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Examining Pleural Fluid.pptx

Examination of Pleural Fluid

1 of 18
PLEURAL FLUID
COLLECTION, TRANSPORT, AND EXAMINATION
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OUTLINE
 Introduction
 Clinical Significance
 Collection
 Transport
 Macroscopic/Gross Examination
 Microscopic Examination
INTRODUCTION
Pleural Cavity:
 A potential space between chest wall and lungs
 There are 2 pleural cavities i.e., one around each lung.
Pleural Fluid:
 Fluid (<10 mL) present in each pleural cavity
 15-20 mL PF is produced daily.
 Ultrafiltrate of plasma
 Lubricates visceral & parietal pleurae
CLINICAL SIGNIFICANCE
Pleural fluid is examined to check for the presence of pleural effusion.
PLEURAL EFFUSION:
 The abnormal accumulation of excess fluid in pleural cavity
 The accumulated fluid may be either transudate or exudate.
1. Transudate: Protein content < 25 g/L
2. Exudate: Protein content > 35 g/L
COLLECTION (THORACENTESIS)
 Pleural fluid is collected by inserting a needle in the chest wall by a procedure called
thoracentesis.
 Thoracentesis may be diagnostic or therapeutic.
 Collect pleural fluid in a labeled clean plastic container or red top tube with no preservatives.
Diagnostic Thoracentesis Therapeutic Thoracentesis
It involves collecting sample for cytologic,
biologic, or chemical analysis.
It involves removing large fluid collection and
improve respiratory function.
Syringe needle is used for collection. Drain is used for collection.
COLLECTION
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Examining Pleural Fluid.pptx

  • 1. PLEURAL FLUID COLLECTION, TRANSPORT, AND EXAMINATION 540129 540131 540136 540149 540151 540157
  • 2. OUTLINE  Introduction  Clinical Significance  Collection  Transport  Macroscopic/Gross Examination  Microscopic Examination
  • 3. INTRODUCTION Pleural Cavity:  A potential space between chest wall and lungs  There are 2 pleural cavities i.e., one around each lung. Pleural Fluid:  Fluid (<10 mL) present in each pleural cavity  15-20 mL PF is produced daily.  Ultrafiltrate of plasma  Lubricates visceral & parietal pleurae
  • 4. CLINICAL SIGNIFICANCE Pleural fluid is examined to check for the presence of pleural effusion. PLEURAL EFFUSION:  The abnormal accumulation of excess fluid in pleural cavity  The accumulated fluid may be either transudate or exudate. 1. Transudate: Protein content < 25 g/L 2. Exudate: Protein content > 35 g/L
  • 5. COLLECTION (THORACENTESIS)  Pleural fluid is collected by inserting a needle in the chest wall by a procedure called thoracentesis.  Thoracentesis may be diagnostic or therapeutic.  Collect pleural fluid in a labeled clean plastic container or red top tube with no preservatives. Diagnostic Thoracentesis Therapeutic Thoracentesis It involves collecting sample for cytologic, biologic, or chemical analysis. It involves removing large fluid collection and improve respiratory function. Syringe needle is used for collection. Drain is used for collection.
  • 8. TRANSPORT  After obtaining the sample, refrigerate it at 4ºC until processing & subsequent storage (up to 48h).  The time b/w extracting & freezing the PF should be ≤ 2 hours.  The perfectly labeled sample and the request are transported to the laboratory together with the informed consent.  Delays in the delivery or analysis may significantly increase the pH.
  • 9. MACROSCOPIC (GROSS/PHYSICAL) EXAMINATION TRANSUDATE EXUDATE APPEARANCE • Clear, • Pale Yellow, • Straw-colored, • Thick, or • Bloody • Does not clot on standing Opaque or turbid: • Tuberculosis • Pancreatitis Purulent: • Bacterial Pneumonia Milky: • Chylous Effusion • Often clots on standing (due to high fibrinogen content) SPECIFIC GRAVITY < 1.0 >1.0 • Pneumonia • Cancer • Pancreatitis
  • 10. MICROSCOPIC EXAMINATION Microscopic examination of pleural fluid includes: 1. Chemical Examination (Concentration) 2. Microbial Examination
  • 11. MICROSCOPIC EXAMINATION 1. CHEMICAL EXAMINATION: Chemical analysis involves the examination of following factors:  pH  LDH  Glucose  Proteins  Lipids  Cells Counts (RBC’s, WBC’s, & Neutrophils)
  • 12. Chemical Component Concentration pH Normal: 7.64 Low: 6.0-6.3 • Esophageal rupture • Rheumatoid pleurisy • Malignancy High: • Empyema Glucose Normal: 70-100mg/dL Low: • Empyema • TB Pleurisy • Rheumatoid pleurisy • Malignant effusion High: • Esophageal perforation RBC’s (Bloody effusion) (>100,000/mL) • Pulmonary infarction • Malignancy • Traumatic Tap Component Transudate Exudate LDH (PF/Serum Ratio) < 0.6 > 0.6 Lipids (gm/dL) 50-110 >110 • Chylous effusion Proteins (gm/dL) < 2.5 • Dural leak • Urinothorax • Entrapped lung > 3.0 • Heart failure • Cancer • Pneumonia WBC’s (/µL) < 1000 • Heart failure • Cancer • Plneumonia > 10,000 • Tuberulosis • Parapneumoni c effusion Neutrophils < 50% • Heart failure • Systematic Sepsis ≥ 50% • Pulmonary Infarction • Parapneumoni c effusion
  • 13. MICROSCOPIC EXAMINATION 2. MICROBIAL EXAMINATION: Analysis of pleural fluid involves examination of following microorganisms:  Fungi  Bacteria (Gram +ve, Gram –ve, or AFB’s) Fungi Diseases/Infections Aspergillus fumigatus • Tuberculosis • Empyema Coccidioides immitis • Pleuritic chest pain
  • 14. MICROSCOPIC EXAMINATION  Bacteria: Bacteria are examined by: 1. Gram Staining 2. Acid-Fast Staining
  • 17. MICROSCOPIC EXAMINATION Gram +ve Bacteria S. pneumoniae S. aureus Gram –ve Bacteria Pseudomonas aeruginosa Acinetobacter spp. Klebsiella spp. Pleural effusion is caused by following bacteria: Acid-Fast Bacteria Non-tuberculous mycobacterium (NTM) Mycobacterium tuberculosis (MTC)