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URINALYSIS AND BODY FLUIDS (SEROUS FLUIDS)

Dr. Essam H. Aljiffri

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.

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.

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.

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.

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).

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 (Wright stained 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/l > 1000/l Spontaneous clotting No Possible _______________________________________________
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