BODY FLUID ANALYSIS FOR CLLULAR COMPOSITION：细胞的构成体流体分析

1、serousal fluids the closed cavities of body are lined by serosal membranes (pleura pericardium and pertoneum) the fluid is a plasma filtrate from capillaries of the parietal membrane the fluid is reabsorbed through the lymphatics and venules of the visceral membrane the small amounts of fluid facili

2、tates movement of two membranes the serosal fluids are plasma ultra filtration and mesothelial lining does not add any substance for laboratory assessment needle aspiration is done (thoracocentesis pericardiocentesis paracentesis)serousal fluids evaluation of serous fluids directed first toward diff

3、erentiating transudate from exudate transudative effusions (usually bilateral in pleura) have mechanical process owning to systemic conditions, leading to increase capillary hydrostatic pressure or decreased plasma oncotic pressure exudative effusions (usually unilateral in pleura) have inflammatory

4、 process, associated with disorders of vascular permeability or interfere with lymphatic resorption transudate and exudateserousal fluids transudate exudateappearance clear cloudyspecific gravity 1.015total protein 3.0 gr/dlf/s protein ratio 0.5ld 200 iuf/s ld ratio 0.6cell count 1000/ulspontaneous

5、clotting no yestotal leukocyte and red cells counts are of limited use in the evaluation of serousal fluidsserousal fluids transudates generally require no further work-up additional testing for cholestrol and albumin gradient may discriminate effusions with equivocal lights criteria (the first thre

6、e criteria) pf/s protein ratio 0.5 pf/s ld ratio 0.6 pleural fluid ld 2/3 upper limit of serum pleural fluid cholestrol 45 mg/dl pf/s cholestrol ratio 0.3 serum-pleural fluid albumin gradient 0.6* bilirubin measurement has not help as a strong discreminatorpleural fluidserousal fluids indications of

7、 thoracocentesis: 1. any undiagnoesd pleural effusion 2. therapeutic purposes in massive effusions collection: 1. heparinized tubes to avoid clotting 2. except for an edta tube for all counts and differentials inoculation into the blood culture medium at the bed side* if necessary fresh specimen for

8、 cytology may be stored up to 48 hours in the refrigerator with satisfactory results.pleural fluid amylase: measurement of this enzyme is recommended for all pleural effusions with unknown ethiology increased levels found in esophageal rupture ph value 7.3 is related to uncomplicated cases ph 7.2 is

9、 related to complicated cases such as bacterial pneumonia, tb or malignancy ph 110 mg/dl indicate a chylous effusion values between 60-110 mg/dl are less certain and require lipoprotein electrophoresis for chylomicrons pleural fluid tg 50% of blood is a good evidence for hemothorax a bloody pleural

10、effusion (hct 1% or rbc 100,000/ul) suggest trauma, malignancy and pulmonary infarction differential cell count on an air-dried romanowskis stain filtration or automated concentration methods with papanicolaou stain for cytologic evaluation preparation of cell block is unnecessary except for effusio

11、ns in which malignancy is a consideration pleural fluid neutrophils: predaminate in pleural fluid with inflammation. over 10% of transudates also have a predominance of neutrophils but has no clinical significance lymphosytes: associated with transudate and no clinical significance * most are small

12、but medium, large and reactive variants may be seen * nuceloi and nuclear cleaving are more prominent in effusions than in prepheral blood * low grade nhl or cll may be difficult to distinguish from benign lymphocyte-rich serous effusions. in conjunction with cellular morphology, immunophenotyping b

13、y flowcytometry or immunocytochemistry is usually helpful serousal fluidspleural fluid eosinophils: an eosinophilic effusion is defined as having 10% eosinophils * the most common causes are related to the presence of air or blood in the pleural cavity * most are exudates * in about 35% of patients

14、the ethiology is unknown * though not of much assistance in diagnosing an effusion, eosinophilia does appear to independently associated with longer survivalserousal fluidspleural fluid mesothelial cells: are common in pleural fluid from inflammatory process. * rare in patients with tb pleurisy, emp

15、yema, ra and patients who have pleurodesis * fibrin deposition and fibrosis occurring in these conditions prevent exfoliation of mesothelial cells * carcinoma cells may form easily recognized tumor clusters or closely mimic mesothelial cells a panel of immunocytochemistry stains may be necessary for

16、 conformationserousal fluidspleural fluidserousal fluidspleural fluidserousal fluidspleural fluid up to 50 ml fluid normally present in peritoneal cavity peritoneal effusion is called ascites laboratory criteria for dividing ascitic fluid into transudate and exudate is not well defined as it is for

17、pleural fluid diagnostic peritoneal lavage (dpl) have limited use: 1. rapid screening for significant abdominal hemorrhage 2. evaluation of hollow viscus injuries peritoneal dialysis: submitted to check for infection peritoneal washing: performed intra operatively to document early intra abdominal s

18、pread of gynecologic and gastric ca.serousal fluidsperitoneal fluid total leukocyte useful in spontaneous bacterial peritonitis (sbp) approximately 90% of (sbp) have leukocyte count 500/ul and over 50% neutrophiles eosinophilia 10% most commonly associates with chronic peritoneal dialysis. also in c

19、hf, vasculitis, lymphoma and ruptured hydatid cyst overall sensitivity of cytology for malignant ascitis is 40-65% peritoneal carcinomatosis accounts for two thirds of malignant effusions immunocytochemical stains are useful in characterizing atypical cells serousal fluidsperitoneal fluid amylase ac

20、tivity in normal peritoneal fluid is similar to blood levels a fluid amylase level greater than three times of serum value is good evidence of pancreas-related ascitis and also in gi perforation increased peritoneal bun and cr + increased serum bun + normal serum cr (due to back diffusion of urea) s

21、uggests bladder rupture cea sensitivity 40-50% specificity 90% using cut off point of 3 ng/ml increase cea in peritoneal washing suggest a poor prognosis of gastric ca ca-125 extremely high in epithelial ca of ovary, follopian tube or endometrium serousal fluidsperitoneal fluidserousal fluidsperiton

22、eal fluidserousal fluidsperitoneal fluidserousal fluidsperitoneal fluid 10-15 ml fluid normally present in pericardial space causes of pericardial effusion: 1)infection 2)neoplasm 3)mi 4)hemorrhage 5)methabolic 6)ra hiv infected patients commonly have asymptomatic pericardial effusion in hiv associated cardiac temponade 45% are idiopathic, tb and bacterial infections each accounts for 20% of cases large effusions (350 ml) most often caus