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1. Body fluid analysis
Course Code: MeLS 343
Credit Hour: 2
Marga G.( MSc, Medical Microbiologist,
LLB in Law, MA in Leadership and
Change management)

2. Introduction to Body Fluid Analysis
• Learning Objectives
1. Identify which laboratory section performs
various body fluid analyses.
2. Describe the composition of body fluids.
3. Describe the main function of body fluids.
4. Explain the process of fluid accumulation in body
cavities.
5. List the causes for abnormal appearance of body
fluids.
5/9/2024
: Marga G.( MSc, Medical Microbiologist,
LLB in Law, MA in Leadership and Change
management)
2

3. Introduction to Body Fluid Analysis
• The study of body fluids presents challenges
to the laboratory.
• Analysis involves multiple departments of the
laboratory and specialized knowledge of each
type of body fluid.
• Hematology is important in examining the
cells and crystals found,
• chemical analyses are required to assess
significant physiologic changes in the patient,
5/9/2024
: Marga G.( MSc, Medical Microbiologist,
LLB in Law, MA in Leadership and Change
management)
3

4. Cont’d…
• Microbiology can help detect infectious
agents in a nearby body cavity or
membrane
• immunological tests and other
miscellaneous tests can also provide the
physician with critical information.
• Further consultation with pathology may
be required for the identification of tumor
cells and other abnormal cells.
5/9/2024
: Marga G.( MSc, Medical Microbiologist,
LLB in Law, MA in Leadership and Change
management)
4

5. BODY FLUID COMPOSITION
• While body fluids vary in composition, they share some
elements in common.
• The critical roles of water and electrolytes are important
determinants of any fluid composition and movement in
the body.
• Water and electrolytes play crucial roles in many
metabolic processes.
• Water enters the system through consumption of either
water or food and also through cellular metabolic
processes.
5/9/2024
: Marga G.( MSc, Medical Microbiologist,
LLB in Law, MA in Leadership and Change
management)
5

6. Cont’d…
• Fluids of the body can be intracellular or extracellular
• with about 55% of the water being intracellular and about
45% being extracellular.
• Extracellular fluid can be further divided into interstitial
fluid, transcellular fluids in various body cavities, and
plasma.
• Fluids typically move around in body because of various
forces and body conditions.
• The electrolyte and enzyme composition of intracellular
fluid differs from extracellular fluids and knowledge of
these differences can aid in understanding disease
processes.
5/9/2024
: Marga G.( MSc, Medical Microbiologist,
LLB in Law, MA in Leadership and Change
management)
6

7. Cont’d…
• For example, potassium levels are higher inside the cell
than outside and sodium concentrations also vary
between the intracellular fluid and the extracellular fluid.
• Depending upon the local conditions of various adjacent
membranes and tissues, other fluid constituent
concentrations can be altered as well.
• Examining these biochemical differences, along with
examination of cellular elements, can assist in
diagnosing and monitoring the patient’s condition.
5/9/2024
: Marga G.( MSc, Medical Microbiologist,
LLB in Law, MA in Leadership and Change
management)
7

8. Important difference b/n ICF and ECF
8

9. TYPES OF BODY FLUIDS
• Body fluids are diverse, with variation in physical
appearance, properties, cell types, and cell counts.
• In general, studies of body fluids are most helpful to assess
inflammation, infection, malignancy, and hemorrhage.
• Body fluids can be divided into categories such as
– cerebrospinal fluid, various serous fluids from cavities
lined with serous membranes,
– synovial fluid,
– semen,
– vaginal secretions,
– respiratory secretions such as from Broncho alveolar
lavage,
– amniotic fluid, and even feces,
5/9/2024
: Marga G.( MSc, Medical Microbiologist,
LLB in Law, MA in Leadership and Change
management)
9

10. ACCUMULATION OF EXCESS
BODY FLUIDS
• Normally, only a small amount of fluid is present:
• 30 mL pleural fluid
• 50 mL pericardial fluid
• 100 mL ascites.
• A delicate equilibrium is maintained by the capillaries
and the lymphatic vessels.
• Any obstruction or altered pressure in these vessels can
affect the amount of fluid and its constituents
5/9/2024
: Marga G.( MSc, Medical Microbiologist,
LLB in Law, MA in Leadership and Change
management)
10

11. Cont’d…
• Several forces, within and outside of the capillaries, work
together to maintain fluid equilibrium.
• The tissue’s colloidal osmotic pressure (interstitial fluid
pressure),
• Along with the capillary’s hydrostatic pressure (filtration
pressure),
– regulates the outward flow of fluid from the capillary.
• The colloidal osmotic pressure of the capillary and the
tissue’s hydrostatic pressure
– regulate the inward flow of fluid into the capillary from
the tissue
5/9/2024
: Marga G.( MSc, Medical Microbiologist,
LLB in Law, MA in Leadership and Change
management)
11

12. cont’d…
• However, an imbalance in pressures causes excess
egress of fluid into tissue spaces and
• can lead to accumulation of fluid in the body cavity.
• This accumulation of fluid is called an effusion.
5/9/2024
: Marga G.( MSc, Medical Microbiologist,
LLB in Law, MA in Leadership and Change
management)
12

13. Functions of body fluids
• They are generally involved with the process of
– Transport oxygen and nutrients
– Excretion of waste products from the tissues
– Temperature regulation
– Lubrication
• Urine, Fluids in the body cavity, Joint fluid, Sweat, Semen etc…
13
5/9/2024
: Marga G.( MSc, Medical Microbiologist,
LLB in Law, MA in Leadership and Change
management)

14. BODY FLUID COLLECTION
• The procedure for collecting body fluid specimens involves a
minor surgical procedure that is usually named for the site of
collection.
• A pleural fluid collection is termed thoracentesis, while
cerebral spinal fluid (CSF) is obtained by a spinal tap.
5/9/2024
: Marga G.( MSc, Medical Microbiologist,
LLB in Law, MA in Leadership and Change
management)
14

15. BODY FLUID APPEARANCE
• The normal color and turbidity of body fluids is dependent on
the body cavity from which they are obtained.
• Cerebrospinal fluid and synovial fluid are normally colorless
and clear, whereas serous fluids are usually slightly yellow and
clear.
• Abnormal color or turbidity may indicate a disease process’s
physiological changes in the body cavity from which the fluid is
obtained.
5/9/2024
: Marga G.( MSc, Medical Microbiologist,
LLB in Law, MA in Leadership and Change
management)
15

16. 5/9/2024
: Marga G.( MSc, Medical Microbiologist,
LLB in Law, MA in Leadership and Change
management)
16

17. Body Fluid Analysis
1- Cerebrospinal fluid analysis
• Cerebrospinal fluid ( CSF) is a clear color less liquid formed
within the cavities or ventricles of the brain.
• About 500ml are formed per day.
Function of CSF
• Physical support and protection.
• Regulate intracranial pressure.
• Transport nutrients and waste products.
• Provision of a controlled chemical states.
5/9/2024
: Marga G.( MSc, Medical Microbiologist,
LLB in Law, MA in Leadership and Change
management)
17

18. Clinical interpretation
1) Abnormal color
a) Blood CSF: -
 if the blood evenly mixed in all three tubes can be subarachnoid
or cerebral bleeding.
 If the blood is present only in the first test tube and decrease in
the 2nd and 3rd test tube may be artificial during LP trauma.
b) Turbid CSF:
 usually indicate
– Increased WBCs, RBCS, microorganism such as bacteria or yeast, Ab-Ag
complex increase turbidity of CSF.
– If it is purulent- make immediately smear for gram’s staining.
5/9/2024
: Marga G.( MSc, Medical Microbiologist,
LLB in Law, MA in Leadership and Change
management)
18

19. C) Xanthochromia:- pale to dark yellow color
– Mostly occur in chronic bleeding.
– In jaundice ( bilirubin)
• Conjugated in adults and un conjugated in infants.
d) protein level (> 150mg/dl):
 clot formed in CSF with high level of proteins (fibrinogen).
5/9/2024
: Marga G.( MSc, Medical Microbiologist,
LLB in Law, MA in Leadership and Change
management)
19

20. Collection of CSF
• CSF is usually obtained by lumbar puncture ( LP) for analysis , at the
site of L4 - L5 or L3 – L4
• Indications of LP are:-
– To examine the CSF
– To determine the intracranial pressure
– To introduce – Anesthetics
- Drugs
- Radiographic contrast media
• Adult total volume 140-170 ml.
• Neonate total volume 10-60 ml.
5/9/2024
: Marga G.( MSc, Medical Microbiologist,
LLB in Law, MA in Leadership and Change
management)
20

21. Laboratory investigation of CSF
a) Macroscopic examination of CSF
b) Microscopic examination of CSF such as cell count and
differential
c) Biochemical analysis
d) Serological and Bacteriological tests
e) Tumor markers studies
• Specimens of CSF collected by LP is usually a liquated in to 3
test tubes
– 1st- for biochemical and serological examination
– 2nd- for bacteriology and fungal study
– 3rd- for microscopic examination (hematology test).
5/9/2024
: Marga G.( MSc, Medical Microbiologist,
LLB in Law, MA in Leadership and Change
management)
21

22. • The color change in macroscopic examination in each test tube
can give either artificial bleeding during LP or pathological
bleeding or chronic bleeding.
i) Macroscopic Examination of CSF
• Visual examination done to observe
– General appearance
– Consistency
– Tendency to clot
• Normal CSF is : clear, free of clot, color less, free of blood
cells.
• There is no turbidity, a newspaper can be read through the tube.
5/9/2024
: Marga G.( MSc, Medical Microbiologist,
LLB in Law, MA in Leadership and Change
management)
22

23. ii) Microscopic examination of cells
1) Total cell count and differential cell count of CSF
• Normal CSF is free of cells.
• When the cells are counted they are identified by cell type.
• Increased cell count in CSF may indicate inflammatory
disease, hemorrhage, neoplasm’s and trauma.
5/9/2024
: Marga G.( MSc, Medical Microbiologist,
LLB in Law, MA in Leadership and Change
management)
23

24. Clinical Interpretation
• Pleocytosis is an increases in the number of WBC in CSF.
– > 50WBCs mostly occur in purulent infection & dominant cells
are granulocytes.
– Between 300-500 WBC with increased mononuclear cells (
lymphocytes) are indicative of viral infection, syphilis of CNS
and TB.
– WBC’s count with 40% or more of monocytes indicates
subarachnoid hemorrhoid.
– Other cells which can be formed in CSF
– Malignant cells, Leukemic cells, Plasma cells
5/9/2024
: Marga G.( MSc, Medical Microbiologist,
LLB in Law, MA in Leadership and Change
management)
24

25. iii) Biochemical analysis of CSF
• The tests of interests are:
– Chloride - lactate
– Glucose - LDH
– Protein - Glutamine
• Most frequently performed biochemical tests are glucose and
protein analysis.
• Both have great diagnostic values.
a) Measurement of glucose in CSF
• Normally CSF glucose level is about 60% to 70% of blood
glucoses.
Reference value
– Adult= 40- 70mg/dl
– Child= 60-80mg/dl
5/9/2024
: Marga G.( MSc, Medical Microbiologist,
LLB in Law, MA in Leadership and Change
management)
25

26. Decreased CSF- glucose- can a result of
1. Disorder in carrier mediated glucose transport into CSF.
2. Active metabolism of glucose by cells or microorganisms.
• Normal in viral and aseptic meningitis.
• Increased level are associated with DM
b) Examination of CSF total and specific protein
• The total protein concentration in CSF is about 5% or 1/20 that
of plasma.
• Clinical significance of CSF protein analysis is used mainly
– To detect increased permeability of the blood brain barrier to plasma
protein.
– To detect increased production of immunoglobilins or tissue
degeneration in CNS.
5/9/2024
: Marga G.( MSc, Medical Microbiologist,
LLB in Law, MA in Leadership and Change
management)
26

27. iv) Bacteriological and serological tests
1) Bacteriological ( fungal ) examination of CSF;
– Gram stain
– AFB stain
– Culture and drug sensitivity
– Indian ink preparation.
2) Serological test of CSF
– VDRL ( RPR) test for syphilis
– Latex cryptococcal Ag test or lateral flow assay.
5/9/2024
: Marga G.( MSc, Medical Microbiologist,
LLB in Law, MA in Leadership and Change
management)
27