Fluid Analysis Ascites Pleural effusion Synovial fluid CSF

Fluid Analysis

幾種常見要判讀的體液 Ascites Pleural effusion Synovial fluid CSF (cerebrospinal fluid)

Ascites Analysis Routine tests: Cell count and differential : 1 PMN for 250 red cells/mm 3 Albumin Total protein Culture in blood culture bottle Optional tests Glucose LDH Gram stain Amylase Unusual tests TB smear/culture Cytology Triglyceride Bilirubin

Ascites Analysis 10~20 m. L fluid in 100 m. L blood culture increase culture positive rate. Several m. L of fluid in red-top tube for biochemistry: albumin, total protein, glucose, LDH, amylase, Bilirubin. 1 m. L in puple-top tube for cell count Gram stain

Ascites Analysis SBP(spontaneous bacterial peritonitis) Ascites PMN ≧ 250 cell counts/mm 3 Positive ascites bacterial culture Serum-ascites albumin gradient High SAAG (≧ 1. 1 g/d. L) Cirrhosis Alcoholic hepatitis Congestive heart failure Massive hepatic metastasis Constrictive pericarditis Budd-Chiari syndrome Low SAAG (< 1. 1 g/d. L) Peritoneal carcinomatosis Peritoneal tuberculosis Pancreatitis serositis Nephrotic syndrome

Ascites Analysis Secondary bacterial peritonitis Ascites PMN ≧ 250 cell counts/mm 3 Positive ascites bacterial culture A surgically treatable intraabdominal infection Total protein >1 g/d. L Glucose < 50 mg/d. L LDH > upper limit of normal serum level Amylase increases in pancreatitis or gut perforation Bilirubin level should be checked when ascites reveals brown or dark orange color(>serum level/>6 mg/d. L)

Ascites Analysis The importance between SBP and 2 nd bacterial peritonitis: The mortality of 2 nd bacterial peritonitis approaches 100% if treatment consists only antibiotics with no surgical intervention. The mortality is approximately 80 % if a patient with SBP receives an unnecessary exploratory laparotomy.

Pleural effusion Transudate or Exudate Light’s Criteria: Pleural effusion protein/serum protein ratio > 0. 5 Pleural effusion LDH/serum LDH > 0. 6 Pleural effusion LDH > 2/3 upper limit of normal LDH level. Two-test rule Pleural effusion cholesterol > 45 mg/d. L Pleural effusion LDH > 0. 45 times the upper limit of serum level Three-test rule Pleural effusion protein > 2. 9 g/L Pleural effusion cholesterol > 45 mg/d. L Pleural effusion LDH > 0. 45 times the upper limit of serum LDH level

Pleural effusion Complicated pleural effusion tubal thoracotomy? Complicated parapneumonic effusion p. H < 7. 20 LDH > 1000 Glucose < 40 mg/d. L

Synovial fluid Number of joints Possible problem 1 = monoarthritis Trauma-induced arthritis Septic arthritis Crystal induced arthritis Osteoarthritis (acute) Lyme disease Avascular necrosis tumor 2~3 = oligoarthritis Lyme disease Reiter’s syndrome Ankylosing spondilitis Gonococcal arthritis Acute rheumatic fever > 3 = polyarthritis SLE RA Viral arthritis Chronic osteoarthritis

Measure Normal Noninflammatory Inflammatory Septic Hemorrhagic Volume, <3. 5 m. L (knee) Often > 3. 5 Often >3. 5 Usually >3. 5 clarity Transparent Translucentopaque Opaque Color Clear Yellow to opalescent Yellow to green Viscosity high low Variable WBC <200 200~2000~10000 >100000 200~2000 PMN(%) <25 ≧ 50 ≧ 75 50~75 Culture Negative Often positive negative Total protein 1~2 1~3 3~5 4~6 LDH Very low High Variable similar glucose Equal >25 lower <25 much lower equal bloody