Chapter 7 Examination of cerebrospinal fluid and serous membrane fluid

examination of cerebrospinal fluid (CSF)

General property: normal CSF is colorless and

transparent watery fluid. In abnormal status , the general property of CSF is changed as follows: yellow CSF: obsolete intracranial hemorrhage purulent CSF: pyogenic meningitis reddish or bloody CSF : intracranial hemorrhage or subarachnoid hemorrhage

Chemical examination:

Protein : Pandy test: (-) or 0.2~0.4 g/ L

elevated protein: purulent meningitis, tubercular meningitis, viral meningitis Glucose : 2.5~4.5 mmol / L increased glucose: purulent tubercular meningitis Chloride: 119~129 mmol/ L Ddecreased chloride: tubercular meningitis, purulent meningitis meningitis,

Microscopic test :
Total cell count: 0~8106/ L

DC: lymphocyte , neutrophil granulocyte

tubercular meningitis: < 500106/L (lymphocyte)

purulent meningitis:
viral menintitis: meningeal leukemia :

> 1000106 /L(neutrophil)

<100 106 /L (lymphocyte)

Examination of serous membrane fluid(SMF) General property Chemical examination Microscopic test Bacteriology

The main differential points of transudate and exudate

transudate quality non-inflammatory exudate inflammatory, tumorous

general property
color light yellowish dark yellow, bloody, purulency transparency coagulability specific gravity transparent < 1.018 cloudy + > 1.018

chemical examination Rivalta test +

protein glucose cell count DC tumor cell

< 25g/L same as blood < 100106/L lymphocyte negative negative

> 30 g/L lower than blood > 500106/L neutrophil or lymphocyte can be found positive ( infectious case)

bacteriological test

Case analysis

History and physical examination: A 28-yearold male was admitted to the hospital because of fever, cough , shortness of breathe and chest pain. After X-ray examination, he was found medium pleural effusion in his right thoracic cavity. In second day , pneumothorax puncture was operated and pleural effusion was examined . Laboratory data: Hb 11g/L, WBC 8109/L, PC 120109, the color of the effusion is yellow and cloudy, SG 1.025, rivalta test (+), protein 45g /L, glucose was apparently lower, cell count: 800106/L, DC lymphocyte.

Question
Please judge the quality of pleural effusion in this case. What is probably diagnosis for this patient? And why?