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= body fluids found between serous

membranes (parietal and visceral)
covering of body cavities and
organs(pleural, peritoneal, pericardial)
= provides lubrication, small amount
because production = reabsorption
Formation & Physiology:

= ultrafiltrates of plasma
= produced as an effect of balance between hydrostatic
pressure and oncotic pressure
= disruption of this balance --- EFFUSION
1. increased hydrostatic pressure (CHF)
2. decreased oncotic pressure (hypoproteinemia)
3. increased capillary permeability (inflammation and
4. Lymphatic obstruction (tumors, parasites)
2 Forms:
1. Transudates = 1 and 2 mechanism
2. Exudates = 3 and 4 mechanism
Specimen Collection and
= Method: Needle Aspiration
Thoracentesis = pleural fluid
Paracentesis = peritoneal fluid
Pericardiocentesis = pericardial fluid
= Handling:
EDTA = cell counts and differential counts
Heparinized = chemical, serologic, microbial,
cytologic studies
Refrigerated = pH
Routine Serous fluid Analysis
A. Physical examination D. Microbiology
1. appearance 1. Gram staining
2. volume 2. AFS staining
3. spontaneous clotting 3. Fungal staining
B. Cell count and differential 4. Culture and sensitivity
count E. Cytology
C. Chemistry detn
1. Protein detn
2. LD detn
3. cholesterol detn
4. fluid to blood ratios of
above subs
Pleural Fluid
Pleural Fluid
A. Appearance:
Normal: clear, pale yellow
a. turbid = increase wbc
= infection, malignancies, arthritis
b. milky = chylous material from thoracic
duct leakage; chronic inflx
c. bloody = hemothorax; hemorrhagic
B. Cell Count and differential Count

Cell Clinical significance

Neutrophils Pneumonia, pancreatitis,
pulmonary infarction
Lymphocytes TB, viral infections,
autoimmune disorders,
Mesothelial Normal and reactive forms
cells Decreased assoc with TB
Plasma cells TB, MM
Malignant cells Primary or metastatic
C. Chemistry Test
Test Clinical Significance

Glucose Decreased in inflammation &

purulent infection
Lactate Elevated in bacterial infection

Triglyceride Elevated in hylous effusions

pH Decreased in pneumonia
and esophageal rupture
Amylase Elevated in pancreatitis,
esophageal rupture, malignancy
D. Microbiologic and Serologic
1. Routine
2. Serologic tests:
a. ANA = SLE
b. RF = rheumatoid arthritis
c. CEA = adenocarcinoma
Pericardial fluid
Significance of Pericardial Fluid
Tests Clinical significance
bloody Infection, malignancy, trauma
milky Chylous and pseudochylous
Diff count
neutrophils Bacterial endocarditis
malignant cells Metastatic tumors
CEA Metastatic Ca
Gram stain, C & S Infective endocarditis
AFB stain, TB effusion
Peritoneal Fluid
Significance of Peritoneal Fluid Testing
Tests Clinical significance
green/bilous GB, pancreatic disorders
peritoneal lavage w/ Blunt trauma injury
>100,000 rbc/uL

WBC >500/uL Bacterial peritonitis, cirrhosis

CEA Malignancy (GIT)
CA 125 Malignancy (ovarian)
Amylase Increased in pancreatitis, GIT perforation
ALP Increased in perforation in GIT
BUN/crea Ruptured or punctured urinary bladder
Gram stain; C & S Bacterial peritonitis
AFB stain TB
Adenosine deaminase TB