OTHER BODY FLUID

Cerebrospinal fluid

 It is defined as the fluid circulating around the central nervous system. It is NOT an ultrafiltrate of plasma.
 CSF supplies nutrients to the Nervous Tissue
 Remove metabolic wastes
 Produce mechanical barrier to cushion the brain and spinal cord against trauma

ORIGIN AND COMPOSITION

 The brain and the spinal cord are lined by the meninges, which contains three layers:
 DURA MATER - outer layer that lines the skull and vertebral canal
 ARACHNOID - spider-like membrane
 PIA MATER - the inner portion that lines the brain and spinal cord
 The SUBARACHNOID SPACE is located between the arachnoid and pia mater. This space is where the CSF
flows.


PLEXUSES and is reabsorbed back to the capillaries through the ARACHNOID GRANULOMATOUS.
 It is produced at a rate of 20 mL/hr
 Approximately 90-150 mL of CSF is present in adults while 10- 60 mL in neonates.
 CSF is NOT an ultrafiltrate of plasma.

SPECIMEN COLLECTION AND HANDLING

 CSF is routinely collected by LUMBAR PUNCTURE performed between the 3RD, 4TH or 5TH lumbar
vertebrae
 Specimens are collected into three sterile tubes, labeled 1, 2, and 3 according to the order of draw.
 TUBE 1 - used for chemical and serologic test
 TUBE 2 - used for microbiology tests
 TUBE 3 - used for the cell count
 A fourth tube may be drawn. It can be used for MICROBIOLOGY LABORATORY but can also be used
for SEROLOGIC TESTS
 Excess supernatant may be used for CHEMICAL OR SEROLOGIC TESTS. Excess fluid should NEVER be
discarded.
  FLUID FOR CENTRIGUGATION MUST BE IN CAPPED TUBES
 WEAR ALWAYS PROTECTIVE GEARS BECAUSE ALL BODY FLUIDS MUST BE CONSIDERED AS CONTAGIOUS

SPECIMEN COLLECTION AND HANDLING

 The tests are always performed in a STAT basis.

 CSF is stored in the following ways:
 Chemistry and Serology tube: FROZEN
 Microbiology tube: ROOM TEMPERATURE
 Hematology tube: REFRIGERATED

APPEARANCE

 Normal CSF macroscopic appearance is CRYSTAL CLEAR.

 Terminologies used to describe CSF appearance:
 CLOUDY/TURBID OR MILKY - increased protein or lipid
but also infection (cloudiness = WBCs)
 KANTHOCHROMIC, HEMOLYZED/BLOODY

Traumatic Intracranial
tap hemorrhage
Uneven Distribution  X
of blood in tubes
Clot formation  X
Xanthocromia X 
Erythrophagocytosis X 
D-Dimer test X 
MICROSCOPIC EXAMINATION

 WBCs
 In adults, normal at 0-5 WBCs/ul
 In newborns, normal at 30 MONONUCLEAR/uL
 Turbidity starts at WBC: >200mL; RBC: > 400/uL
 Cell counts: Usually done for WBCs, seldom for RBCs
 Total cell count - can be done undiluted or diluted
 WBC count = lysis of RBCs using 3% GLACIAL ACETIC ACID
 Add methylene blue to stain WBCs, to differentiate neutrophils from mononuclear cells
 CSF differential
- Sedimentation, filtration, centrifugation, and cytocentrifugation Justin Louis
- 100 cells are counted and classified Adults usually have the predominance of lymphocytes and monocytes
(70:30), while the ratio is reversed in children
- PLEOCYTOSIS is the term used to describe the increased in number of WBCs
- BACTERIAL MENINGITIS: High CSF WBC count (Predominant cell is Neutrophil)
- VIRAL MENINGITIS, TUBULAR, FUNGAL OR PARASITIC ORIGIN: Moderately elevated CSF WBC with a
high percentage of Lymphocytes and monocytes
- EOSINOPHIL: associated with parasitic infections, fungal primarily Coccidiodes immitis
- MACROPHAGES: indicates previous hemorrhage; it removes cellular debris such as RBC. (Yellow
Hematoidin crystals represent further dege consisting hemoglobin and unconjugated bilirubin)
- LYMPHOBLASTS, MYELOBLASTS and MONOBLASTS in the CSF are frequently seen in acute leukemia.

DILUTION OF CSF

Clarity Dilution Amount of Amount of

Sample Diluent
Slightly hazzy 1:10 30 uL 270 uL

Hazy 1:20 30 uL 570 uL

Slightly cloudy 1:100 30 uL 2970 uL

Slightly bloody 1:200 30 uL 5970 ul

Cloudy/bloody/tu 1:10,000 0.1 mL of 1:100 9.9 mL

rbid dilution
 TYPE OF CELL DESCRIPTION

NEUTROPHIL -May be present having a pyknotic nucleus which

indicate degenerating cells
-Found in bacterial meningitis

nRBCs -Result of bone marrow contamination during spinal

tap
LYMPHOCYTES/MONOCYT -Increased in multiple sclerosis, viral meningitis,
ES tubercular meningitis

EOSINOPHILS -Parasitic infection, fungal infection, introduction of

foreign material to the CNS

MACROPHAGES -Appears within 24 hours after RBCs enter the CSF;

indicative of previous hemorrhage

CHOROIDAL CELLS -Derived from the epithelial lining of the choroid

plexuses
EPENDYMAL CELL -Derived from the linings of ventricles and neural
canal
SPINDLE-SHAPED CELLS -Derived from the linings of the arachnoid mater

MALIGNANT CELLS -Either lymphoblast, monoblast, or myeloblast;

indicates acute leukemia

Chemical examination

CSF PROTEIN

 This is the most frequently performed chemical test on CSF

 CSF protein is <1% compared to total serum protein, and is normal at 15-45 mg/dL.
 The major protein in the CSF is ALBUMIN.
 The second major protein in the CSF is PREALBUMIN.
 IgG is the primary immunoglobulin in CSF. (followed by IgA)
 IgM, FIBRINOGEN and BETA LIPOPROTEIN are proteins that are not normally seen in the CSF
 TRANSFERRIN is the major beta globulin in the CSF
 "TAUtransferrin" is the beta globulin not present in serum but present in CSF
 Protein correction: for every 1200 RBCs, subtract 1 mg/dL in the CSF protein measurement
 Methodology: the two-common available are: TURBIDITY PRODUCTION and DYE BINDING ABILITY.
 CSF/Serum albumin index: determines the integrity of the blood-brain barrier

FORMULA:

CSF/SERUM ALBUMIN INDEX = CSF albumin (mg/dL)

Serum albumin (g/dL)

  A value of 9 implies an intact blood-brain barrier. A value greater than that implies the damage of the
barrier.
 IgG index: determines if there is intrathecal production of IgG in the CSF.

FORMULA:

IgG INDEX = CSF glolbumlin (mg/dL) /Serum IgG (e/dL)

CSF albumin (mg/dL)/ Serum Albumin (g/dL)

 A value of 0.70 implies the production of lgG in the CNS.

CSF PROTEIN

 Electrophoresis can also be done to asasse different diseases

 The presence of OLIGOCLONAL BANDS represents IgG production and can be a tool to distinguish multiple
disorders in the CSF
 The presence of two or more oligoclonal bands in the CSF with
subsequent absence in the serum is almost indicative of MULTIPLE
SCLEROSIS.
 Other disorders that produce oligoclonal banding are: Guillain-Barre
syndrome, Neurosyphilis, encephalitis, and some neoplasms.
 The presence of MYELIN BASIC PROTEIN (MBP) in the CSF is
indicative of recent myelin sheath destruction (demyelination).

This protein can be measured to monitor the course of multiple sclerosis.

IMMUNOASSAY is used to measure MBP

CSF GLUCOSE

 CSF glucose is approximately 60% to 70% that of plasma glucose

 A blood glucose must always be run for comparison to achieve accurate results
 The blood glucose must be drawn 2 HOURS before the CSF puncture
 Glucose determination in CSF should be perform immediately because glycolysis occurs rapidly in CSF.
 The only reason of CSF glucose increase is the increase in plasma levels
 CSF glucose can also be decreased when there are alterations in the BBB and during increased brain cell
demand
 Significant in identifying the causative agent of meningitis:

Type of CSF glucose Other findings

meningitis
Bacterial Markedly decreased Increased WBC (predominant is
neutrophil)
 Tubercular/Fungal Decreased Increased WBC (predominant is
lymphocytes

Viral NORMAL Increased WBC (predominant is

lymphocytes

CSF LACTATE

 Aids in the diagnosis and management meningitis

 Levels greater than 35 mg/dL are associated with bacterial meningitis
 >25 mg/dL - Tubercular/fungal meningitis
 In Viral meningitis, the CSF lactate level usually does not exceed 25 mg/dL.
 Hypoxia in the CNS also elevates the lactate
 They can be falsely elevated by bloody or xanthochomic specimen

CSF GLUTAMINE

 Normal value: 8 to 18 mg/dL

 Is produced in the presence of excess ammonia in the CNS
 May eventually lead to a coma
 Elevation is associated with liver disorders.
 75% of children with REYE'S SYNDROME have elevated glutamine.

Microbiologic examination

Gram staining

 may produce errors due to its subjectivity

 Encountered organisms would include S. pneumoniae (+), S. agalactiae (+), monocytogenes (+), H.
influenzae (-), N. meningitides (-), E. coli ()
 A "starburst pattern is associated with Cryptococcus neoformans.

Special staining

 India ink preparation can be used to detect

Cryptococcus neoformans.
 Acid fast staining may be used to detect Tubular meningitis
 Naegleria fowleri
 Primary Amebic Meningoencephalitis
Limulus Lysate Test

 useful in the diagnosis of meningitis caused by gram negative bacteria

 Reagent: Blood of the Horseshoe crab (Limulus Polyphemus), also called
amebocytes
 Amebocytes contain a copper complex that gives them a blue color
 Endotoxin from the cell walls of gram-negative bacteria coagulates
amebocyte lysate within 1 hour when incubated at 37'C. The test is
sensitive to small amounts of endotoxin
 Remember: the confirmatory test in detecting bacterial or fungal
meningitis is CULTURE.
 Latex agglutination and ELISA are now the momt preferred tests due
to their high accuracy and specificity and ease of use.

SEROLOGIC EXAMINATION

 Important in detecting neurosyphilis

 VDRL or FTA-ABS is used.
SEMEN ANALYSIS
AND OTHER BODY FLUID

SEMEN

 Secretion of the male reproductive system composed of fractions

contributed by the testes, epididymis, seminal vesicles, prostate, and
the cowper's gland.
 Semen analysis is performed to assess infertility, post-vasectomy and
forensic analyses.

ORIGIN AND COMPOSITION

 The testes are the sites of sperm production. They contain SEMINIFEROUS TUBULES that are directly
responsible for forming the sperm. Spermatozoa are being produced in the epithelial cells of these
structures.
 The SERTOLI CELLS provide nutrients and support to the germ cells as they undergo meiosis and mitosis
(Spermatogenesis), hence they are called the "nurse cells".
 When spermatogenesis is complete, the non-motile immature sperm goes to the EPIDIDYMIS to mature.
During this stage the spermatozoa develop flagella. They remain here until ejaculation.

Main
% Remarks
component
 Located in the epithelial cells
Spermatozoa 5% Sperm cells
of the seminiferous tubules
 Transport medium for sperm
cells.
 Sperm cells metabolize
High
fructose for energy needed
concentration
Seminal Fluid 60% to 70% for the flagella to propel.
of fructose
 Absence of fructose do not
and flavin
display motility.
 Flavin is responsible for the
gray appearance of semen.
Acidic fluid
Acid  Proteolytic enzymes are
Phosphate responsible for the
Prostate Fluid 20% to 30% Citric acid coagulation and liquefaction
Zinc of the semen following
Proteolytic ejaculation.
enzymes
 Helps to neutralize the
acidity from the prostate
Bulbourethra
5% secretions and the vagina.
l secretions
 Without neutralization sperm
motility would be diminished.
SPECIMEN COLLECTION

1. Patient is advised to undergo sexual abstinence for 2 DAYS, but not more than 7 DAYS, before the test.
2. Specimens collected after prolonged abstinence have higher volume and decreased motility.
3. The specimen should be delivered as fresh as possible, not longer than 1 HOUR after collection.
4. The most preferred method of collection is MASTURBATION.
5. If not possible, ordinary, non-lubricant containing rubber or polyurethane condoms should be used.

Ways to Collect Semen

 Masturbation - directing the semen into a clean sample cup. Do not use a lubricant which can kill sperms
 Coitus interruptus - withdrawing the penis from the partner just before ejaculating follow by ejaculating
into a clean sample cup.
 Coitus - by using a condom. A special (silicon) condom that does not contain any substance that kills
sperm (spermicide). After ejaculation, carefully remove the condom from the penis. Tie a knot in the open
end of the condom and place it in a container that can be sealed in case the condom leaks or breaks.
Ordinary condoms should not be used since they usually contain spermicides
 Assisted ejaculation - electro-ejaculation used in paralegics

Semen Collection

Good and reliable SA results starts from semen collection, preferably by masturbation.

o Abstinence days 2-6

o Pass urine
o Wash hands with soap, dry
o Collect the entire sample into the wide mouth sterile container, 70% of sperms is in the first part of the
ejaculate
o Keep the sample at body temperature, no sunlight
o Deliver the sample within one hour of ejaculation

Step 1: Allow it to stand for 1 hour for liquefaction

Step 2: Note the Appearance

Normal: Whitish to gray and opalescent

Abnormal: 1. Red-brown: presence of blood
2. Yellow: Jaundice or medication effect
Step 3: Measure the volume of the semen
Normal volume: 2-5 mL
Hypospermia: below 2 mL
Hyperspermia: above 5mL
Step 4: Perform Sperm count

20 to 100 million sperms per mL of semen.

Terminologies of SA

 Oligospermia is a male fertility issue defined as a low sperm

concentration in the ejaculate.
 Asthenozoospermia (or asthenospermia) is the medical term for
reduced sperm motility.
 Teratozoospermia, also known as teratospermia, is a semen
alteration in which there is a large number of spermatozoa with
abnormal morphology.
 OAT =Oligo-astheno-teratozoospermia
 Azoospermia - no spermatozoa in semen
 Polyzoospermia- ++ high sperm concentration, >200M/m
 Hypospermia - semen volume< 1.5 ml
 Hyperspermia - semen volume > 6.0 ml
 Aspermia- no semen volume
 Pyospermia - leukocytes present in semen, >1M/ml
 Hematospermia - red blood cell present in semen
 Necrozoospermia- "dead" sperm

SEMEN ANALYSIS : APPEARANCE

1. Gray-white color, translucent. Has a musty odor

2. Red coloration - blood
3. Clear - low sperm concentration
4. Yellow coloration - urine contamination, prolonged abstinence and medications.
5. Urine is toxic to sperm, affecting the evaluation of motility.
6. Increased white turbidity - presence of WBCs and infection within the reproductive tract.
7. WBCs must be differentiated from immature sperm (spermatids) by using LEUKOCYTE ESTERASE in
reagent strip.

SEMEN ANALYSIS : LIQUEFACTION

1. Should liquefy witin 30 to 60 MINUTES after collection

2. If after 2 hours the specimen failed to liquefy, then DULBECCO'S PHOSPHATE-BUFFERED SALINE or
PROTEOLYTIC ENZYMES (ALPHA- CHYMOTRYPSIN or BROMELAIN may be added.

SEMEN ANALYSIS
  Normal volume: 2 to 5 ml
 Viscosity: easily drawn into a pipette and form small discrete droplets that do not appear clumped or
stringy when falling by gravity from the pipette. Droplets that form threads longer than 2cm are considered
as highly viscous.
 PH: 7.2 to 8.0

SEMEN ANALYSIS Sperm concentration and Sperm count

1. Concentration refers to the number of sperm cells per mL of the specimen

2. Count refers to the number of sperm cells in the whole volume of the specimen given
3. The sperm concentration is counted using the Neubauer counting chamber, using the same formula given
for CSF cell counts.
4. Dilution can be achieved using a positive displacement pipet 1:20 is the most common dilution factor. The
diluents used are:
 Sodium bicarbonate with formalin (immobilizes
 the sperms) Saline and distilled water may also be used
5. The sperm cells are counted in the 5 RBC squares
6. Results are always multiplied with 1000 because the unit used for sperm concentration is mL (as opposed
to the ul units in blood counting)
7. After the sperm concentration is obtained, multiply the value with the total volume to obtain the sperm
count

SEMEN ANALYSIS: MOTILITY

 Two types of grading: WHO rating scale and Traditional scale

Traditional WHO
WHO criteria
scale grading
4.0 a Rapid, straight line motility
3.0 Slower speed, some lateral
b
movement
2.0 Slow forward progression,
b noticeable lateral
movement
1.0 c No forward progression
0 d No movement

SEMEN ANALYSIS

 Within 1 hour, 50% or more sperm should be motile in categories a, b, and c, or 25% or more should show
progressive motility (a and b).
 COMPUTER-ASSISTED SEMEN ANALYSIS (CASA) is the new automated system used to assess sperm
motility. It is able to detect sperm velocity and trajectory

SEMEN ANALYSIS : Sperm Morphology

 Must evaluate at least 200 sperms cells.

 Routine criteria: 30% normal morphology
 Kruger's strict criteria: 14% normal morphology

SEMEN ANALYSIS : Sperm viability

  Determines if the individual has live or dead sperms
 EOSIN-NEGROSIN is the main stain used
 100 cells are counted
 Live sperm cells remain BLUISH WHITE in color
 Dead sperm cells become RED in color
 A normal sperm viability should have at least 75% (50% Strasinger 6th edition) living cells

SEMEN ANALYSIS : Seminal Fluid Fructose

 Used to assess the function of the Seminal vesicles

 Test used: RESORCINOL TEST
 Positive result: ORANGE COLOR
 Normal levels are equal to >13umol per ejaculate
 It must be tested within 2 hours of collection r frozen

SEMEN ANALYSIS : Antisperm antibodies

 Can be present in both male and females

 May be detected in semen, cervical mucosa or serum and possible cause of infertility
 Presence of antibodies in a male can be suspected during routine sperm analysis are the following:
 Clumps of sperms
 Stick to each other head to head, heat to tail, or tail to tail pattern
 Two tests are available
 MIXED AGGLUTINATION REACTION (MAR) is a screening procedure to detect lgG Abs against
sperm cells
 IMMUNOBEAD TEST is more specific since it can detect lgG, lgM, and lgA antibodies against
the specific area of sperm cell. The presence of beads on less than 50% of the sperm is normal
as defined by WHO.

SEMEN ANALYSIS : Microbial and chemical testing

 Presence of more than 1 million/mL indicates infection in the reproductive system.

 Aerobic and anerobic cultures of Chlamydia trachomatis, Mycoplasma hominis and Ureaplasma
urealyticum are most frequently performed.
 Decreased fructose levels - lack of seminal fluid
 Decreased of neutral a-glucosidase, glycerophosphocholine and L-carnitine - disorder in the epididym
 Decreased zinc, citric acid, glutamyl transpeptidase and acid phosphatase - lack of prostatic acid

SEMEN ANALYSIS : Sperm Function Test

Test Description
Hamster egg penetration Sperm are incubated with species- nonspecific hamster eggs and
penetration is observed
Cervical mucosa penetration Observation of sperm's ability to penetrate partner's midcycle cervical
Hypo-osmotic swelling Sperm exposed to low sodium concentrations are evaluated for
membrane integrity and sperm viability
In vitro acrosome reaction Evaluation of the acrosome to produce enzymes essential for ovum
penetration
SPECIMEN COLLECTION
  Synovial fluid is collected CALLED ARTHROCENTESIS
 Should be analyzed within 1 hour
 Specimens for crystal analysis should not be refrigerated because that can produce additional crystals
 Usually collected using a syringe moistened by HEPARIN
Tubes:
1. Microbiology - Sterile tube, add 25 U heparin/mL fluid
2. Hematology- add 25 U heparin/ml fluid, liquid EDTA may also be used

1. Chemistry-Red top; observe for clotting

2. Glucose measurement - Sodium fluoride tubes

SYNOVIAL FLUID

ORIGIN, COMPOSITION, AND APPEARANCE

 It contains high levels of HYALURONIC ACID

 Normal synovial fluid does not clot
 Synoviocytes secrete mucopolysaccharide containing hyaluronic acid (contributes to the viscosity)
 Viscous, should be able to form a string 4 to 6 cm long.
 WBC count: <200 cells/ul
 Glucose: <10 mg/dL of blood glucose; Protein: <3 g/dL
 The Synovial fluid is an ultrafiltrate of plasma
 Often referred as "joint fluid" found in the cavities of the movable joints (diathroses)
 Bones in the SF arelined with articular cartilage (damage to articular membranes is called arthritis)
 "Synovium"= "Like egg
 Colorless to pale yellow, clear
 Normal volume: <3.5 mL

JOINT DISORDERS

Joint Disorder Classification Pathologic significance

Non inflammatory Degenerative joint disorders, osteoarthritis
Inflammatory Immunologic disorders, rheumatoid arthritis,
lupus erythematosus, scleroderma,
polymyositis, anklylosing spondylitis,
rheumatic fever, and Lyme arthritis; Crystal-
induced gout and pseudogout
Septic Microbial infection
Hemmorhagic Traumatic injury, tumors, hemophilia, other
coagulation disorders Anticoagulant overdose

SYNOVIAL FLUID ANALYSIS

 Rope’s test/ Mucin clot test

  Measures the degree of hyaluronate polymerization
 Reagent: 2% to 5% ACETIC ACID

Grade Description
GOOD Solid clot
FAIR Soft clot
LOW Friable clot
POOR No clot
SYNOVIAL FLUID ANALYSIS

Cell counts

 Total WBC (leukocyte) count = most frequently performed cell count on synovial fluid
1. For very viscous specimens = add a pinch of hyaluronidase to 0.5 mL of fluid
2. Clear fluids can be counted undiluted
3. Remember! Never use WBC diluting fluids (they contain acetic acid!)
4. Normal saline is the most preferred diluent; if there is a need to lyse the RBCs, use Hypotonic saline
or Saline with saponin
5. Count using the Neubauer counting chamber. Standard formula applies

SYNOVIAL FLUID ANALYSIS

 Other cells found in Synovial fluid

1. LE CELL = A WBC that has ingested nuclear mass of a destroyed cell
2. REITER CELL = Vacuolated macrophage with ingested neutrophil
3. RA CELL (RAGOCYTE)=Neutrophils with dark cytoplasmic granules (precipitated rheumatoid factor)
4. RICE BODIES = collagen and fibrin in structure, resembled as polished rice
5. FAT DROPLETS = Seen in crush injuries or traumatic injury
6. CARTILAGE CELLS = large, multinucleated cells

SYNOVIAL FLUID ANALYSIS

Crystals in synovial fluid

 Normal synovial fluid has no crystals

 MONOSODIUM URATE is seen during gout; appearance is needle like; primary crystals seen in SF
 CALCIUM PYROPHOSPHATE DIHYDRATE is seen during pseudogout; appearance is needle like or in rods

 To differentiate these two crystals, use compensated polarized light

 MONOSODIUM URATE = Negative birefringence; yellow color
 CALCIUM PYROPHOSPHATE DIHYDRATE = Positive birefringence; red color

Other crystals:

1. Hydroxyapatite crystals = seen in osteoarthritis

2. Cholesterol
3. Cortiscosteroid = seen in injections
4. Calcium oxalate = Renal dialysis

SYNOVIAL FLUID ANALYSIS

Chemistry test

 Synovial fluid can be assayed for glucose levels, protein, and uric acid

Microbiologic test

 Gram stain and culture is performed

 Common agents of infection include Staphylococcus, Streptococcus, Haemophilus, and Neisseria

Serologic test

 For the detection of autoimmune-related joint dosorders

 RA, SLE, Lyme disease

SEROUS FLUID

 Defined as the fluid found between the parietal and visceral membranes.
 They are found in the closed cavities of the body- the peritoneum, pericardium, and pleura.
 It serves as a lubricant between organs. They are ultrafiltrates of plasma.

EFFUSIONS

 The refers to the accumulation of fluid between the membranes

 They are classified as either Transudates and Exudates
 Transudates = Serous effusions that results from the disturbance of the fluid production and
regulation between serous membranes.
 Causes: changes of hydrostatic pressure (Congestive Heart Failure or hypoproteinemia)
 Exudates = are purulent fluids that form in any body cavity as a result of inflammatory process
- Causes: Infections and malignancies

Transudate Exudates
Appearance Clear Cloudy
Fluid: Serum portion
<0.5 >0.5
ratio
Fluid: Serum LD ratio <0.6 >0.6
WBC Count <1000/uL >1000/uL
Spontaneous clotting No Possible
Serum ascites
>1.1 <1.1
albumin gradient

PLEURAL FLUID

 Appearance: Clear/Pale yellow

 Abnormal colors:
 Turbid - due to WBCS
 Bloody- Hemothorax
 Brown - Rupture of amoebic liver disease
 Black - Aspergillosis
 Viscous - Malignant mesothelioma (Elevated hyaluronic acid)
 Milky - due to Chylous or Pseudochylous effusions .
 CHYLOUS MATERIAL = Due to thoracic duct leakage. Milky white color; high lymphocytes,
high TAG, positive sudan staining, no cholesterol crystals present
  PSEUDOCHYLOUS MATERIAL = Due to chronic inflammation. Milky with greenish tinge, low
TAG, negative sudan III staining, cholesterol crystals present

Chemistry:

 Adenosine deaminase = increased in TB and malignancy

 pH=Decreased in pneumonia
 Lactate = increased in bacterial infection
 Amyalse= increased in pancreatitis

PERICARDIAL FLUID

 Normal amount is 10 to 50 mL found between pericardial serous membranes

 Infection in pericardium is PERICARDITIS
 Appearance: Clear/Pale yellow Turbid, blood streaked = infections and malignancies Grossly bloody =
accidental cardiac puncture/ misuse of anticoagulants
 Bacterial endocarditis = WBCs greater than 1000/ul. Specimens can be cultured.
 Effusion is suspected when TAMPONADE is noted in physical examination

PERITONEAL FLUID

 Accumulation of fluid in peritoneum Ascites (Peritoneal fluid Ascitic fluid)

 PERITONEAL LAVAGE is a sensitive test for the detection of intra-abdominal bleeding in blunt trauma
cases
 To determine if the ascitic fluid is a transudate or exudate, use Serum-ascites albumin gradient
 ObTained by subtracting the fluid albumin from the serum albumin
 A value greater than or equal to 1.1 = TRANSUDATE EFFUSION OF HEPATI ORIGIN
 Values lower than 1.1= EXUDATE

PERITONEAL FLUID

 Appearance: Clear/Pale yellow

 WBC counts are less than 350 cell/uL
 WBCs increase during BACTERIAL PERITONITIS AND CIRRHOSIS
Chemical testing:
 Glucose: decreased during tubercular peritonitis and malignancy
 Amyalase: increased during pancreatitis, Gl perforations
 Alkaline phosphatase: increased during intestinal perforations
 BUN and Creatinine: Tested when a wrong puncture is suspected during paracentesis
 PSAMMONA BODIES Contains concentric striations of collagen-like material can be seen in benign
conditions and are also associated with ovarian and thyroid malignancies
 Microbiological testing:
 Grams staining and Bacterial cultures can be made
 It is advisable to inoculate the fluid into blood culture bottles at the bedside to increase the
recovery of anaerobic organisms.