PLEURAL AND ASCITIC FLUID STANDARDS Introduction 1.

Sample Handling All samples should be centrifuged (or filtered) and the appearance noted on the laboratory report. There is normally no reason to analyse blood stained samples. . I! T" indicated Sample should be handled in Category 3 containment or not at all. #. Sample Re$uirement% A plain fluid sample is required for analysis of total protein, albumin, L ! and triglyceride. "luoride o#alate additi$e is required for analysis of glucose. Anaerobic sample collection is required for p! measurement ie gas sample &. La'orator( )et*od% "or all analyses the laboratory method should be optimised for the fluid matri# and concentration ranges e#pected and should be C% mar&ed. The only methods accurate enough for p! measurement are blood gas analysers or a calibrated p! meter. +. ,ualit( Control Currently no appropriate '(C matri# is a$ailable and no %(AS e#ists. -. Range o! Anal(%e% and Cut .!!% Pleural Fluid Anal(%e% There is e$idence for the measurement of total protein, L !, triglycerides and p! in pleural fluid aspirate in the follo)ing situations*+ 'dentifying e#udates measure Total protein L ! Application of Lights criteria requires simultaneous serum analysis Confirm chylous effusion measure Triglyceride 'ndicate drainage of a paranemonic effusion measure p!

Pleural Fluid Cut .!!% These should be literature based and currently the best e$idence indicates the follo)ing cut+offs should be applied*+

,leural fluid total protein -3.g/L )ith a serum total protein )ithin the reference inter$al is consistent )ith an e#udate. 'f the serum total protein is abnormal and the pleural fluid total protein is bet)een 01g/L and 31 g/L then application of Lights criteria is indicated*+ Lights criteria states that fluid is an e#udate if any of the follo)ing are true "luid L ! -0/3 the upper limit of the reference inter$al "luid*Serum total protein -..1 "luid*Serum L ! - ..2 Chylous effusion if fluid triglyceride -3.01 mmol/L ,aranemonic effusion requires drainage if fluid p! 4 5.0

A%citic Fluid Anal(%e% There is e$idence for the measurement of total protein, albumin and glucose in ascitic fluid samples in the diagnosis of*+ Spontaneous bacterial peritonitis in alcoholic cirrhosis measure Total protein 6lucose ,ortal hypertension measure Albumin Calculation of gradient requires simultaneous serum analysis

A%citc Fluid Cut /.!!% These should be literature based. The follo)ing are currently cited*+ Spontaneous bacterial peritonitis if ascitic fluid total protein 4 3.g/L and fluid glucose - 0.7 mmol/L Albumin gradient consistent )ith portal hypertension if (serum albumin+ fluid albumin) - 33g/L

0. Re!erence% Tarn AC, Lap)orth 8. Ann Clin Biochem 0..39 #1* 333+300 Light 8:, ;ac6regor ;', Luchsinger ,C, <all :C. Ann Intern Med 3=509 00* 1.5+133 >effery >, ;urphy ;>. Hosp Med 0..39 - * 070+072 <ritish Thoracic Society 6uidelines* 3. ;as&ell ?A, 8>A <utland. Thorax 0..39 +1* 7+35 0. a$ies C:!, 6leeson "@, a$ies 8>A. Thorax 0..39 +1* 37+07