16 Body Fluids

Cerebrospinal Fluid

3rd major body fluid

Functions

Supplies nutrients to the CNS

Removes metabolic wastes
Cushions brain & spinal cord against trauma
Volume
140-170 mL in adults
10-60 mL in neonates
NB: Production rate: 20mL per hr in the choroid plexus

Collection
rd
th
th
th

Lumbar puncture between 3 and 4 or 4 and 5

lumbar vertebrae
Note intracranial pressure & prevent introduction of

infection & damage to neural tissues

Collected in 3 sterile test tubes
1. Chemical & serologic tests
2. Microbiological
3. Cell count
4. (additional tests)
Characteristics

Differential Diagnoses of Meningitidis

Bacterial
Viral
TB
WBC,
WBC,
WBC,
neutrophils lymphocyte
lymphocytes
s
& monocytes
CHON
CHON
CHON
CHO
Normal CHO
CHO
Lactate
LD4 &
LD5

Normal
Lactate
LD2 &
LD3

Lactate

Fungal
WBC,
lymphocytes
& monocytes
CHON
Normal -
CHO
Lactate

LD2 & LD3

LD2 & LD3

CSF cytology (Lymphocyte:Monocyte ratio 70:30)

Appearance

Clear - normal
Cloudy - presence of WBC

Xanthochromic - pink, orange or yellow

presence of RBC degradation products

(bilirubin, carotene, protein, melanin)
Bloody - intracranial hemorrhage or

traumatic tap
Hemorrhage
Blood evenly distributed in
all 3 test tubes
No clot
Xanthocromic supernatant

Traumatic tap
Heaviest concentration of
blood in tube 1
Clots, due to introduction of
plasma fibrinogen into the CSF
Clear supernatant

Cell count
Adult 0-10 WBC/mL (lymphocytes:monocytes 70:30)
Neonates 0-30 WBC/mL (more monocytes)
Protein
Glucose
Lactate

15-45 mg/dL, mostly albumin

60-70% of plasma glucose (2 hours prior to LP)
25 mg/dL
(Elevations can result from conditions that
decrease O2 flow to the tissues)
(Used to monitor severe head injuries)
Glutamine 8 to 18 mg/dL
(35 mg/dL: disturbance in consciousness coma)
Enzymes

A.

B.

Lactate dehydrogenase (LD)

LD1 LD2
Brain tissue
LD2 LD3
Lymphocytes
LD4 LD5
Neutrophils
Creatine kinase isoenzyme CKBB
< 17 mg/mL Predict recovery after
cardiac arrest
> 17 mg/mL Poor prognosis

CSF Gram stain: Gram (-) diplopcocci characteristic of

N. meningitidis
Seminal Fluid Analysis
1.
2.

Evaluation of fertility cases

Post-vasectomy cases

Composition

Spermatozoa produced in the testis & mature in the

epididymis
Viscous liquid from the seminal vesicles that furnishes

fructose & other nutrients

Enzymes from prostate containing acid phosphatase

& proteolytic enzymes that act on the fluid for in
coagulation & liquefaction
Collection

Specimen should be collected in a sterile container 3

days after sexual abstinence

Specimen should liquefy within 30 min of collection

Volume
Viscosity
pH
Sperm count
Motility
Morphology

2-5 mL
Pours in droplets
7.3 8.3
20-160 million/mL (borderline:10-20 M/mL)
50-60% (with fair quality within 3 hr)
Oval head 3x5u with long tapered tail

NB: < 30% abnormal forms

rainwater@mymelody.com || 1st semester, AY 2011-2012

Synovial Fluid

Viscous fluid found in joint cavities

Ultrafiltrate of plasma across the synovial membrane

Composed of mucopolysaccharide containing

hyaluronic acid & protein

Supplies nutrients to the cartilage & acts as lubricant

to surfaces of moving joints

Collection
Volume
Characteristics
Viscosity
Cell count

Arthrocentesis
3.5 mL
Clear to pale yellow, does not clot
Polymerization of hyaluronic acid
(string test: 4-6 cm)
WBC <200 cells/mL

Classification of Joint Disorders

Group
Pathologic
Classification Significance
I.
Degenerative
Nonjoint
inflammatory disorders

Lab Findings

Transparent xanthochromic
Good viscosity
WBC < 3,000/ml
Neutro < 30%; No RBCs
Glucose (blood/SF difference:
mg/dl): 0-10 (normal)
II.
Immunologic Transparent to opaque
Inflammatory disorders
xanthochromic to
white/bloody
including RA
Poor viscosity
& SLE
WBC 3,000-75,000/ml
Neutro > 50%; No RBCs
Glucose(bld/SF diff):
0-40 mg/dl
Possible autoantibodies
present
III.
Opaque, white to yellow
Microbial
Septic/
green fluid,
infection
Infectious
Poor viscosity
WBC 50,000-200,000
Neutro > 90%; RBCs
Glucose (bld/SF dif.):
20-100 mgs/dl
Positive culture and Gram
stain
IV.
Gout
Cloudy or milky fluid
CrystalPseudogout Poor viscosity
induced
WBC <50,000
Neutro < 90%
Decreased glucose
Elevated uric acid
Crystals present
V.
Trauma
Opaque, red-brown or
Hemorrhagic Coagulation
xanthochromic fluid
deficiencies Poor viscosity
WBCs 50,000-10,000/ml;
<50% PMNs; RBCs present
Glucose (bld/SF diff.):
0-20 mg/dl
Crystals
Monosodium urate
Calcium
Pyrophosphate
Cholesterol
Apatite
Corticosteroids

Monosodium urate crystals (polarized light) from a patient

with urate gout

Shape
Needle
Rod
Needle
Rhombus
Notched
Rhombic plate
Small needle
Flat plate

Pathology
Gout
Pseudogout

Cholesterolosis

Monosodium urate crystals in synovial fluid (ASCP 1993)

Cholesterol crystals in synovial fluid (polarized light)

Serous fluids
1. pleural - thoracentesis
2. pericardial - pericardiocentesis
3. peritoneal - paracentesis
Collection
1. EDTA tube - cell count
2. sterile tube - culture
3. heparinized tube - chemistry
Effusions - are fluids that have escaped into a part or tissue
1. Transudates result from changes in thehydrostatic
pressure
2. Exudates result from an inflammatory process

Appearance
Specific gravity
Total protein
LD
Fluid : serum protein
Cell count
Spontaneous clot
Pleural fluid cholesterol

Transudate
clear
< 1.015
< 3.0 g/dL
< 200 IU
< 0.6
< 1,000/uL
no
< 55 mg/dL

Exudate
cloudy
> 1.015
> 3.0 g/dL
> 200 IU
>0.6
>1,000/uL
possible
> 55 mg/dL

Minerals from cartilage

Intra-articular
injections
rainwater@mymelody.com || 1st semester, AY 2011-2012