Serous Fluid

Pleural Fluid

Hematology Tests
As mentioned previously, the differential cell count is the most diagnostically significant
hematology test performed on serous fluids. Primary cells associated with pleural fluid include
macrophages, neutrophils, lymphocytes, eosinophils, mesothelial cells, plasma cells, and
malignant cells. Macrophages normally account for 64% to 80% of a nucleated cell count
followed by lymphocytes (18% to 30%) and neutrophils (1% to 2%) These same cells are also
found in pericardial and peritoneal fluids. Similar to other body fluids, an increase in pleural fluid
neutrophils indicates a bacterial infection, such as pneumonia. Neutrophils are also increased in
effusions resulting from pancreatitis and pulmonary infarction.

Chemistry Tests
In addition to the chemical tests performed to differentiate between a pleural transudate and a
pleural exudate, the most common chemical tests performed on pleural fluid are glucose, pH,
adenosine deaminase (ADA), and amylase. Triglyceride levels may also be measured to
confirm the presence of a chylous effusion. Decreased glucose levels are seen with
tuberculosis, rheumatoid inflammation, and purulent infections. As an ultrafiltrate of plasma,
pleural fluid glucose levels parallel plasma levels, and values less than 60 mg/dL are considered
decreased. Fluid values should be compared with plasma values. Pleural fluid lactate levels are
elevated in bacterial infections and can be considered in addition to the glucose level.