Lecture 05 - Body Fluids 2008
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Transcript of Lecture 05 - Body Fluids 2008
Cerebrospinal Cerebrospinal FluidFluid
CSFCSF
Third major fluid in the bodyThird major fluid in the body
Functions:Functions:
1.1. Supply nutrients to the CNSSupply nutrients to the CNS
2.2. Remove metabolic wastesRemove metabolic wastes
3.3. Produce a mechanical barrier to Produce a mechanical barrier to cushion brain and spinal cord cushion brain and spinal cord against traumaagainst trauma
Volume:Volume: 20 ml/hr in the choroid plexuses and 20 ml/hr in the choroid plexuses and
reabsorbed by the arachnoid villireabsorbed by the arachnoid villi 140-170 ml in adults140-170 ml in adults 10-60 ml in neonates10-60 ml in neonates
Collection:Collection: Lumbar puncture between 3Lumbar puncture between 3rdrd and 4 and 4th th
or 4 or 4thth and 5 and 5thth lumbar vertebrae lumbar vertebrae Note intracranial pressure and Note intracranial pressure and
prevent introduction of infection and prevent introduction of infection and damage to neural tissues damage to neural tissues
Collected in 3 containers:Collected in 3 containers:
1.1. Chemical and serologic tests Chemical and serologic tests
2.2. MicrobiologicalMicrobiological
3.3. Cell countCell count
4.4. Additional testsAdditional tests
Characteristics:Characteristics:1.1. AppearanceAppearance
- crystal clear, hemolyzed/bloody- crystal clear, hemolyzed/bloody- cloudy – presence of WBC- cloudy – presence of WBC- xanthocromic - pink, orange and yellow- xanthocromic - pink, orange and yellow
- presence of RBC degradation - presence of RBC degradation products, products,
elevated bilirubin, carotene, increased elevated bilirubin, carotene, increased protein protein
concentrations, melanin pigmentsconcentrations, melanin pigments- bloody - indication of intracranial - bloody - indication of intracranial hemorrhage or hemorrhage or
traumatic taptraumatic tap
HemorrhageHemorrhage Traumatic tapTraumatic tap
1.1. Blood evenly Blood evenly distributed in all distributed in all 3 CSF specimen 3 CSF specimen tubestubes
2.2. No clot No clot
3.3. Xanthocromic Xanthocromic supernatantsupernatant
1.1. Heaviest Heaviest concentration of concentration of blood in tube 1blood in tube 1
2.2. Clot formation due Clot formation due to introduction of to introduction of plasma fibrinogen plasma fibrinogen into the CSFinto the CSF
3.3. Clear supernatantClear supernatant
2.2. Cell Count:Cell Count:
- adult - 0-5 WBC/ml - adult - 0-5 WBC/ml
(lymphocytes:monocytes 70:30)(lymphocytes:monocytes 70:30)
- neonates - 0-30 WBC/ml - neonates - 0-30 WBC/ml
(more monocytes)(more monocytes)
- specimens with 200 WBC/ml or 400 - specimens with 200 WBC/ml or 400
RBC/ml → clearRBC/ml → clear
3.3. Protein: 15-45 mg/dl, mostly albuminProtein: 15-45 mg/dl, mostly albumin4.4. Glucose: 60-70% of plasma glucose drawn 2 hrs prior to Glucose: 60-70% of plasma glucose drawn 2 hrs prior to
LPLP5.5. Lactate: Lactate:
- 25 mg/dl- 25 mg/dl- elevations can result from any condition that - elevations can result from any condition that
decreases decreases
the flow of Othe flow of O2 2 to the tissuesto the tissues- used to monitor severe head injuries- used to monitor severe head injuries
6.6. Glutamine Glutamine - 8 to 18 mg/dl- 8 to 18 mg/dl- 35 mg/dl : show disturbance in consciousness → - 35 mg/dl : show disturbance in consciousness →
comacoma- ↑ ammonia in CSF ↓ - ↑ ammonia in CSF ↓ αα ketoglutarate ketoglutarate
8.8. Enzymes:Enzymes:A. Lactate dehydrogenase (LD)A. Lactate dehydrogenase (LD)
LD1 LD2LD1 LD2 brain tissuebrain tissueLD2 LD3LD2 LD3 lymphocyteslymphocytesLD4 LD5LD4 LD5 neutrophilsneutrophils
B. Creatine kinase isoenzymes CKBBB. Creatine kinase isoenzymes CKBB < 17 mg/ml< 17 mg/ml predict predict
recovery after recovery after cardiac arrestcardiac arrest
> 17 mg/ml> 17 mg/ml poor prognosispoor prognosis
Differential Diagnosis of Differential Diagnosis of MeningitisMeningitis
BacterialBacterial ViralViral TBTB FungalFungal
↑ ↑ WBC, WBC, neutrophilsneutrophils
↑ ↑ WBC, WBC, lymphocytelymphocytess
↑ ↑ WBC, WBC, lymphocytelymphocytes and s and monocytesmonocytes
↑ ↑ WBC, WBC, lymphocytelymphocytes and s and monocytesmonocytes
↑ ↑ CHONCHON ↑ ↑ CHONCHON ↑ ↑ CHONCHON ↑ ↑ CHONCHON
↓ ↓ CHOCHO Normal Normal CHOCHO
↓ ↓ CHOCHO Normal - ↓ Normal - ↓ CHOCHO
↑ ↑ LactateLactate Normal Normal LactateLactate
↑ ↑ LactateLactate ↑ ↑ LactateLactate
↑ ↑ LD4 & LD4 & LD5LD5
↑ ↑ LD2 & LD2 & LD3LD3
↑ ↑ LD2 & LD2 & LD3LD3
↑ ↑ LD2 & LD2 & LD3LD3
Seminal Fluid Seminal Fluid AnalysisAnalysis
Seminal Fluid AnalysisSeminal Fluid Analysis
1.1. Evaluation of fertility casesEvaluation of fertility cases
2.2. Post vasectomy casesPost vasectomy cases
Composition:Composition: Spermatozoa produced in the testis Spermatozoa produced in the testis
and mature in the epididymisand mature in the epididymis Seminal vesicles form viscous liquid Seminal vesicles form viscous liquid
that furnishes fructose and other that furnishes fructose and other nutrients to maintain the spermatozoanutrients to maintain the spermatozoa
Prostate produce milky liquid Prostate produce milky liquid containing acid phosphatase and containing acid phosphatase and proteolytic enzymes that act on the proteolytic enzymes that act on the fluid from the seminal vesicles fluid from the seminal vesicles resulting in coagulation and resulting in coagulation and liquefaction of the semenliquefaction of the semen
Collection:Collection: Specimen should be collected in Specimen should be collected in
sterile containers following a 3 day sterile containers following a 3 day period of sexual abstinenceperiod of sexual abstinence
A fresh specimen is collected and A fresh specimen is collected and should liquefy within 30 minutes of should liquefy within 30 minutes of collectioncollection
Volume: 2-5 mlVolume: 2-5 ml
Viscosity: pours in dropletsViscosity: pours in droplets
pH: 7.3 – 8.3 (alkaline)pH: 7.3 – 8.3 (alkaline)
Sperm count: 20-160 million/mlSperm count: 20-160 million/ml
: 10-20 million/ml borderline: 10-20 million/ml borderline
Motility: 50-60% with fair quality within 3 Motility: 50-60% with fair quality within 3 hourshours
Morphology: oval head 3x5 um with long Morphology: oval head 3x5 um with long tapered tapered
tailtail
: < 30% abnormal forms: < 30% abnormal forms
Synovial FluidSynovial Fluid
Synovial FluidSynovial Fluid
Joint fluidJoint fluid Viscous fluid found in joint cavitiesViscous fluid found in joint cavities Ultrafiltrate of plasma across the Ultrafiltrate of plasma across the
synovial membranesynovial membrane Composed of mucopolysaccharide Composed of mucopolysaccharide
containing hyaluronic acid and proteincontaining hyaluronic acid and protein Supplies nutrients to the cartilage and Supplies nutrients to the cartilage and
acts as lubricant to surfaces of moving acts as lubricant to surfaces of moving jointsjoints
Collection: fine needle aspiration or Collection: fine needle aspiration or arthrocentesisarthrocentesis
Volume: 3.5 mlVolume: 3.5 ml
Characteristics: clear to pale yellowCharacteristics: clear to pale yellow
: does not clot: does not clot
Viscosity: polymerization of the Viscosity: polymerization of the hyaluronic acid hyaluronic acid
string test 4-6 cmstring test 4-6 cm
Cell count: WBC>200 cells/mlCell count: WBC>200 cells/ml
Classification of Joint Classification of Joint DisordersDisorders
Group ClassificationGroup Classification Pathologic Pathologic SignificanceSignificance
Lab FindingsLab Findings
I. Non-inflammatoryI. Non-inflammatory Degenerative joint Degenerative joint disordersdisorders
Clear yellow fluidClear yellow fluid
Good viscosityGood viscosity
WBC < 2,000WBC < 2,000
Neutro < 30%Neutro < 30%
Glucose normalGlucose normal
II. InflammatoryII. Inflammatory Immunologic Immunologic disorders including disorders including RA & SLERA & SLE
Cloudy yellow fluidCloudy yellow fluid
Poor viscosityPoor viscosity
WBC 2,000-5,000WBC 2,000-5,000
Neutro > 50%Neutro > 50%
Decreased glucoseDecreased glucose
Possible Possible autoantibodies autoantibodies present present
III. SepticIII. Septic Microbial infectionMicrobial infection Cloudy, yellow Cloudy, yellow green fluidgreen fluid
Poor viscosityPoor viscosity
WBC 10,000-WBC 10,000-200,000200,000
Neutro > 90%Neutro > 90%
Decreased glucoseDecreased glucose
Positive culture Positive culture and gram stainand gram stain
IV. Crystal-IV. Crystal-inducedinduced
GoutGout
PseudogoutPseudogoutCloudy or milky Cloudy or milky fluidfluid
Poor viscosityPoor viscosity
WBC <50,000WBC <50,000
Neutro < 90%Neutro < 90%
Decreased glucoseDecreased glucose
Elevated uric acidElevated uric acid
Crystals presentCrystals present
V. HemorrhagicV. Hemorrhagic TraumaTrauma
Coagulation Coagulation deficienciesdeficiencies
Cloudy, red fluidCloudy, red fluid
Poor viscosityPoor viscosity
WBC >5,000WBC >5,000
Neutro < 50,000Neutro < 50,000
Normal glucoseNormal glucose
RBC present RBC present
CrystalsCrystals ShapeShape PathologyPathology
Monosodium Monosodium urateurate
NeedlesNeedles GoutGout
Calcium Calcium pyrophosphatpyrophosphatee
RodsRods
NeedlesNeedles
RhombusRhombus
PseudogoutPseudogout
CholesterolCholesterol Notched Notched rhombic rhombic platesplates
CholesterolosCholesterolosisis
ApatiteApatite Small needlesSmall needles Minerals from Minerals from cartilagecartilage
CorticosteroiCorticosteroidsds
Flat platesFlat plates Drug Drug infectionsinfections
Serous fluids:Serous fluids:1.1. Pleural - thoracentesisPleural - thoracentesis2.2. Pericardial - pericardiocentesisPericardial - pericardiocentesis3.3. Peritoneal - paracentesisPeritoneal - paracentesis
Collection:Collection:1.1. EDTA tube: cell countEDTA tube: cell count2.2. Sterile tube: cultureSterile tube: culture3.3. Heparinized tube: chemistryHeparinized tube: chemistry
Effusions - systemic disorder that Effusions - systemic disorder that disrupts the balance in the disrupts the balance in the regulation of fluid filtration and regulation of fluid filtration and reabsorptionreabsorption
1.1. Transudates results from changes in Transudates results from changes in hydrostatic pressurehydrostatic pressure
2.2. Exudates results from an Exudates results from an inflammatory processinflammatory process
TransudateTransudate ExudateExudate
AppearanceAppearance ClearClear CloudyCloudy
Specific gravitySpecific gravity < 1.015< 1.015 > 1.015> 1.015
Total CHONTotal CHON < 3.0 g/dl< 3.0 g/dl > 3.0 g/dl> 3.0 g/dl
LDLD < 200 IU< 200 IU > 200 IU> 200 IU
Fluid : serum Fluid : serum protein ratioprotein ratio
< 0.6< 0.6 >0.6>0.6
Cell countCell count < 1,000/uL< 1,000/uL >1,000/uL>1,000/uL
Spontaneous clotSpontaneous clot No No PossiblePossible
Pleural fluid Pleural fluid cholesterolcholesterol
< 55 mg/dl< 55 mg/dl > 55 mg/dl> 55 mg/dl