SEROUS FLUID ➢ Sterile heparinized or sodium polyanethol sulfonate

(SPS) - used for microbiology and cytology

SEROUS MEMBRANES ➢ For better recovery of microorganisms and abnormal
- Closed cavities of the body cells, concentration of large amounts of fluid is
● Pleural performed by centrifugation
● Pericardial ➢ Plain tubes or heparin tubes – on clotted specimens for
● Peritoneal chemistry tests
Parietal membrane​ – lines the cavity wall ➢ Specimens for pH must be maintained anaerobically in
Visceral membrane​ – covers the organs within the cavity ice
SEROUS FLUID
- fluid between the membranes
- provides lubrication between the parietal and visceral
membranes

Formation
Serous fluids
- are formed as ultrafiltrates of plasma
- no additional material is contributed by the mesothelial cells
that line the membranes
Production and reabsorption are subject to​:
● hydrostatic pressure and colloidal pressure (oncotic pressure)

EFFUSION
- Increase in fluid between the membranes due to disruption of
the mechanisms of serous fluid formation and reabsorption
Primary causes of effusions
● Increased hydrostatic pressure = Congestive heart failure
● Decreased oncotic pressure = Hypoproteinemia
● Increased capillary permeability = Inflammation and infection
● Lymphatic obstruction = Tumors
Specimen Collection and Handling
● Thoracentesis = Pleural
● Pericardiocentesis = Pericardial
● Paracentesis = Peritoneal
- Abundant fluid (>100 mL) is usually collected:
➢ EDTA tube - used for cell counts and the differential
General classification of an effusion
● Transudate
- Effusions that form because of a systemic disorder that
disrupts the balance in the regulation of fluid filtration
and reabsorption
● Exudate
- Produced by conditions that directly involve the
membranes of the particular cavity, including infections
and malignancies
 Hematology Tests
- Differential cell count - the most diagnostically significant
Pleural Fluid hematology test performed on serous fluids
- obtained from the pleural cavity, located between the parietal - Primary cells associated with pleural fluid include
pleural membrane lining the chest wall and the visceral pleural macrophages, neutrophils, lymphocytes, eosinophils,
membrane covering the lungs mesothelial cells, plasma cells, and malignant cells. -
- Pleural effusions may be either transudative or exudative ● Macrophages : 64% to 80%
- two additional procedures are helpful when analyzing pleural ● Lymphocytes: 18% to 30%
fluid ● Neutrophils: 1% to 2%
● the pleural fluid cholesterol and fluid:serum cholesterol
ratio
● pleural fluid:serum total bilirubin ratio
- Pleural fluid cholesterol >60 mg/dL or a pleural fluid:serum
cholesterol ratio >0.3 = EXUDATE
- Fluid:serum total bilirubin ratio of 0.6 or more = EXUDATE
 - Gram stains, cultures (both aerobic and anaerobic), acid-fast
stains, and mycobacteria cultures are performed on pleural
fluid when clinically indicated.
- Serologic testing - used to differentiate effusions of
immunologic origin from noninflammatory processes
- Tests for ANA and RF – most frequently performed
- Detection of the tumor markers CEA, CA 125, CA 15.3 and CA
549, and CYFRA 21-1 - provide valuable diagnostic
information in effusions of malignant origin
PLEURAL FLUID TESTING ALGORITHM

Chemistry Tests
- Most common chemical tests performed on pleural fluid are
glucose, pH, adenosine deaminase (ADA), and amylase
Pericardial Fluid
Microbiologic and Serologic Tests
- Only a small amount (10 to 50 mL) of fluid is normally found
- Microorganisms primarily associated with pleural effusions
between the pericardial serous membranes
include ​Staphylococcus aureus​, Enterobacteriaceae,
- Pericardial effusions​ - are primarily the result of changes in the
anaerobes, and ​Mycobacterium tuberculosis
membrane permeability due to infection (pericarditis),
malignancy, and trauma-producing exudates
 - Primary causes of transudates: metabolic disorders (uremia),
hypothyroidism, and autoimmune disorders
- An effusion is suspected when cardiac compression
(tamponade) is noted during the physician’s examination
Peritoneal Fluid
- Ascites​ - accumulation of fluid between the peritoneal
membranes
- Fluid is commonly referred to as ascetic fluid rather than
peritoneal fluid
- Hepatic disorders - frequent causes of ascitic transudates
- Bacterial infections (peritonitis) and malignancy - most
frequent causes of exudative fluids
- Peritoneal lavage - a sensitive test to detect intra-abdominal
bleeding in blunt trauma cases

Laboratory Tests
- Tests are primarily directed at determining whether the fluid is
a transudate or an exudate
- fluid:serum protein and
lactic dehydrogenase (LD)
ratios
- >1000 WBCs/μL with a high Laboratory Tests
percentage of neutrophils - Normal WBC counts: less than 350 cells/μL,
can indicate bacterial - count increases with bacterial peritonitis and cirrhosis
endocarditis - Absolute neutrophil count must be performed to distinguish
- Cytologic examination of - Bacterial peritonitis = >250 cells/μL or >50% of the total WBC
pericardial exudates for the count
presence of malignant cells - Lymphocytes – predominant cell in tuberculosis
is an important part of the Cellular examination
fluid analysis - Examination of ascitic exudates for the presence of malignant
- Cells most frequently encountered: metastatic lung or breast cells is important for detecting tumors of primary and
carcinoma and resemble those found in pleural fluid metastatic origin.
 - Malignancies are most frequently of gastrointestinal, prostate,
or ovarian origin.
- Other cells present in ascitic fluid : leukocytes, abundant
mesothelial cells, and macrophages, including lipophages
- Psammoma bodies
- contain concentric striations of collagen-like material
- can be seen in benign conditions
- are also associated with ovarian and thyroid
malignancies
- Inoculation of fluid into blood culture bottles at the bedside -
increases the recovery of anaerobic organisms
Serologic Tests
● CEA and CA 125​ - is a valuable procedure for identifying the
primary source of tumors producing ascitic exudates
● Presence of CA 125 antigen with a negative CEA - suggests
the source is from the ovaries, fallopian tubes, or endometrium

Chemical Testing
- Consists primarily of glucose, amylase, and alkaline
phosphatase determinations
- ↓Glucose: bacterial and tubercular peritonitis and malignancy
- Amylase - is determined on ascitic fluid to ascertain cases of
pancreatitis
- ↑ALP: highly diagnostic of intestinal perforation
- BUN and Crea: requested when a ruptured bladder or
accidental puncture of the bladder during the paracentesis is
of concern
- Bilirubin – measured when leakage of bile into the peritoneum
is suspected following trauma or surgery
Microbiology Tests
- Gram stains and bacterial cultures (aerobes and anaerobes) -
performed when bacterial peritonitis is suspected