Chapter 7 Examination of cerebrospinal

fluid and serous membrane fluid

examination of cerebrospinal fluid (CSF)

General property: normal CSF is colorless and
transparent watery fluid. In abnormal status , the
general property of CSF is changed as follows:
yellow CSF: obsolete intracranial hemorrhage
purulent CSF: pyogenic meningitis
reddish or bloody CSF : intracranial hemorrhage or
subarachnoid hemorrhage

Chemical examination:
Protein : Pandy test: (-) or 0.2~0.4 g/ L
elevated protein: purulent meningitis,
tubercular meningitis, viral meningitis
Glucose : 2.5~4.5 mmol / L
increased glucose: purulent meningitis,
tubercular meningitis
Chloride: 119~129 mmol/ L
Ddecreased chloride: tubercular meningitis,
purulent meningitis

Microscopic test :
Total cell count: 0~8106/ L
DC: lymphocyte , neutrophil granulocyte
tubercular meningitis: < 500106/L (lymphocyte)
purulent meningitis: > 1000106 /L(neutrophil)
viral menintitis: <100 106 /L (lymphocyte)
meningeal leukemia :
Examination of serous membrane
fluid(SMF)
General property
Chemical examination
Microscopic test
Bacteriology
The main differential points of transudate and exudate
transudate exudate
quality non-inflammatory inflammatory, tumorous
general property
color light yellowish dark yellow, bloody,
purulency
transparency transparent cloudy
coagulability - +
specific gravity < 1.018 > 1.018
chemical examination
Rivalta test - +
protein < 25g/L > 30 g/L
glucose same as blood lower than blood
cell count < 100106/L > 500106/L
DC lymphocyte neutrophil or lymphocyte
tumor cell negative can be found
bacteriological test negative positive ( infectious case)

Case analysis
History and physical examination: A 28-year-
old male was admitted to the hospital
because of fever, cough , shortness of
breathe and chest pain. After X-ray
examination, he was found medium pleural
effusion in his right thoracic cavity. In second
day , pneumothorax puncture was operated
and pleural effusion was examined .
Laboratory data: Hb 11g/L, WBC 8109/L,
PC 120109, the color of the effusion is
yellow and cloudy, SG 1.025, rivalta test (+),
protein 45g /L, glucose was apparently lower,
cell count: 800106/L, DC lymphocyte.
Question
Please judge the quality of pleural
effusion in this case.
What is probably diagnosis for this
patient?
And why?