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- 3. CSF Pleural Peritoneal & pericardial Bronchoalveolar lavage Hydatid cyst Joint fluid
- 4. Cerebrospinal fluid (CSF) is a clear, colorless body fluid found in the brain and spinal cord.
- 5. Cerebrospinal fluid (CSF) analysis is a way of looking for conditions that affect your brain and spine. It’s a series of laboratory tests performed on a sample of CSF. CSF is the clear fluid that cushions and delivers nutrients to your central nervous system (CNS). The CNS consists of the brain and spinal cord. An analysis of the sample involves the measurement of and examination for - fluid pressure proteins glucose red blood cells white blood cells chemicals bacteria viruses other invasive organisms or foreign substances
- 6. Analysis can include: measurement of the physical characteristics and appearance of CSF chemical tests on substances found in your spinal fluid or comparisons to levels of similar substances found in your blood cell counts and typing of any cells found in your CSF identification of any microorganisms that could cause infectious diseases
- 7. (CSF) analysis is a set of laboratory tests that examine a sample of the fluid surrounding the brain and spinal cord This fluid is an ultrafiltrate of plasma. It is clear and colorless. It contains glucose, electrolytes, amino acids, and other small molecules found in plasma, but has very little protein and few cells CSF protects the central nervous system from injury, cushions it from the surrounding bone structure, provides it with nutrients, and removes waste products by returning them to the blood CSF analysis includes tests in clinical chemistry, hematology, immunology, and microbiology.
- 8. Usually three or four tubes are collected. The first tube is used for chemical and/or serological analysis and the last two tubes are used for hematology and microbiology tests. Routine examination of CSF includes virual observation of color and clarity and tests for glucose, protein, lactate, lactate dehydrogenase, red blood cell count, white blood cell count with differential, syphilis serology (testing for antibodies indicative of syphilis), Gram stain, and bacterial culture.
- 9. GROSS EXAMINATION. Color and clarity are important diagnostic characteristics of CSF. Straw, pink, yellow, and indicate the presence of bilirubin, hemoglobin, red blood cells, or increased protein. Turbidity (suspended particles) indicates an increased number of cells. The latter is often associated with sequential clearing of CSF as it is collected; streaks of blood in an otherwise clear fluid; or a sample that clots.
- 10. GLUCOSE. CSF glucose is normally approximately two-thirds of the fasting plasma glucose. A glucose level below 40 mg/dL is significant and occurs in bacterial and fungal meningitis and in malignancy. PROTEIN. Total protein levels in CSF are normally very low, and albumin makes up approximately twothirds of the total. High levels are seen in many conditions including bacterial and fungal meningitis, multiple sclerosis, tumors.
- 11. LACTATE. The CSF lactate is used mainly to help differentiate bacterial and fungal meningitis, which cause increased lactate, from viral meningitis, which does not. LACTATE DEHYDROGENASE. This enzyme is elevated in bacterial and fungal meningitis, malignancy, and subarachnoid hemorrhage.
- 12. WHITE BLOOD CELL (WBC) COUNT. The number of white blood cells in CSF is very low, usually necessitating a manual WBC count. An increase in WBCs may occur in many conditions including infection (viral, bacterial, fungal, and parasitic), allergy, leukemia, multiple sclerosis, hemorrhage, traumatic tap. The WBC differential helps to distinguish many of these causes
- 13. RED BLOOD CELL (RBC) COUNT. While not normally found in CSF, RBCs will appear whenever bleeding has occurred. Red cells in CSF signal hemorrhage. Since white cells may enter the CSF in response to local infection, inflammation, or bleeding, the RBC count is used to correct the WBC count so that it reflects conditions other than hemorrhage. This is accomplished by counting RBCs and WBCs in both blood and CSF. The ratio of RBCs in CSF to blood is multiplied by the blood WBC count. This value is subtracted from the CSF WBC count to eliminate WBCs derived from hemorrhage.
- 14. GRAM STAIN. The Gram stain is performed on a sediment of the CSF and is positive in at least 60% of cases of bacterial meningitis. Culture is performed for both aerobic and anaerobic bacteria. SYPHILIS SEROLOGY. This involves testing for antibodies
- 15. Normal results Gross appearance: Normal CSF is clear and colorless. CSF opening pressure: 50–175 mm H 2 O. Specific gravity: 1.006–1.009. Glucose: 40–80 mg/dL. Total protein: 15–45 mg/dL. LD: 1/10 of serum level. Lactate: less than 35 mg/dL. Leukocytes (white blood cells): 0–5/microL (adults and children); up to 30/microL (newborns).
- 16. Differential: 60–80% lymphocytes; up to 30% monocytes and macrophages; other cells 2% or less. Monocytes and macrophages are somewhat higher in neonates. Gram stain: negative. Culture: sterile. Syphilis serology: negative. Red blood cell count: Normally, there are no red blood cells in the CSF unless the needle passes through a blood vessel on route to the CSF
- 18. Pleural fluid is found in the pleural cavity as a lubricant for the movement of the lungs during inhalation and exhalation. It is derived from a plasma filtrate from blood capillaries and is found in small quantities between the layers of the pleurae - membranes that cover the chest cavity and the outside of each lung.
- 19. It is the fluid present in the pleural cavity, located between the parietal and visceral pleural membranes.
- 20. The normal volume of pleural fluid is around 0.26ml/kg body weight. 1 , 2
- 21. The pleural fluid is a thin serous fluid which acts as lubricating agent and prevents friction between the lungs and the ribs when breathing. It also keeps the lungs inflated.
- 22. The pleural fluid is collected by a procedure called pleural tap. This is a procedure where the needle is inserted into the chest wall, to collect/drain fluid collected in the pleural cavity
- 23. Appearance color Disease associated Clear or pale yellowNorma White/turbid Infections Bloody Tuberculosis, malignancy, trauma Brown/anchovysauce-----Rupture of amebic abscess BlackFungal infections as in aspergillosis
- 24. The components are Physical examination—Appearance, Color Chemical examination----pH, Glucose, Protein, LDA denosine deaminase, Amylase Microbiologic examination-----Gram stain, Acid fast Stain, Culture Serologic examination( if required)--Antinuclear antibody (ANA), Rheumatoid factor ( RF) Tumor markers(in suspected malignancies) Microscopic examination---For cell typing, To rule out malignancies
- 25. Pleural fluid pH below 7.2 indicates empyema which needs chest tube insertion and drainage Pleural fluid below 6 – esophageal rupture Pleural fluid greater than 7.4 – congestive cardiac failure
- 26. Neutrophil---Bacterial pneumonia, Pulmonary infarction, Pancreatitis, Subphrenic abscess, Early tuberculosis, Transudate ( in around 10 %) Lymphocytes-Tuberculosis, Viral infection, Malignancies, True chylothorax, Rheumatoid pleuritis, SLE, Uremic effusion, Transudate (approx 30%)
- 27. Eosinophils-------Air in pleural space, Trauma, Pulmonary infarction, Congestive cardiac failure, Parasitic or fungal infections, Hypersensitivity reactions, Drug reactions, Rheumatologic desease, Hodgkin disease RBC ----’sIntrapleural malignancy ( 60% of cases), Traumatic tap, Pulmonary infarction, Pleural infection, Closed chest trauma, Postmyocardial hepatic syndromes, Hepatic cirrhosis Immature blood cells----Chronic myeloid leukemia, Myeloid metaplasia( extramedullary hematopoiesis)
- 28. The foul smelling pleural fluid is seen in a. Anaerobic infections b. Urinothorax (urinous/ammonical odour)
- 29. The causes of increased amylase in the pleural fluid are a. Pancreatic disease b. Esophageal rupture. What is the significance of macrophages in pleural fluid? These cells have round to bean shaped nuclei and moderate amount of cytoplasm and phagocytosed dark cytoplasmic particles. These appear in groups or in sheet like appearance. Giant multinucreated macrophages are seen in rheumatoid pleuritis. When they are in clumps, they can be mistaken for mesothelial cells or malignant
- 30. Joint fluid analysis is a test to look at joint fluid under a microscope for problems such as infection, gout , pseudogout , inflammation , or bleeding. The test can help find the cause of joint pain or swelling.
- 31. infections inflammatory conditions, degenerative conditions, bleeding conditions
- 32. Physical characteristics: especially the color. Chemical tests: glucose levels, protein levels, uric acid levels, etc. Microscopic examination: to examine the presence of microbes and crystals. Total cell counts: especially the amount of white blood cells and red blood cells. Gram stain: to examine the presence of microbes.
- 34. Peritoneal fluid is a normal, lubricating fluid found in the peritoneal cavity -- the space between the layers of tissue that line the belly's wall and the abdominal organs (such as the liver, spleen, gall bladder, and stomach) The primary function of peritoneal fluid is to reduce the friction between the abdominal organs as they move around during digestion.
- 35. Peritoneal fluid analysis is a lab test. It is done to look at fluid that has built up in the space in the abdomen around the internal organs. This area is called the peritoneal space
- 36. the fluid to measure: Albumin Protein Red and white blood cell counts Tests will also check for bacteria and other types of infection. Alkaline phosphatase Amylase Cytology (appearance of cells) Glucose LDH
- 37. Abnormal results may mean: Bile-stained fluid may mean you have a gallbladder or liver problem. Bloody fluid may be a sign of tumor or injury. High white blood cell counts may be a sign of peritonitis. Milk-colored peritoneal fluid may be liver, lymphoma, tuberculosis, or infection.