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Group 9 ± Pleural Fluid a 36-Year

Group 9 ± Pleural Fluid a 36-Year

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Published by: chocoholic potchi on Mar 18, 2010
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05/12/2014

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GROUP 9 ± PLEURAL FLUID
 A 36-year old construction worker was rushed to the emergency room of AUFMC andwas diagnosed to have unilateral pleural effusion. Thoracentesis was performed and thepleural fluid was sent to the laboratory for evaluation.
BLOOD CHEMISTRY RESULTS
Total protein: 7.0 g/dL (Reference range: 6.0 to 8.3 g/dL)Lactate dehydrogenase (LD) 520 U/L (Reference range: 275 to 645 U/L)FBS: 75 mg/dL (Referente range: 70 to 110 mg/dL)
PLEURAL FLUID RESULTS
 A. Physical exama. Color: yellowb. Clarity: cloudyc. Clots present: noB. Microscopic exama. Leukocyte count: 1100 cells/uLb. Differential count:i. Mononuclear cells 93%ii.Neutrophils 3%C. Chemical exama. Total protein: 4.2 g/dLb. LD: 345 U/Lc. Glucose: 55 mg/dLD. Gram stain: no organisms seen; leukocytes present
1. Calculate the fluid-to-serum total protein ratio.
The fluid-to-serum total protein can be derived from dividing the pleural fluid protein withthe serum protein. Then, the result obtained is compared to a standard in which if thecomputed value is less than 3.0 g/dl it is comsidered as transudate, but if the computedvalue is greater than 3.0 g/dl the obtained pleural fluiud is an exudate.Computation:4.2 g/dl / 7.0 g/dL =
0.6 g/dl
 According to our research, some books says that a pleural fluid which have total proteinlevels higher than 3.0 g/dl are characteristic of exudate.
2. Calculate the fluid-to-serum lactate dehydrogenase ratio.
The fluid-to serum lactate dehydrogenase ratio can be derived from dividing the pleuralfluid lactate dehydrogenase by serum lactate dehydrogenase. Then the result obtainedis compared to a standard in which if the computed value is less than 0.6 it isconsidered as transudate, but if the computed value is greater than 0.6, then theobtained fluid is an exudate.
 
Computation:345 U/L / 520 U/L =
0.66 U/L
 The computed value is in borderline case, which gives us a slight confusion if the pleuralfluid obatained is wether a transudate or an exudate. But the group still stands that theobtained fluid is an exudate.
3. Classify this pleural fluid specimen as a transudate or exudate and state twophysiologic mechanisms that can cause this type of effusion.
The group stands that the obtained fluid is an
exudate
.
 
The following supports our conclusion:
y
 
The ratio of pleural fluid protein to serum protein is greater than 0.5.
y
 
The ratio of pleural fluid LDH and serum LDH is greater than 0.6.
y
 
P
leural fluid LDH is more than two-thirds normal upper limit for serum.
Malignant Pleural Effusions
Malignant pleural effusions are generally treated to relieve shortness of breath and/or chest pain caused by the presence of mesothelioma (caused by asbestosis) or neoplasmsthat have metastasized from elsewhere in the body; the lungs or breast are usually the primary site. Metastatic involvement is far more frequent than primary malignancies of the pleura (mesotheliomas).Mechanism of malignant pleural effusion:a.
 
increased capillary permeability as a result of inflammation or disruptiopn of thecapillary endothelium b.
 
impaired lymphatic drainage or decreased drainage in the pulmonary veinsecondary to obstrustion by tumor c.
 
direct invasion of the pleural space by the tumor 
4.
What is the possible diagnosis of the patient? Explain
.
 
Since pleural effusions are associated with many systemic disorders. We conclude thatthe patient suffers from mesothelioma. Due to the exposure of the construction worker toasbestos, a naturally occurring silicate minerals exploited commercially for their desirable physical properties and for The inhalation of asbestos fibres can cause serious illnesses, including malignant lungcancer, mesothelioma (a rare malignant neoplasm strongly associated with exposure toasbestos), and asbestosis (a type of pneumoconiosis)Malignant pleural effusion is a condition in which cancer causes an abnormal amount of fluid to collect between the thin layers of tissue (pleura) lining the outside of the lung and
 
the wall of the chest cavity. Lung cancer, breast cancer, lymphoma, and leukemia causemost malignant pleural effusionsReferences:
y
 
http://www.medicalcriteria.com/site/index.php?option=com_content&view=article&id=102%3Apullight&catid=77%3Apulmonary&Itemid=80&lang=en
y
 
http://en.wikipedia.org/wiki/
P
leural_effusion
y
 
http://www.pulmonologychannel.com/pleuraleffusion/treatment.shtml
y
 
Supportive care in cancer: a handbook for oncologists Ni Jean Klastersky,StephenC. Schimpff,Hansjorg Senn

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