The document provides a detailed overview of pleural fluid, its function, collection, and examination methods. It highlights the formation, composition, and the various conditions leading to pleural fluid accumulation, including infections and neoplasms. Additionally, it outlines the procedures for fluid collection and the subsequent physical, chemical, and microscopic examinations to analyze pleural fluid samples.

1. Ms Ankita R Bhatiya
Assistant Professor
Shree P.M.Patel COLLEGE OF
PARAMEDICAL SCIENCE N
TECHNOLOGY

2.  It include:
 1.What is Pleural fluid?
 2.Function of Pleural fluid.
 3.Collection of Pleural fluid.
 4. Examination of Pleural fluid.

3.  Introduction:
 It is fluid which is present in the pleural cavity of
lungs b/w parietal pleura n visceral pleura.
 The pleural cavity is a potential space lined by
mesothelium of the visceral n parietal pleura.
 Pleural fluid Formation:
 Pleural fluid is a selective ultrafiltrate of plasma.
 Small amount of the Pleural fluid is also formed
from the cells lining the pleura and other by capillaries.
 There is about 60-70 ml of pleural fluid at any one time
and about 125 ml is generated every day.

4.  Composition of Pleural fluid:
o Volume: 60-70 ml
o Cell/mm3: 1000-3000
Mesothelial cell :60%
Monocyte:30 %
Lymphocyte: 5%
Neutrophil: 5%
o Protein: up to 3 gm/dl
o Glucose: Same as plasma
o LDH:70-140 U/L

5.  Function of Pleural fluid:
 Protection: It helps to protect the lungs from the
sudden injury n damaged.
 Also acts as a medium for the transfer of
substances from the lung tissue to blood .
 Nutrition :
 Removal of waste :
 Lubrication :

6.  Collection of Pleural fluid:
 Throracentesis is a process by
which pleural fluid is collected.
 A needle is placed through the
skin and muscles of the chest wall into
the pleural space.

7.  Indication of Pleural fluid:
1.Infections: Tuberculosis, Pneumonia (Bacterial,viral,fungal)
2. Neoplasm: Bronchogenic carcinoma, Metastatic carcinoma,
Lymphoma, Mesothelioma
3. Pulmonary infract
4.Non infections non inflammatory disease:
Rheumatoid disease
Systemic lupus erythreomatous
5. Extra pleural sources:
Pancreatitis
Ruptured esophagus
Urinithrorax

8.  Procedure:
1.Take consent of a patient.
2.Position of patient: The patient is sitting in an upright
position with arms & head extended to over bed table.
3.Proper aseptic precautions are taken
with the help of spirit –iodine-spirit.
4.Before puncture give injection of atrophin
intramuscularly to prevent vasovagal shock.
5.Give xylocane injection as local anesthesia before puncture.

9. 6.Then insert the needle b/w intercostal space & allow the fluid to flow
in container.
7. Pleural fluid is collected in 3 tubes:
1. EDTA Bulb: Cell count n differential count.
2. Flouride Bulb: For glucose examination.
3. Plain Bulb: Chemical n immunology study

10.  Examination of Pleural fluid:
1. Physical examination:
2. Chemical examination:
3. Microscopic examination:

11.  Physical examination of Pleural fluid:
1.Volume:
 Normally: 60 to 70 ml
 Transudates– 100 to 150 ml
Condition: Increase hydrostatic pressure
Decrease plasma oncotic pressure
Congestive heart failure
Hepatic cirrhosis
Hypoproteinemia
 Exudates– More than 150 ml
Condition: Pneumonia( Bacterial, Viral,Fungal)
Tuberculosis
Bronchogenic carcinoma, Metastatic carcinoma,
Lymphoma, Mesothelioma
Pulmonary infract
Rheumatoid disease
Systemic lupus erythreomatous
Pancreatitis, Ruptured esophagus,Urinithrorax

12. 2. color:
 Normally: colorless
 Transudates: Pale yellow or straw clr
 Exudates:
Reddish: Presence of blood (Bacterial
pneumonia, Cancer, Pancreatitis.)
Green; Pseudochlyous effusion.

13. 3.Appreance:
 Normally: Clear or transparent
 Transudate: Clear or transparent
 Exudate:
Turbid: Bacterial n viral Pneumonia,
Tuberculosis, Pancreatitis
Cloudy: Bacterial n fungal pneumonia
Purulent: Bacterial Pneumonia
Milky :Chylous effusion

14. 4. Clot:
 Normally: absent
 Transudate: absent
 Exudate: Present
Tuberculous Peunomia
5,Specific gravity:
 Transudate: below 1.010
 Exudate: above 1.010
Pneumonia( Bacterial, Viral, Fungal)
Cancer
Pancreatitis
Rheumatoid pleuritis

15.  Chemical examination of Pleural fluid:
1.Glucose:
 Normal range: same as blood glucose
 Transudate: same as blood glucose
 Exudate: slightly reduce
 Method:
1.Visualised method
Benedict test
2.Colorimetric method
GOD-POD
 Condition for decrease glucose:
Bacterial pneumonia
Viral pneumonia
Fungal pneumonia
Pancreatitis
Tuberculosis
Rheumatoid pleuritis
Esophagaus rupture
Cancer

16. 2. Protein:
 Normal range: 6-8gm/dl
 Transudate: below 3 gm/dl
 Exudate: Above 3 gm/dl
 Method:
1.Turbidometric method method
SSA
Heat n acetic acid
2.Colorimetric method
Biuret
 Condition for Increase protein:
Pneumonia(Bacterial, fungal,viral)
Tuberculosis

17. 3. Lactate:
 Normal range: 140-280U/L
 Transudate: NORMAL
 Exudate: Above 280U/L
 Method:
1.Colorimetric method
2. U.V.Kinetic method
 Condition for Increase protein:
Pleuritis(Bacterial, fungal,viral)
Tuberculosis
Melingancy

18. 4. Amylase:
 Normal range: 30-110 U/L
 Transudate: Normal
 Exudate: Above 110U/L
 Method:
1.Colorimetric method
2. U.V.Kinetic method
 Condition for Increase protein:
Pancreatitis
Melingancy
Esophageal rupture

19. 5. Lipid: (Tg)
 Normal range: 50-110 mg/dl
 Transudate: Normal
 Exudate: Above 110U/L
 Method:
1.Colorimetric method
 Condition for Increase protein:
Chylous effusion

20. 6.Tumor marker:
 CEA: Carcino embryogenic antigen
 Transudate: Absent
 Exudate: Positive
 Condition for present tumor marker:
Lung carcinoma
Brest carcinoma

21.  Microscopic examination of pleural fluid:
1.TLC (Total leukocyte count):
 Normally: 0-50 cell/cumm
 Transudate: 0-50 cell/cumm
 Exudate: 50-500 cell
 Method: Same as Blood
 Condition in increase TLC count:
Bacterial Pneumonia
Viral Pneumonia
Fungal Pneumonia
Parasitic Infection
Pancreatitis
Tuberculosis
Malignancy
SLE
Congestive heart failure
Hypersensitivity reaction

22. 2. DC:
 Method: Same as Blood
 Neutrophilia:
Bacterial Peumonia
Pulmonary infraction
Tuberculous Peumonia
Pancreatitis
Metastatic Tumor
 Lymphocytosis:
Viral Peumonia
Tuberculosis
Malignancy
Rheumatoid pleuritis
SLE
Leukemia
 Eosinophilia:
Parasitic Infection
Air in pleural space
Leukemia
Hypersensitivity reaction
Congestive heart failure

23. 3.Gram’s Stain:
 Normally: Bacteria absent
 Transudate: Bacteria absent
 Exudates: Bacteria present
 Clinical Condition: Bacterial Pneumonia,pancreatitis
 Bacteria: Diplococci
Streptococcus
Pseudomonas
Neisseria
Homophiles influenza
4.AFB Stain:
 Normally: Bacteria absent
 Transudate: Bacteria present
 Exudates: Bacteria present
 Clinical Condition: Tuberculous Peumonia
 Bacteria: Mycobacterium Tuberculosis