important

1. BODY FLUID EXAMINATION
Dr Tanmoy Ganguly

2. Types of Body Fluid
• CSF
• Sputum
• Pleural fluid
• Pericardial fluid
• Peritoneal/Ascitic fluid
• Urine
• Synovial Fluid

3. Examination Steps
• Physical examination
• Chemical examination
• Cytological examination (Cell counts, Cell types, Malignant cells)
• Microbiological examination
• Other tests

4. Physical Examination
1. Volume
2. Appearance

5. Appearance
• Transudate
• Exudate

6. Transudate
• Clear
• Pale yellow
• Straw
• Do not clot on standing
• Seen in
• Congestive cardiac failure
• Cirrhosis of liver
• Pulmonary embolism (pleural fluid)
• Budd-Chiari syndrome (ascitic fluid)

7. Exudate
• Opaque/Turbid (Increased protein, leukocytes)
• Bloody (Traumatic tap, Malignancy, Embolism)
• Milky/Chylous (Lymphatic obstruction, high TG)
• Often clot on standing (due to high fibrinogen content)
• Seen in
• Bacterial/Parasitic Infections
• TB
• Malignancy
• Trauma

8. CSF
• Usually- Clear and colorless like water
• Abnormally
Turbid- Bacteria, Fungi, TB (Increased leukocytes, RBCs)
Blood-mixed- Trauma, SAH
Yellowish/Xanthochromia- SAH, Jaundice
• Others
• Pink- Red cell lysis and Hb breakdown
• Brownish- Meningeal metastatic melanoma
• Orange- High carotene ingestion
• Cobweb formation- TB

9. Sputum
• Whitish
• Bloody- TB, Abscess, Bronchiectasis, CA
• Green- Pseudomonas
• Purulent- Bronchiectasis, Abscess
• Pink, frothy- Pulmonary edema

10. Chemical Examination
• Pleural fluid (Light’s criteria)
Protein
LDH
• Peritoneal fluid
Albumin (SAAG)
LDH
Amylase
Bilirubin
• CSF
Protein
Glucose

11. Cytological Examination
• Cell count
• Cell type
• Malignant cells

12. Microbiological Examination
• Gram Stain
• ZN stain
• India Ink preparation (CSF)
• Culture
• PCR

13. Other Tests
• CSF protein electrophoresis
• Measurement of albumin and IgG in CSF(MS)
• D-dimer (Pleural fluid- pulmonary embolism)
• Rheumatoid factor (Rheumatoid effusion)
• ANA (Lupus pleuritis)
• CEA (Malignancy)

14. Thank You