SYNOVIAL FLUID “JOINT FLUID”

3. SEPTIC Cloudy yellow- green fluid

● Lubrication in the joints
variable viscosity
● Arthrocentesis → needle aspiration
WBCs 50,000-100,000 ul
SAMPLE ANTICOAGULANT REQUIREMENT neutrophils >75%
decreased glucose level
→ Sterile heparinized tube for gram stain and culture positive culture and gram
stain
→ Heparin or EDTA for cell counts
4. HEMORRHAGIC Cloudy red fluid
→ A non anticoagulated tube for other tests low viscosity
WBCs equal to blood
→ A NaF tube for glucose analysis
neutrophils equal to blood
● discard first 3-5ml → contaminated with maternal blood normal glucose level
tissue fluid and cells
● transport with ice if for phospolipid determination
● performed at 14 weeks gestation
● 15018weeks → genetic and chromosomal studies
IMPORTANT CELLS SEEN IN SYNOVIAL FLUID

SYNOVIAL FLUID ANALYSIS

WBC/mm3 COLOR VISCOSITY

NORMAL <150 COLORLESS/STRAW HIGH

NONINFLAMMATORY <3000 STRAW/YELLOW HIGH

INFLAMMATORY >3000 YELLOW LOW

SEPTIC >50000 PUS/MIXED MIXED

HEMORRHAGIC SIMILAR TO BLOOD RED LOW

CELL COUNTS

SYNOVIAL FLUID CRYSTALS

● Total leukocyte count
● seldom RBC count
● Viscous fluid → ptreat with a inch of hyaluronidase to
0.5ml of fluid or one drop of 0.005% hyaluronidase in
phosphate buffer per ml of fluid → 37c for 5 minutes
● count same manner as CSF
● Diluting fluid : normal saline (0.3%)
● methylene blue : stain WBC nuclei
● Differential count : same with CSF

LABORATORY FINDING IN JOINT DISORDER

GROUP CLASSIFICATION LABORATORY FINDINGS

1. NON- Clear, yellow fluid

INFLAMMATORY Good viscosity
WBC’s <1000 ul
Neutrophils <30%
normal glucose ( similar to
blood glucose)

2. INFLAMMATORY Clodu, yellow fluid

A. immunologic poor viscosity
origin WBCs 2000-75000ul
neutrophils >50%
decreased glucose level
possible autoantibodies
present

B. Crystal - induced origin cloudy or milky fluid

low viscosity
wbc’s up to 100,000 ul
neutrophils <70%
decreased glucose level
crystal present