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Hem Yr 2 Sem 2 > Week 7 > Flashcards

Week 7 Flashcards

(64 cards)

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1
Q

how do you obtain a csf

A

lumbar puncture

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2
Q

how do you obtain a serous fluid

A

needle aspiration

Thoracentesis
Pericardiocentesis
paracentesis

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3
Q

how do you obtain synovial fluid

A

needle aspiration
arthrocentesis

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4
Q

do we anti coagulate the samples or no

A

cells counts cant be done on clotted samples
-Csf doesnt have fibrinogen since the BBB controls filtration of plasma compenents

Serous fluids and synovial fluids are plasma ultra filtrates

seminal fluid clots and liquefies

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5
Q

What type tube does each fluid need

A

CSF- 2-3 ml, 3-4 tube with NO anticoagulant

Serous - ~100 ml in EDTA

Synovial fluid - 3 tubes in EDTA or heparin

seminal fluid - 2-3ml in sterile container no anticoagulant

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6
Q

What do we look at the neat fluid for and what does it indicate

A

Colour
Turbidity
Consistency

abnormality type and how its processed

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7
Q

if its red or bloody

yellow or xanthochromic

A

be blood or hemolysis - centrifuge and look at SUPERNATANT and then describe the supernatant color

bilirubin

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8
Q

if fluid is turbid what does it indicate

A

infection

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9
Q

what are the types of consistency the sample can have

A

Stringy
Clotted
Thick

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10
Q

testing times for fluids

A

CSF - in one hour

Others - 24 hours

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11
Q

when you look at the BF what type of processing options are there

A

counting manually not diluted

manual counting with dilution

Manuals must be done for low CSF counts

automated on cell counter - sample must be bloody, must check analyzer linearity because they may not be accurate at low RBC counts . Not good for WBC

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12
Q

How do you do a manual count of a clear fluid

A

-add to chamber neat or undiluted

-entire chamber is counted (9 squares on both sides)

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13
Q

how do you count cloudy , blood fluids

A

-dilute 1:10 or 1:200
-count all 9 squares if there arent too many cells
- do WBC squares or RBC squares

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14
Q

how to dilute samples for a low count

A

-use the smallest dilution
-flood chamber with neat sample and assess
-less accuracy with dilution

-use saline for RBC/WBC
-acetic acid to lyse RBC = for WBC
-TURK solution with acetic acid and methylene blue for WBC count since it stains nuclei

-DONT USE ACETIC ACID FOR SYNOVIAL FLUID
ADD HYALURONIDASE to synovial fluid to liquefy before doing counts or prepping cytocentrifuge slides

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15
Q

What is the cytocentrifuge
how are they prepped

A

concentrates sample into a small area so counts can be done
-you can also spin sample and make a circular sediment smear

Must have a circle on slide to find cells – low cell counts are hard to see
-stain with Wrights stain
-count 100 wbc and nrbc
-comment on bacteria that are present

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16
Q

What are the normal lining cells in the

CSF

SEROUS FLUID

SYNOVIAL FLUID

A

-Ependymal & choroid plexus cells, spindle-shaped cells, Large with lots of cytoplasm, found in clumps

-Mesothelial cells

-Synoviocytes (synovial lining cells)

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17
Q

How are lining cells different than normal ones

A

Lining cells are :
- larger
- flat clumps or sheets
- large, central, round nuclei, multi-nuclei
- moderately abundant blue cytoplasm

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18
Q

What cells are seen in
normal

Bacterial infection

Viral infection

Parasitic infections
Allergic reaction
Shunt

A

normal- hypersegmented neuts with filaments , few lymphs in adults and monocytes for peds,

Bacterial infection - neutrophils (meningitis) early TB, viral or fungal

Viral infection - lymphs, and reactive lymphs

Parasitic infections - eos, basos
Allergic reaction
Shunt

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19
Q

What cells are seen in fluid of

Leukemia /Lymphoma

Inflammation

TRAUMA

Caner/tumors

A

Leukemia /Lymphoma - Leukemic Blasts, Lymphoma cells, Plasma cells

Inflammation -Neutrophils, LE cells

TRAUMA -Red Blood Cells Siderophages

Caner/tumors -Tumour cells

recognition of these cells is done in diagnostic cytology
-send smear to pathologist

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20
Q

when looking at a CSF

A

gross appearance
Clear = report
Cloudy, bloody - spin and report supernatant appearance

Cell count
Clear - count UNDILUTED
cloudy/bloody - dilute
Turks (1:2 or WBC 1:20 = WBC reported
RBC 1:200 - report RBC, fresh and crenated

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21
Q

diseased CSF can cause
how many tubes and which goes to what department

A

hydrocephalus - increased volume
Meningitis - symptoms of headache, fever

trauma can cause intracranial hemorrhage

STAT= draw 3-4 tubes -No Anticoagulant
analyze now since RBC and WBC can degenerate

Tube # 1 for Chemistry & serology 2-8 fridge
Tube # 2 for Microbiology - RT (keep orgs viable)
Tube # 3 for Hematology -2-8 fridge
Cell counts
Tube # 4 (if possible) for
cytology

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22
Q

What do we look for in a visual assessment

A

-all tubes assessed first

-turbid, cloudy, = meningitis , hemorrhage, blood tap
-bloody = hemorrhage= blood tap
-pellicle = TB

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23
Q

What are the 2 possibilities when assessing a blood CSF

A

-intracranial bleeding due to trauma

-blood in sample only because of poor procurement technique (bloody tap)

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24
Q

What must hematology do before all departments

A
  • look at all tubes if bloody
    -count cells BEFORE chem spins
    -enter Micro tube with sterile technique
    -smears or cytospins on all tubes
    -send rest to all departments
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25
What are the characteristics of a traumatic tap
Clear supernatant Clearing from tube to tube 1st tube cloudiest Progressively less cloudy Fresh RBCs
26
What are the characteristics of a Pathological Hemorrhage
Xanthochromic / hemolyzed supernatant Same appearance in all tubes Crenated RBCs a blood tap get progressively less bloody whereas hemorrhage is bloody in all tubes when spun a blood tap has a clear supernatant whereas a hemorrhage has a supernatant which is xanthochromic due bilirubin from broken cells blood from blood tap may clot
27
What does CSF dilution in saline depend on
appearance Clear ---- Undiluted Hazy ----- 1/10 Cloudy ---1/100 Bloody/Turbid -----1/1000
28
What is the 1 count method for CSF
load chamber with neat CSF on both sides -count all cells that differentiating WBC and RBC -dont diff the WBC in a counting chamber -no dilution
29
What is the 2 Dilutions/counts
-if you have a higher cell count do TWO different cell counts Total cell count and WBC count -count all cells without dilution = TOTAL cell count -dilute with acetic acid - WBC only since RBC got lysed Total - WBC = RBC so you dont have differentiate the two types but you still do 2 types of assessments
30
What is the QC required on CSF
needed to assess the count check equipment check for reagent contamination incorrect concentration of acetic acid
31
When must you do cytospin on csf
if any WBC are seen
32
commonly seen orgs on a gram of csf
GNDC GPC GNCB - H FLU Crypto
33
Where do you take serous fluids from and when can you aspirate them
- they are lubricant in small closed cavities pleural - round the lung pericardial - around the heart peritoneal - around the intestine -only take if there is a disease process constant volume Production = reabsorption
34
What is Effusion in serous fluids
-when fluid accumulates in a cavity ascites = large amount of fluid in peritoneal cavity divided into transudates and exudates
35
What is a transudate
-problem in formation/absorption mechanism -formed due to increased capillary hydrostatic pressure or decreased plasma oncotic pressure -develop as part of system disease process -seen in congestive heart failure
36
What are exudates
-problem with membrane -problem with reabsorption at the location where the fluid originates -also occur due to increased capillary permeability or decreased lymphatic resorption -indicates inflammatory disorders that are associated with bacterial/viral infections, malignancy, pulmonary emboli, and SLE
37
if a serous effusion is turbid and cloudy what does it suggest depending on where its from
Pleural: microbial infection, pneumonia, TB Pericardial: Bacterial endocarditis Peritoneal: Peritonitis (perforated bowel, appendix) If fluid is cloudy dilute with Turk’s fluid: Count Total or RBC then WBC with Turk’s
38
why would a serous effusion be milky
chylous material (triglycerides) from thoracic duct
39
Why would a serous effusion be bloody
Hemothorax – hemorrhage in pleural sac
40
What are cells that are normally seen in serous fluids
Mesothelial cells that look like fried eggs -lymphs -macros
41
What are some abnormal cells seen in serous fluids
-malignant cells from primary or metastatic tumors -same as the malignant cells found in CSF -neuts in bacterial infection -Eos and basos due to allergic sensitivity of foreign material
42
What is seen in in pleural cells due to SLE
LE cell -appear due to environmental conditions AB in fluid, Trauma to cells, incubation -ANA or RA done on pleural fluids
43
synovial fluid what is it what does it secrete
-formed as ultrafiltrate of plasma -normal is 3.5 ml -membrane cells secrete Hyraluronic acid to make the fluid viscous and allow for joint movement
44
how is synovial fluid tested
- can clot so anticoagulant can be used -use EDTA or heparinized tube -normally it will be viscous with few cells and no crystals do a visual check with color, turbidity, viscosity, and microscopic examination for crystals and cells
45
how is viscosity assessed for synovial fluids
-measure ability of the fluid to form a string 4-6 cm long -hyaluronic acid helps with joint movement -makes cell counts smear prep difficult -to reduce viscosity add ‘Hyaluronidase’ enzyme to liquefy the fluid AFTER you look for crystals
46
What types of crystals can you see in synovial joint fluid
Monosodium urate - NEEDLE LIKE Calcium Pyro - RHOMBOID Cholesterol - NOTCHED WEDGE
47
What are the different types of joint disorders
Noninflammatory - degenerative disorder Inflammatory /Immunological - RA, SLE, = crystal induced: Gout or Pseudogout Septic - Microbial infection Hemorrhagic -Trauma, Bleeding disorders
48
What can different colored fluid suggest in synovial fluid abnormalities
Deeper yellow with inflammation Green-yellow with infection Red : Presence of blood due to hemorrhage or traumatic tap Brown/Pink : Old hemorrhage / lysed blood
49
how are cell counts done with synovial fluid
same way as CSF -higher dilution is used for turbid samples -count cells in 5 large squares and multiply by dilution to get cells/uL -WBCS will be high in inflammatory, septic and hemorrahagic joint disorders -RBCs are increased in hemorrhagic disorders
50
What are normal cells seen in synovial fluid
-lymphocytes, Monocytes/histocytes -synovial cells are lining cells that look like mesothelial cells
51
How do you prep for looking at crystals from a fluid
-can have intra or extracellular crystals -can view on slide with coverslip or make a cytospin -examin with polarizing mic and red filter
52
What can crystal in fluid result in what are the most common types and causes
-result in acute, painful inflammation common Monosodium urate (MSU) in gout Calcium pyrophosphate (CPPD) in pseudogout- stain with Wrights (blue when parallel to polarized light and yellow when rotated 90 degrees) Cholesterol in chronic arthritis and rheumatoid arthritis Caused by Metabolic disorders Decreased renal excretion Increased intake Degeneration of cartilage and bone Injection of medication viz. corticosteroids
53
What will you see in non inflammatory disorders in synovial fluid
Colour/Clarity: Yellow/clear Good viscosity WBCs <3000/µL, Neutrophils<30% RBCs not present
54
What will you see in non Inflammatory Disorders (Immunologic) in synovial fluid
Colour/Clarity: Yellow/Cloudy Poor viscosity WBCs 3000 – 75,000 /µL, Neutrophils >50% RBCs not present
55
What will you see in Inflammatory (Crystal-induced) in synovial fluid
Colour/Clarity: Yellow/Cloudy, milky fluid Poor Viscosity WBCs 500 – 200,000 /µL, Neutrophils <90% RBCs not present
56
What will you see in Septic Disorders in synovial fluid
Colour/Clarity: yellow-green/turbid Poor viscosity WBCs 50,000-200,000 /µL, Neutrophils >90% RBCs present
57
What will you see in Hemorrhagic Disorders in synovial fluid
Colour/Clarity: Red-brown/cloudy Poor viscosity WBCs 50 – 10,000/µL, Neutrophils <50% RBCs >2000/µL
58
What will you see in Autoimmune in synovial fluid
LE cells in SLE & ANA positive in SLE RA factor in RA
59
What do we look at seminal fluid for
infertility post vasectomy semen has four fractions Testes and epididymis: Sperms (5%) Seminal vesicles: Fluid rich in fructose (60%) Prostate: Acids and proteolytic enzymes (30%) Bulbourethral glands: Alkaline mucus (5%)
60
What is assesed in semen
appearance - GREY TRANSLUCENT -volume 2-5ML -viscosity -sperm count -sperm concentration (density)- # per volume -sperm motility >50% IN AN HOUR -% of normal and abnormal (defective) -coagulation and liquefaction - thick to liquid (POUR IN DROPLETS AND LIQUID IN 30-60 MINS) -fructose = energy pH = acidity SHOULD BE 7.2-8 -immature sperm -# of WBCs
61
how is sperm collected
collected by masturbation after >3 days and <5 days of sexual abstinence -WHOLE specimen needs to be sent to the lab within an hour of collection -note collection time -keep at 37C until liquefaction then process immediately
62
how do we study sperm morph
-thin smear -air dry -Wright’s, Giemsa or Papanicolaou stain -count 200 sperm -look for abnormal forms -Note WBCs or Premature sperms if present
63
how to count sperm
1/20 dilution in fluid/saline -charge chamber -count sperms in 5 RBC squares Sperms/mL = Sperms counted X 106 Total Sperm Count = Sperms/mL X Vol of Fluid
64
What tested post vasectomy
- confirm success of vasectomy by absence of spermatozoa -do monthly intervals until 2 consecutive specimens show no sperms -look for sperm on wet prep -motile or non motile -confirm absence by spinning for 10 mins and looking at sediment

Hem Yr 2 Sem 2 (12 decks)

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