URINALYSIS AND BODY FLUIDS

(SEROUS FLUIDS)

Dr. Essam H. Jiffri

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 SEROUS FLUIDS

- The closed cavities of the body mammal; the

pleural, pericardial, and peritoneal cavities are
each liner by two membranes referred to as the
serous membranes.

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 SEROUS FLUIDS

- One membrane lines the cavity wall (parietal

membrane), and the other covers the organs
within the cavity (visceral membrane).

- The fluid between the membranes which

provides lubrication as the surfaces move
against each other, is called serous fluid.

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 SEROUS FLUIDS

- Normally only a small amount of serous fluid is

present because production and absorption take
place at a constant rate.

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 Formation

- Serous fluids are formed as ultrafiltrates of

plasma, with no additional material contributed
by the membrane cells.

- Production and reabsorption are subject to

hydrostatic and colloidal (oncotic) pressures
from the capillaries serving the cavities under
normal conditions.

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 Formation

- The greater hydrostatic pressure in the systemic

capillaries on the parietal side favors fluid
production through the parietal membrane and
reabsorption through the visceral membrane.

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 Formation

- Fluids for laboratory examination are collected by

needle aspiration from the respective cavities.

- These aspiration procedures are referred to as:

 thoracentesis (pleural)
 pericardiocentesis(pericardial).
 paracentesis (peritoneal).

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 Formation

- Abundant fluid is usually collected; therefore,

suitable specimens are available for each
section of the laboratory.

- An anti-coagulated specimen is needed for cell

counts, a sterile tube for culture.

- Large volumes of fluid should be prepared prior

to microbiologic and cytologic examinations
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 General Laboratory Procedures

- Routine fluid examination including classification

as a transudate or exudate, appearance, cell
count, differential, chemistry and microbiology
procedures is performed in the same manner on
all serous fluids.

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 General Laboratory Procedures

- Cell counts are usually performed manually using

the Neubauer counting chamber.

- Differential counts are performed on (Wright­stained

smears).

- Any suspicious cells been on the differential should

be referrer to the cytology laboratory or the
pathologist.
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 Summary of Serous Fluid Testing

Pleural Fluid

Normal appearance: Clear, pale yellow

Turbidity: White blood cells and microorganisms
Blood: Traumatic injury, malignancy, traumatic tap
Milky: Chylous or pseudochylous material
Neutrophils: Bacterial infection
Lymphocytes: Tuberculosis, malignancy
Normal glucose: Parallels serum glucose
Low glucose: Tuberculosis, rheumatoid- inflammation, malignancy
Low pH: Tuberculosis, malignancy, esophageal rupture
Elevated amylase: Pancreatitis

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 Summary of Serous Fluid Testing

Pericardial Fluid

Normal appearance: Clear, pale yellow

Milky: Lymphatic drainage
Turbidity: Infection, malignancy
Blood: Tuberculosis, tumor, cardiac puncture
Neutrophils: Bacterial endocarditis
Low glucose: Bacterial infection, malignancy

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 Summary of Serous Fluid Testing

Peritoneal Fluid

Normal appearance: Clear, pale yellow

Turbidity: Peritonitis, cirrhosis
Blood: Trauma
Neutrophils: Peritonitis
Low glucose: Tubercular peritonitis, malignancy
Elevated amylase: Pancreatitis, gastrointestinal perforation
Elevated alkaline phosphatase: Intestinal perforation
Elevated urea or creatinine: Ruptured bladder

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 TRANSUDATES AND EXUDATES

- Many pathologic conditions can cause a buildup

(effusion) of serous fluid.

- A general classification of the cause of the

effusion can be accomplished by separating the
fluid into the category of transudate or exudate.

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 TRANSUDATES AND EXUDATES

- Exudates are produced by conditions that directly

involve the membranes of the particular cavity,
including infections, malignancies and from an
inflammatory process.

- Transudates also can be thought of as resulting

from a mechanical process,

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 TRANSUDATES AND EXUDATES

- A variety of laboratory tests have been used to

differentiate between transudates and exudates,
including appearance, specific gravity, total
protein, lactic-dehydrogenase, cell counts, and
spontaneous clotting.

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 TRANSUDATES AND EXUDATES

- As can be seen using these criteria, one would

expect a transudate to be a clear fluid with a
specific gravity less than 1.015, protein less than
3.0 g per dl, and a lactic dehydrogenase below
200 IU.

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 TRANSUDATES AND EXUDATES

- Traditionally, specific gravity and protein were

considered to be the most valuable criteria for
classification.

- In recent years, the lactic dehydrogenase has

replaced the specific gravity.

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Laboratory Differentiation of Transudates and Exudate

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Transudate Exudate
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Appearance Clear Cloudy

Specific gravity < 1.015 > 1.015
Total protein < 3.0 g/dl > 3.0 g/dl
Lactic dehydrogenase < 200 IU > 200 IU
Cell count < 1000/µl > 1000/µl
Spontaneous clotting No Possible
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