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.

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