Analysis of Different Fluid Inside our body Their Chemical, Macroscopic and Microscopic Examimation Exudative and Transudative Pleural Fluid Pathophysiology

1. Fluid Routine Examination
Prepared By:
Zeeshan Siddique

2. Pleural Fluid Introduction:
▪ Pleurl Fluid analysis is test that examines a sample of fluid that has
collected in Pleural space.
▪ This is the space between the lining of the outside of lungs and wall of
the chest.
▪ Normal Pleural Fluid consists of small amount of thin (Serous) fluid
that functions as a lubricant during breathing.
▪ When fluid collects in pleural space, the condition is called pleural
effusion.

3. ▪ Pleural fluid keeps the pleura moist and reduce friction between the
membranes when you breathe.
▪ The area which contains pleural fluid is known as pleural space.
▪ Normally there is small amount of pleural fluid in pleural space.

5. Pleural Fluid Analysis
▪ A procedure called thoracentesis is used to get a sample of pleural fluid. The
health care provider examines the sample to look for:
 Cancerous (malignant) cells
 Other types of cells (for example blood cells)
 Levels of glucose, protein and other chemicals
 Bacteria, fungi, viruses, and other germs that can cause infections
 Inflammation

6. Thoracentesis
▪ Thoracentesis is a procedure to remove fluid from the space between the
lining of the outside of the lungs (pleura) and the wall of the chest.
The test is done in the following way:
▪ You sit on a bed or on the edge of a chair or bed. Your head and arms rest on
a table.
▪ The skin around the procedure site is cleaned. A local numbing medicine
(anesthetic) is injected into the skin.
▪ A needle is placed through the skin and muscles of the chest wall into the
space around the lungs, called the pleural space. The health care provider
may use ultrasound to find the best spot to insert the needle.

7. Continued
▪ You may be asked to hold your breath or breathe out during the
procedure.
▪ You should not cough, breathe deeply, or move during the test to
avoid injury to the lung.
▪ Fluid is drawn out with the needle.
▪ The needle is removed and the area is bandaged.
▪ Then fluid analysis performed in laboratory.

8. Transudative pleural effusion
▪ An imbalance between the pressure within blood vessels (which drives fluid out of the
blood vessel) and the amount of protein in blood (which keeps fluid in the blood vessel)
can result in accumulation of fluid (called a transudate).
▪ Conditions associated with transudative pleural effusions include:
– Congestive heart failure
– Liver cirrhosis
– Severe hypoalbuminemia
– Nephrotic syndrome
– End-stage kidney disease

9. Exudate
▪ Injury or inflammation of the pleurae may cause
abnormal collection of fluid (called an exudate).
▪ When a pleural effusion has been determined to be
exudative, additional evaluation is needed to determine
its cause, and amylase, glucose, pH and cell counts
should be measured.

10. ▪ Conditions associated with exudative pleural effusions:[2]
– Parapneumonic effusion due to pneumonia
– Malignancy (either lung cancer or metastases to the pleura from
elsewhere)
– Infection (empyema due to bacterial pneumonia)
– Trauma
– Pulmonary infarction
– Pulmonary embolism

12. Purpose and Lab Examinations:
▪ Test results can help distinguish between types of pleural fluid and
help diagnose the cause of your fluid accumulation.
Fluid
Appereance
Protein,Album
in or LD Level
Cell Count Type of Fluid Cause
Clear Low Few Cells Transudate CHF or
Cirrhosis
Cloudy High Increased Exudate Several causes
additional
testing required

13. Macroscopic Examination:
▪ Pleural fluid is usually light yellow and clear. Abnormal results may
give clues to the conditions or diseases present.
▪ Reddish -pleural fluid may indicate the presence of blood.
▪ Cloudy, thick pleural fluid may indicate an infection and/or the
presence of white blood cells.

14. Chemical Examination:
▪ Total cell counts—increased WBCs may be seen with infections and
other causes of pleuritis. Increased RBCs may suggest trauma,
malignancy, or pulmonary infarction.
▪ WBC differential—identifies different types of WBCs present; an
increased number of neutrophils may be seen with bacterial infections.
An increased number of lymphocytes may be seen with cancers and
tuberculosis.

16. Synovial Fluid
▪ Synovial fluid, also called synovia, is a viscous, non-Newtonian fluid found in
the cavities of synovial joints.
▪ With its egg white–like consistency, the principal role of synovial fluid is to
reduce friction between the articular cartilage of synovial joints during
movement.
▪ Synovial fluid is a small component of the transcellular fluid component of
extracellular fluid.

17. ▪ The inner membrane of synovial joints is called the synovial
membrane and secretes synovial fluid into the joint cavity.
▪ Two cell types (type A and type B) are present: Type A is derived from
blood monocytes, and it removes the wear-and-tear debris from the
synovial fluid.
▪ Type B produces hyaluronan. Synovial fluid is made of hyaluronic
acid and lubricin, proteinases, and collagenases.

20. Synovial Fluid Laboatory Analysis:
▪ ThreeTubes are used for Sample collection od Synovial fluid;
Synovial Fluid
Tube 1
Chemistry and
Immunology
Tube 2
Microbiology
Tube 3
Cytology and
haematology

21. Macroscopic Examination:
▪ Volume;
▪ Normal upto <3.5 ml of fluid
▪ Can reach upto 25 ml in inflammatory conditions.
▪ Appereance;
▪ Colorless to pale yellow and clear – Normal
▪ Red, brown or xanthochromic-hemorrhage in joint
▪ Yellow and cloudy-Inflammation

22. Microscopic Examination:
▪ Total Leukocyte count – <200 cells
▪ Differential Leukocyte Count (DLC);
▪ Incubate with hyaluronidase.
▪ Neutrophils- <25% of differential
▪ Lymphocytes- <15 %
▪ Note:
▪ Incase of Increase Neutrophils-Septic condition

23. ▪ Gram Staining:
▪ The SF Gram stain is used for septic arthritis.
▪ Culture and susceptility testing is ordered to determine what type of
microorganism are present, susceptibility testing against certain
antibiotics can be performed to guide antibiotic therapy.

24. Chemical Examination:
▪ Glucose:
▪ Compare to serum glucose level.
▪ <10 mg/dl lower than blood glucose
▪ Decreased- Joint disorder
▪ Uric Acid:
▪ Normal – 6 to 8 mg/dl
▪ Increased- gout

25. Lactate Dehydrogenase:
▪ Elevated in synovial fluid
▪ Normal in serum level
▪ Increase LDH indicates RA.

26. Synovial Fluid Analysis
▪ A synovial fluid analysis is a group of tests that checks
for disorders that affect the joints. The tests usually include the
following:
An exam of physical qualities of the fluid, such as its color and
thickness
Chemical tests to check for changes in the fluid's chemicals
Microscopic analysis to look for crystals, bacteria, and other
substances

27. Synovial Fluid Analysis Used For
▪ A synovial fluid analysis is used to help diagnose the cause of
joint pain and inflammation. It can cause pain, swelling, redness,
and loss of function in the affected area. Causes of joint problems
include:ed
▪ Osteoarthritis the most common form of arthritis. It is a chronic,
progressive disease that causes joint cartilage to break down. It can
be painful and lead to loss of mobility and function.
▪ Gout type of arthritis that causes inflammation in one or more
joints, usually in the big toe

28. ▪ Rhemotoid Arhtritis, a condition in which the body's Immune
system attacks healthy cells in your joints
▪ Joint effusion, a condition that happens when too much fluid builds up
around a joint. It often affects the knee. When it affects the knee, it
may be referred to as knee effusion or fluid on the knee.
▪ Infection in a joint

29. Gastric Fluid
▪ Gastric fluid analysis, medical procedure used to examine the
secretions and other liquid substances occurring in the stomach. By
means of a tube passed through the nose and into the stomach, gastric
fluid can be obtained from the stomach.
▪ The most common reason for this test is to look for blood in the upper
gastrointestinal tract.

30. Complications:
▪ vomiting, nausea, abdominal distention, and/or pain can be possible. Sore
throat also is likely to occur.
▪ Bleeding.
▪ Dysrhythmia.
▪ Laryngospasm.
▪ Esophageal perforation.
▪ Decreased mean p0₂ (a measure of blood oxygen levels).