Body fluids, hematology, CSF
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| 5 types of body fluids | 1. Pleural
2. Peritoneal
3. Pericardial
4. CSF
5. Synovial
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| Pleural fluid 1. Anatomic site. 2. procedure | 1. Pleual cavity 2. Thoracentesis
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| Peritoneal fluid 1. Anatomic site. 2. procedure | 1. Peritoneal cavity 2. Paracentesis
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| Pericardial fluid 1. Anatomic site. 2. procedure | 1. Pericardial cavity 2. Pericardial aspiration
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| Synovial fluid 1. Anatomic site. 2. procedure | 1. Joint space 2. Joint aspiration (arthrocentesis)
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| CSF 1. Anatomic site. 2. procedure | 1. Spinal cord 2. Spinal tap, lumbar puncture
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| What 2 body sites normally contain fluids? | 1. CNS 2. Joint spaces
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| Name pleural lining that covers the lung. | Visceral pleura.
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| Name the lining that covers the inside of the chest wall | Parietal pleura
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| Ascites | Fluid accumulation in peritoneal cavityt.
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| What 4 organs are covered by peritoneal lining? | 1. Pancreas; 2. Duodenum; 3. Some lymph nodes; 4. Abdominal aorta.
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| 2 layers of peritoneal lining. | 1. Mesothelial cells layer; 2. Submesothelial connective tissue.
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| What is pericardium? | A thin membrane that covers pericardial cavity.
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| Cardiac tamponade. | Fluid accumulates in pericardial sac restricting the normal heart beat.
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| 6 layers that cover brain | 1. Pia mater;
2. Subarachnoid space;
3. Arachnoid mater;
4. Subdural space;
5. Dura mater;
6. Scull
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| The meninges consists of... | 1. Dura mater; 2. Arachnoid mater; 3. Pia mater.
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| What produces CSF? | Coroid plexus cells and ependymal lining cells found in the ventricles.
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| What space does CSF occupy? | Subarachnoid space between the arachnoid mater and pia mater.
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| Total volume of CSF: 1. in adults; 2. in neonates. | 1. 90 - 150 ml; 2. 10 - 60 ml
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| Rate of CSF production | 21 ml/hour
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| Special tissue cells in body fluids: 1. Pleural; 2. Peritoneal; 3. Pericardial; 4. Synovial; 5. CSF. | 1 - 3 Mesothelial cells;
4. Synovial cells + hyaluronic acid;
5. Choroid plexus cells & ependymal cells.
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| In what 3 fluids we can see neutrophils? | 1. Pleural; 2. Peritoneal; 3. Pericardial.
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| 3 types of lymphocytes in body fluids | 1. Small; 2. Large; 3. Reactive
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| Increased number of basophils can indicate… | Myloproliferative disorders
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| Syncytium | In CSF, cluster of arachnoid cells with a mass of cytoplasm containing several nuclei.
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| Cytocntrifuge artifact in neutrophils | Peripheral localization of nuclear lobes
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| 3 cytocentrifuge artifacts in lymphocytes. | 1. More prominent nucleoli;
2. Cytoplasmic projections;
3. Irregular shaped nucleus.
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| What lining produces pleural, pericardial and peritoneal body fluids? | Parietal
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| What lining absorbs pleural, pericardial and peritoneal body fluids? | Visceral
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| 4 factors affecting body fluid formation. | 1. Capillary hydrostatic pressure;
2. Plasma oncotic pressure;
3. Lymphatic resorption;
4. Capillary permeability.
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| Effusion | Abnormal fluid accumulation in pleural, pericardial and peritoneal spaces.
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| Transudate accumulates due to…. 2 examples of conditions. | A systemic disease state :
1. Increased capillary hydrostatic pressure in congestive heart failure;
2. Decreased plasma oncotic pressure due to hypoproteinemia of nephrotic syndrome or liver failure.
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| Exudate accumulates due to… | A primary pathologic state of the area.
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| Chylous effusion. 3 characteristics. | 1. Milky, opaque appearance.
2. High triglycerides (> 110 mg/dl);
3. Lymphocytes are predominant
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| Chylous effusion is a result of.. | Chylous effusion is a result of.. Leakage of lymphatic vessels due to malignancy or trauma.
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| Pseudochylous effusion is a result of… | Chronic effusion due to tuberculosis and rheumatoid arthritis.
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| Pseudochylous effusion. 2 characteristics. | 1. Triglycerides <50 mg/dl
2. Mixed reactive, inflammatory and necrotic cells.
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| 4 nonspecific reactive changes in mesothelial cells | 1. Multiple nuclei;
2. Nucleoli;
3. Mitotic activity;
4. Increase cell size.
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| Traumatic tap vs CNS hemorrhage. | Traumatic tap: RBCs in the 1st tube>> RBCs in the last tube collected
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| Xantochromia. What does it indicate? | Pink to orange CSF. Indicates true CNS hemorrhage.
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| What is definitive sign of CNS hemorrhage (on cellular level)? | Erythrophagocytosis by histiocytes.
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| How long does it take for histiocytes to phagocyte erythrocytes? | 18 hours after CNS hemorrhage.
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| What is an indicator of old (>18 hours) CNS hemorrhage? | Presence of hematoidin crystals.
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| Transudate. Specific gravity | <1.015
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| Transudate.Total protein | <3.0 g/dl
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| Transudate.Fluid:serum protein ratio | < 0.5
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| Transudate.Lactate dehydrogenase fluid:serum ratio | < 0.6
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| Transudate.WBC count | < 1000/ ul
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| Exudate. Specific gravity | >1.015
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| Exudate. Total protein | > 3.0 g/dL
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| Exudate. Fluid:serum protein ratio | > 0.5
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| Exudate. Lactate dehydrogenase fluid:serum ratio | > 0.6
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| Exudate. WBC count | > 1000 /ul
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| What is the most common microorganism seen in CSF? | Cryptococcus
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| Hyaluronic acid | Mucopolysaccharide secreted by synovial cells.
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| CSF. Slightly hazy. Dilution. | 1:10 (30μl of sample + 270μl)
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| CSF. Hazy. Dilution | 1:20 (30 μl of sample + 570μl)
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| CSF. Slightly cloudy. Dilution | 1:100 (30 μl of sample + 2970μl)
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| CFS. Slightly bloody. Dilution | 1:200 (30 μl of sample + 5970μl)
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| CSF. Cloudy, bloody, turbid. Dilution | 1:10,000 (0.1 ml of a 1:100 dilution + 9.9ml)
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| Bacterial meningitis. 6 CSF findings. | 1.↑ WBC
2. Neutrophils
3. ↑↑ Protein
4. ↓↓ Glucose
5. Lactate > 35 mg/dl
6. Pos. Gram stain
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| Viral meningitis. 5 CSF findings. | 1.↑ WBC
2. Lymphocytes
3. mod.↑ protein
4. normal glucose
5. Normal lactate
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| Tuberculosis. 5 CSF findings. | 1.↑ WBC
2. Lymphocytes and monocytes
3. ↑ protein
4. ↓ glucose
5. lactate > 25 mg/dl
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| Fungal meningitis. 6 CSF findings. | 1.↑ WBC
2. lymphocytes and monocytes
3. ↑ protein
4. normal/↓ glucose
5. lactate > 25 mg/dl
6. pos. India ink
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| Pleural fluid. Clear, pale yellow. | Normal
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| Pleural fluid. Turbid white. | Microbial infection (tuberculosis).
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| Pleural fluid. Bloody. | Hemothorax. Hemorrhagic effusion.
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| Pleural fluid. Milky. | Chylous or pseudochylous effusion.
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