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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5512_Библиотеки_им_академика_М_И_Перельмана.pdf
Introduction
ultra-ltrates of
plasma.
eusion.
transudates exudates.
Clinical Significance
Transudates
oedema. exudates,
pleural eusion
ascites.
Ascites uid
Specimen Collection
Laboratory Investigation
Phical an
Appearance and Colour
Appearance:
Colour:
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Medical Laborato Technology: Volume 2
Clot Formation
Specic Gravity
roscopic minan
Total Cell Count
acetic acid to haemolyse red cells
Comment
malignancy, trauma, or pulmonary infarct.
Dierential Count
malignant tumour cells
Chemical ination
Glucose
Protein Test
Qualitative st for Protein
Special Note to Distinguish Exudates om Transudates
transudate.
exudate.
Medical Laborato Technology: Volume 2
robiological mination
OL FLUID
Introduction
Clinical Significance
FIGURE Synol joint and the
site of soal uid
TABLE
Laboratory test
Appearance
Viscosity
Mucin clot
Leukocyte
(count/cu. mm.)
Neutrophils (%)
Glucose (Dierence
blood-SF, mg/dL)
Comments
MSU = Monosodium urate stals
Abnormal ngs oal uid
Normal
Clear
yellow
High High
Good Good
-
Non-inammatory
Clear yellow
,-
Inammatory
Mild
Slight turbid
Decreased Decreased
Good to fair
Severe
rbid
Fair to poor
MSU: Gout CPPD:
Pseudo gout
Infectious
rbid to
purulent
Decreased
Gram stain+
Culture +
Poor
Specimen Collection
Laboratory Investigation
Phical an
appearance
Turbidity
Xanthochromia
traumatic tap
bloody synovial uid
Tests for Viscosity
String Test
Mucin Clot Test
polymerization of
hyaluronic acid.
Medical Laboratory Technology: Volume 2
866
boom of the tube, a dense white precipitate (clot) of protein hyaluronate forms. The quality
of the clot is graded as ‘good’, ‘fair’, or ‘poor’. A ‘good’ clot remains intact even when the
tube is shaken; a ‘poor’ clot resembles a few formed shreds in a turbid solution. An alternate
method is to prepare a 1:4 solution of joint uid and 2% acetic acid. The solution is mixed and
examined for the presence of a mucin clot. The quality of the clot is graded as just described.
The cause of poor mucin clot formation is uncertain. The quality of the mucin clot is not solely
related to the uid leukocyte count or the percentage of neutrophils; abnormal synovial cell
metabolism resulting in production of altered forms of hyaluronate may also be a factor.
Hyaluronic acid content decreases in inammatory conditions and the clot is poor. Both
viscosity and mucin clot tests are only rough guidelines. Results that are more meaningful are
obtained from microscopic examination.
Clot Formation
Normal joint uid does not clot because it lacks high-molecular weight coagulation proteins,
including brinogen, prothrombin, various coagulation factors, antithrombin and tissue
thromboplastin. The formation of a clot can help distinguish a truly bloody eusion from a
traumatic aspiration of an inammatory eusion.
Microscopic Examination
Total leukocyte count and dierential count of synovial uid are very important for the diagnosis of joint-related disorders. An anticoagulated (EDTA) specimen is used for the cell count.
The total leukocyte count and dierential count are done in the same way as described with
other body uids.
The leukocyte count of normal synovial uid is very low (about 50–200 cells/µL). Hence,
dilution is not commonly performed unless the specimen is turbid. Saline containing methylene blue is used as the diluent for total leukocyte count. Do not use diluted acetic acid as the
diluent for white cell count. Acetic acid causes mucin cloing. The method of dilution and
procedure of cell counting is similarly described under spinal uid.
Note If the uid is too viscous to permit dilution and cell counting, 0.05% hyaluronidase in
phosphate buer may be added as a diluent; however, leukocyte counts are said to be slightly
higher in hyaluronidase-treated uids.
In the absence of a haemocytometer chamber, counting leukocytes under high-power
(400×) microscopic eld (HPF) can provide a rough estimate of the leukocyte count in
undiluted uid. When a WBC count of <2/HPF is noted, the chamber count commonly shows
less than 1000 сells/µL. In cases where the WBC is higher than 2/HPF, chamber counts should
be performed to ensure accuracy. Electronic counts are not very reliable as it might count
artefactual objects rather than white cells.
Haemolyse erythrocytes if the specimen is bloody. This is performed by diluting the
specimen with 0.1 N hydrochloric acid or 1% saponin in saline. Make the blood smear thin
as hyaluronic acid distorts the cells. Preparation of smear from fresh specimen is also done,
in which case an EDTA-anticoagulated specimen is recommended. Staining of the smear is
performed similarly as described earlier with other body uids.
Normal synovial uid has a few mononuclear white cells; increased neutrophil count
(over 70%) is suggestive of bacterial arthritis even when the total white cell count is within
the normal range. With inammatory disorders, the white cell count in synovial uid is
moderately high (>10 000 cells/µL).
Microscopic Examination of Crystals
The microscopic examination includes analysis of a wet preparation, leukocyte dierent
count, cytological evaluation using stained slides and crystal examination using compensated
polarized microscopy.
Wet Mount
Chemical ination
Microbiological mination
INAL DISCHARGE
Clinical Significance
albicans Trichomonas va
inalis.
g
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Medical Laborato Technology: Volume 2
Specimen
sterile swab
N.
Laboratory Investigation
roscopic minan
Three-slide Test for Vaginitis
(KOH)
depression slide
Note
Obseation
Gardnerella vaginalis
Potassium Hydroxide (KOH) t Mount
albicans.
Gram-stain Smear
Neisseria
Obseations
(Lactobacillus),
Laboratory Culture
(N gonorrhoeae),
Neisseria gonorrhoe
ae
°
Rid Tests for Vaginosis and Vaginitis
GASTRIC JUICE
Clinical Significance
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Medical Laborato Technology: Volume 2
Microscopic Examination
malignant cells
Chemical analysis
FIGURE 26.5
croscopic ew of stomach contents
REVIEW QUESTIONS