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Cytology of Body Fluid
Cytology of Body Fluid
Cytology of Body Fluid
CAVITY FLUIDS
Pericardial
CAVITY FLUIDS
Sampling techiques appearance during collection EDTA to prevent clotting direct smear delayed processing Cell concentration Protein concentration
Feature
Gross appearance Specific gravity
Transudate
Watery, clear
Exudate
Turbid or cloudy
Protein
Clots cells
No
Usually benign: Few
Yes
More mesothelial cells, or chronic
mesothelial acute
cells,
MODIFIED TRANSUDATE
Moderate protein concentration: 2,52,5- 7,5g/dl Moderate cellularity 1000-7000 cells/ g Cardiovascular disease Neoplastic disease Rupture of urinary bladder Hepatic disease
Tract
Tract
Cavity Tract
Gastrointestinal Effusions
Cerebral
Spinal Fluid
fluid
Amniotic
exam
Microscopic Any
cytology(
Test
SAMPLE COLLECTION
FIXATION
1ml
clotting
N.B.:
Stain
Hx
&E
block for remnant sediment and histopathological
Cell
examination.
Other
confirm diagnosis.
Cell block
Adding plasma and thrombin solution Wrapped in filter paper Placed in a cassette
Embedded in paraffin
Cut and H&E stain
Adequacy: on site Background: necrotic, mucinous Cell concentration: high, low Cell preservation: lysis Inflammatory cells: which? dominant? Lining cells: mesothelial, epithelial Cells of interest: tumor cells
1- CEREBROSPINAL FLUID
Fluid
count
and differentiate cells seen usually are few; increased with viral,
Lymphocytes:
Eosinophils/Basophils:
Plasma cells: not normally present; associated with viral disorders, and Hodgkin's diseases.
CSF EVALUATION
Tube 1-cell count and differential Tube 2-glucose, protein Tube 3-cultures, gram stain, cytology, (HSV PCR, West Nile, India ink, Crypto Antigen, VDRL, Lyme Ab, AFB...) Tube 4-cell count and differential
OPENING PRESSURE
Normal = 80-180 mmHg Obese pts: up to 250mmHg can be normal Pathologically elevated: >250mmHg If elevated, likely due to cerebral edema from intracranial pathology Infection (cryptococcal meningitis), tumor, benign ICH (pseudotumor)
RBCS
Always send tube #1 and #4 for cell count and compare RBCs Traumatic tap: Elev RBC in tube 1, nl in tube 4
SAH or HSV: Elev RBC in tube 1 AND tube 4 Crenated RBCs and xanthochromia (yellow supernatant after centrifuge)
Seen in hyperbilirubinemia (ESLD), old SAH, old blood from prior traumatic LP or bleed
WBCS
Infection! PMN predominance: likely bacterial meningitis Lymphocytic predominance: viral vs. fungal vs. TB vs. malignancy
PROTEIN
Normal: protein is excluded from CSF by bloodCSF barrier Increased: nonspecific Elevated in all infectious meningitis
GLUCOSE
Normal Viral infection Low glucose Bacterial meningitis, TB, fungal Really low <18 is strongly suggestive of bacterial meningitis
Effusion:
Transudate
Exudates
Cells unique to the lungs: Mesothelial cells RBCs and WBCs: are limited, if increased without
WHAT TO ORDER?
Serum LDH, total protein (Add on to am labs) Pleural fluid: Total Protein, LDH Glucose, cell count and diff, pH (on ice) Gram stain, culture, fungal stain and culture, AFB Cytology Other: triglyceride level to r/o chylothorax; amylase to r/o pancreatitis, esoph perf; Adenosine deaminase to eval TB
TRANSUDATE
Result
from imbalances in oncotic and hydrostatic pressure Usually low oncotic +/- high hydrostatic pressure Pulm Edema/CHF Cirrhosis with ascites Hypoalbuminemia/Nephrotic syndrome, ESLD Fluid overload s/p aggressive IVF Peritoneal dialysis
EXUDATE
Caused by local, not systemic, factors Infection Neoplasm Pancreatitis Esoph perf RA SLE Sarcoid, Wegeners, PE, Meigs, Chylothorax
LYMPHOCYTOSIS
Malignancy (50-70% lymphs) Also TB, sarcoid, RA, chylothorax (>90% lymphs)
PLEURAL EOSINOPHILIA
Pneumothorax Hemothorax Pulm infarct Parasitic disease
3- PERITONEAL FLUID
Abnormal
cavity: Ascites
Ascites:
Must have an accumulation of > 100ml (several 100) before effusion can be detected on physical exam.
Removal procedure-
paracentesis
PHYSICAL CHARACTERISTICS
Peritoneal
Total
APPEARANCE OF FLUID
Clearusually indicates uncomplicated ascites, ie liver failure/cirrhosis Turbid/cloudyinfected Pink/bloodytraumatic, punctured collateral vessel, malignancy
SBP
SAAG > 1.1 Suspect if >250 PMNs (>100 PMNs in pt on peritoneal dialysis) 70% GNR (E.coli, Klebsiella) 30% GPC (S. pneumo, Enterococcus) Treat with ceftriaxone, cefotaxime Culture negative SBP if >250 PMNs but cx neg; treat the same
4- Pericardial Fluid
Pericardial
Measure pH: pH less than 7.0 associated with infection or rheumatoid disorder.
5- Seminal Fluid
Examine physical, chemical and microscopic detail Count number of sperm, report morphology and motility
6- Synovial Fluid:
Viscosity test Mucin Clot test Note crystals (intracellular vs. extra cellular)
Slide exam: usually performed on concentration of the fluid using Giemsa or Papnicolaou
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