Synovial Fluid o Hemorrhage: Traumatic injury, tumors,

o Viscous liquid found in the cavities of synovial hemophila, other coagulation disorders,
joints anticoagulant overdose
o Ultra filtrate of plasma across the synovial
membrane Group Classification Laboratory Findings
Primary function: Non inflammatory  Clear, yellow fluid
o Lubrication  Good viscosity
o Provides nutrients  WBCs <1000 uL
o Shock absorber  Neutrophils <30%
 Norma lglucose (Similar to
Production of Synovial Fluid blood glucose)
o Articulating bone Inflammatory  Cloudy ,yellow fluid
o Joint cavity (Immunologic Origin)  Poor Viscosity
o Articular cartilage  WBCs 2000 = 75 000 uL
o Synovial membrane  Neutrophils >50%
o Fibrous capsule  Decreased glucose level
 Possible autoantibodies
Arthritis present
o Damage to the articular membrane produces
pain and stiffness in the joints  Cloudy or milky fluid
(Crystal Induced
Significant Laboratory Test  Low viscosity
Origin)
o WBC Count  WBC sup to 100 000 ul
o Gram Stain  Neutrophils <70%
o Culture  Decreased glucose level
o Crystal Examination  Crystals present
Septie  Coudy, yellow green fluid
Normal Synovial Fluid Values  Variable viscosity
o Volume: <3.5 Ml  WBC’s 50 000 – 100 000 uL
o Color: Colorless To Pale Yellow  Neutrophils >75%
o Clarity: Clear  Decreased glucose levels
o Viscosity: Able To Form A String 4 – 6 Cm Long  Positive culture & gram
o Leukocyte Count: <200 Cells/Ul stain
o Nutrophils: <25% Of Differential Hemmorrhagic  Cloudy, red fluid
o Crystals: None Present  Lowviscosity
o Glucose Plasma Difference: <10mg/Dl Lower  WBC’s ewual to blood
Than Blood Glucose  Neutrophils equal to blood
o Total Protein: <3 G/Dl  Normal glucose level

Classification and Pathologic Significance of Joint Specimen Collection and Handling

Disorders o Synovial fluid iscollected by needle aspiration
called arthrocentesis
o NonInflammatory: Degenerativejoint disorders, o Normal synovial fluid does not clot
Osteoarthritis
o Inflammatory: Immunologic disorders, Test Tube Used
rheumatic arthritis, lupus erythematosus, o Sterile heparinized tube
scleroderma, polymyositis, anklyosing o Heparin or EDTA
spondylitis, rheumatic fever and lhyme arthritis. o Non anticoagulant tube
Crystal induced got and pseudogot o Sodium fluoride
o Septie: Microbial infection
Test
o Gram stain and culture
 o Cell counts Causes of Crystal Formation
o Other test o Metabolic disorder
o Glucose analysis o Decreased renal excretion
o Degeneration of cartilage and bone
Color and Clarity o Injection of medications
Appearance Clinical Significance
Colorless/Pale yellow Normal Crystal Shape Compensated Significance
Deeper yellow Non inflammatory and Polarized
inflammatory conditions Light
Greenish tinged Bacterial infection Monosodium Needles Negative Gout
Red Traumatic tap Urate birefringence
Hemorrhage Calcium Rhombus Positive Pseudogout
Pyrophosphat square rods birefringence
Viscosity e
o Comes from the polymerization of the
hyaluronic acid Choleterol Notched, Negative Extracellular
rhombic plates birefringence
Methods of Measuring the Viscosity of Synovial Fluid
o String test Corticosteroid Flat, variable Positive and Injections
o Ropes/Mucin Clot test shaped plates negative
birefringence
Cell Counts Calcium Envelopes Negative Renal
o Total leukocyte is the most frequently perform Oxalate birefringence dialysis
cell count on synovial fluid Apatite (Ca Small particles No Osteoarthriti
o Very viscous fluid may need to be pre treated hosphate) Require birefringence s
o Neubauer counting chamber is used for manual electron
counting microscopy
o WBC diluting fluid cannot be use
Slide Preparation
Differential Count o Temperature and pH can affect the result of
o Should be performed on cytocentrifuged crystal determination
o Both MSU and CPPD crystal are reported as
Normal: being located extracellularly and intracellularly
o Neutrophil
o Lymphocyte Crystal Polarization
o Monocyte o Once the presence of the crystal has been
o Macrophages determined using direct polarization, positive
o Synovial tissue cells identification is made using compensated
polarized light
Abnormal:
o Reiter cells Chemistry Test
o RA cells o Glucose determination
o Lipid droplets o Total protein
o Hemosiderin granules o Uric acid determination
o LE cells
o Cartilage cells Microbiologic Test
o Gram stain
Crystal Identification o Culture
o Microscopic examination of synovial fluid for the
presence of crystals in an important diagnostic Serologic Test
test in the evaluation of arthritis
o Because of the association of the immune
system to the inflammation process, serologic
testing plays an important role in the diagnosis
of joint disorder
o Arthritis is a frequent complication of Lyme
disease