCs: 2000-7500/uL
• Neutrophils: >50%
• Decreased glucose levels
• Possible autoantibodies present
Inflammatory
83
WBCs up to 100 000/uL
• Neutrophils: < 70%
• Decreased glucose levels
• Crystals present
Inflammatory
84
WBCs: 50 000 – 100 000/uL
• Neutrophils: > 75%
• Decreased glucose levels (due to the presence of bacteria)
• Positive culture and gram stain
Septic
85
WBCs and Neutrophils are equal to blood
Normal glucose level
RBCs present
Hemorrhagic
86
Synovial fluid: Cloudy, yellow-green fluid, variable viscosity
Septic
87
Synovial fluid: Cloudy, red fluid, low viscosity
Hemorrhagic
88
Synovial fluid: Cloudy or milky fluid, low viscosity
Inflammatory
89
Synovial fluid: Cloudy, yellow fluid, poor viscosity (no clot)
Inflammatory
90
Synovial fluid: Clear, yellow fluid, good viscosity (Good viscosity- solid clot with acetic acid)
Noninflammatory
91
Noninflammatory
Degenerative joint disorders
92
Inflammatory
RA, Immunologic Disorders, Lyme Arthritis,
Crystal-induced gout and pseudogout
93
Septic
Microbial infection
94
Hemorrhagic
Traumatic injury, coagulation deficiencies
95
Fluid between the parietal membrane and visceral membrane that provide lubrication to prevent friction between the two membranes.
SEROUS FLUID
96
Formed as an ultrafiltrate of plasma
SEROUS FLUID
97
production and reabsorption are subject to hydrostatic pressure and oncotic pressure.’
SEROUS FLUID
98
Increase in fluid due to disruption of the mechanics of serous fluid formation and reabsorption.
Effusion
99
It can be transudate or exudate
Effusion
100
TYPES OF SEROUS FLUIDS
Pleural Fluid
Pericardial Fluid
Peritoneal Fluid
101
Pleural Fluid
method of collection
thoracentesis
102
Pericardial Fluid method of collection
pericardiocentesis
103
Obtained located between the parietal pleural membrane lining the chest wall and visceral pleural membrane covering the lungs.
Pleural Fluid
104
Peritoneal Fluid
method of collection
paracentesis
105
About ________ mL of fluid found between the pericardial serous membranes
Pericardial Fluid
106
__________ effusions are primarily the result of changes in the membrane permeability due to infection, malignancy and trauma-producing exudates.
Pericardial effusions
107
the accumulation of fluid between the peritoneal membranes
ASCITIC FLUID
108
ASCITES
Peritoneal Fluid
109
An effusion resulting from disruption of fluid production and regulation between membrane
Transudates
110
Transudates Caused by
Congestive Heart Failure or Hypoproteinemia
111
Exudates Caused by
infection or malignancy
112
An effusion resulting from direct damage to the membrane
Exudates
113
fluid: serum protein ratio in transudates
<0.5
114
fluid: serum protein ratio in exudates
>0.5
115
appearance in transudates
clear
116
appearance in exudates
cloudy
117
WBC Count in Transudates
<1000/uL
118
WBC Count in Exudates
>1000/ uL
119
spontaneous clotting in Transudates
No
120
spontaneous clotting in Exudates
Possible
121
pleural fluid: cholesterol in transudates
<45.60 mg/dL
122
pleural fluid: cholesterol in exudates
>45.60 mg/dL
123
pleural fluid: serum cholesterol ratio in transudates
<0.3
124
pleural fluid: serum cholesterol ratio in exudates
>0.3
125
pleural fluid: bilirubin ratio in transudates
<0.6
126
pleural fluid: bilirubin ratio in exudates
>0.6
127
serum-ascites albumin gradient in transudates
>1.1
128
serum-ascites albumin gradient in
<1.1
129
Black Serous Fluid
Aspergillus
130
Brown Serous Fluid
Rupture of amoebic liver abscess
131
Viscous Serous Fluid
malignant mesothelioma
132
Milky Serous Fluid
a) Chylous – thoracic duct leakage
b) Pseudochylous – chronic inflammation
133
Bloody Serous Fluid
Hemothorax,
Hemorrhagic Effusions,
Pulmonary Embolus,
Tuberculosis,
Malignancy
134
milky/white
chylous
135
milky/green tinge
pseudochylous
136
leukocytes for chyle
lymphocytes
137
lekocytes for pseudochylous
mixed cells
138
cholesterol crystal for Chylous
absent
139
cholesterol crystals for pseudochylous
present
140
Triglycerides for chylous
>110 mg/dl
141
TRIGLYCERIDES FOR Pseudochylous
<50 mg/dl
142
sudan III staining for Chylous
strongly positive
143
sudan III Staining for Pseudochylous
negative / weakly positive
144
pneumonia, pancreatitis, pulmonary infection
Neutrophils
145
tuberculosis, viral infection, autoimmune disorders, malignancy
Lymphocytes
146
-Normal and reactive forms have no clinical significance
– Decreased mesothelial cells are associated with tuberculosis
Mesothelial Cells
147
Tuberculosis
Plasma Cells
148
Primary adenocarcinoma and small-cell carcinoma, metastatic carcinoma
Malignant Cells
149
membranous sac that surround the fetus.
AMNIOTIC FLUID
150
During Latter THIRD to HALF OF PREGNANCY Secretions of lung liquid:
Lecithin
Sphingomyelin
Phosphatidylglycerol
151
normal amniotic fluid
800-1200 mL
152
<800 mL
Oligohydramnios
153
>1200 mL
Polyhydramnios
154
Due to increase fetal swallowing, membrane leakage, and urinary tract deformities
Oligohydramnios
155
(Most Common) AMNIOCENTESIS
Transabdominal
156
Safe to do the amniocentesis
14th Week gestation (4th month / 2nd Trimester)
157
Determine Fetal lung maturity, fetal hemolytic disease
3rd Trimester
158
Amniotic fluid can be extracted for Chromosomal or generic defects (Trisomy 21 / Down syndrome)@ 3rd Trimester– Determine Fetal lung maturity, fetal hemolytic dise
2nd Trimester
159
Placed on Ice for delivery
– Refrigerated or frozen (3 days)
– Filtration prevents loss of phospholipids
FETAL LUNG MATURITY
160
bilirubin analysis (OD450) Bilirubin present are tested through Optical Density 450
– Protect from light, using amber-colored tubes
HEMOLYTIC DISEASE OF NEWBORN (HDN)
161
– Processed aseptically, sterile condition– Room temperature or body temperature (37oC)
CYTOGENIC STUDIES
162
Amniotic Fluid Urea
< 30 mg/dL
163
Maternal Urine
Urea
> 300 mg/dL
164
Amniotic Fluid Creatinine
< 3.5 mg/dL
165
Maternal UrineCreatinine
> 10 mg/dL
166
Amniotic Fluid Glucose
Positive
167
Maternal Urine
Glucose
Negative
168
Amniotic FluidProtein
Positive
169
Maternal Urine Protein
Negative
170
(+) fern-like crystals
due to protein and sodium chloride content
171
On a glass slide, vaginal fluid is air dried at room temperature then microscopically observed
FERN TEST
172
Used to evaluate premature rupture of the membranes
FERN TEST
173
Amniotic Fluid Colorless
Normal
174
Amniotic Fluid Blood-streaked
▪ Traumatic tap
▪ Abdominal trauma
▪ Intra-amniotic hemorrhage
175
Amniotic Fluid Dark-green
Meconium, first fetal bowel movement.
176
Amniotic FluidDark Red-brown
fetal death
177
Amniotic Fluid Yellow
Bilirubin, due to Hemolytic Disease of Newborn
178
Liley Graph Zone 1
Mildly affected fetus
179
Liley Graph Zone 2
Moderate hemolysis
180
Liley Graph Zone 3
Severe Hemolysis
181
Incomplete closing of the backbone and membranes around the spinal cord.
SPINA BIFIDA
182
“Split Spine”
SPINA BIFIDA
183
Absence of a major portion of the brain, skull, and scalp that occurs during embryonic development
ANENCEPHALY
184
Increased ALPHA-FETOPROTEIN (AFP)
NTD
185
Decreased ALPHA-FETOPROTEIN (AFP)
Down Syndrome
186
NV: ALPHA-FETOPROTEIN (AFP)
< 2 MoM – Multiples of the Median
187
Screening Test for NTD
ALPHA-FETOPROTEIN (AFP)
188
Confirmatory test for NTD
ACETYLCHOLINESTERASE (AChE)
189
When neural tube defect is suspected
Maternal Serum AFP is initially used. If increased, Amniotic Fluid AFP is then used.If also increased, Acetylcholinesterase is used to confirm.
190
most frequent complication of early delivery, morbidity, and mortality of premature infant
– Caused by insufficiency of lung surfactant productionand structural immaturity of fetal lungs
Respiratory Distress Syndrome
191
Tests for the presence of phospholipids amniotic fluid
FETAL LUNG MATURITY
192
Immunologic agglutination test for phosphatidylglycerol
AMNIOSTAT-FLM
193
Uses polyclonal anti-PG antisera specific for PG
containing lamellar bodies in the amniotic fluid
AMNIOSTAT-FLM
194
Not affected by blood or meconium
AMNIOSTAT-FLM
195
REFERENCE METHOD for Fetal lung maturity,
LECITHIN-SPINGOMYELIN (L/S) RATIO
196
lungs is already mature in
LECITHIN-SPINGOMYELIN (L/S) RATIO
≥ 2.0
197
Affected by blood and meconium since it tests for Lecithin and Sphingomyelin.
LECITHIN-SPINGOMYELIN (L/S) RATIO
198
> 32 000 uL LBC:
Adequate FLM
199
LAMELLAR BODY COUNT
Specimens are stored at
2–8oC, never frozen
200
storage form of Lecithin and Sphingomyelin, thus it is also affected by blood and meconium.
Lamellar Bodies
201
Lamellar body density analysis
OD 650
202
Examined using wavelength of 650 nm
OD 650
203
Examined using wavelength of 650 nm
OD 650
204
The presence of lamellar bodies increases the OD of amniotic fluid
OD 650
205
OD 0.150
indicates FLM
206
All tests that examine phospholipids, including Lecithin and Sphingomyelin and their storage form (lamellar bodies), are affected by
Blood and Meconium
207
Amniotic fluid + 95% Ethanol then shake for 15 secs then stand undisturbed for 15 mins
FOAM TEST
