occurs in cardiac ascites, sinusoidal obstruction syndrome, or early Budd-Chiari

syndrome.

3. Albumin level

Compare with serum albumin level (SAAG)

4. Glucose level

Low in bacterial and tuberculosis peritonitis, pancreatic peritonitis

Cell count and differential

A normal leukocyte count (<250-500 cells/µl) is seen in cirrhosis, nephrosis and

congestive heart failure

Elevated leukocyte count: predominant

polymorphonuclear neutrophiles: bacterial peritonitis; predominantly lymphocytes:

tuberculous peritonitis: also suggests bowel perforation from the paracentesis needle.

SBP is defined by a polymorphonuclear neutrophil (PMN) count of 250/mm3 in the

ascitic fluid.

6. Gram and acid fast staining

7. Culture, with ascetic fluid inoculated directly into blood culture bottles

8. Cytologic examiniation - looking for malignancy

SERUM ASCITES ALBUMIN GRADIENT

Serum albumin concentration – ascitic fluid albumin concentration

SAAG ≥ 1.1 g/l indicates portal hypertension as the cause of ascites

• Cirrhosis

• usually the paracentesis fluid may be removed directly from the patient’s dialysis
catheter)