SEROUS FLUID

- Parietal membrane: lines cavity wall

- Visceral membrane: covers the organs
- Serous Fluid: provides lubrication between membranes

FORMATION
- Hydrostatic pressure: causes fluid to enter
- Oncotic Pressure: favors reabsorption of fluid
- Effusion: increase in fluid

PATHOLOGIC CAUSES OF EFFUSIONS

INC. HYDROSTATIC DEC. ONCOTIC INC. CAPILLARY LYMPHATIC
PRESSURE PRESSURE PERMEABILTY OBSTRUCTION
CHF Nephrotic syndrome Microbial infections Malignant tumors,
Salt and fluid retention Hepatic cirrhosis Membrane inflammations lymphomas
Malnutrition Malignancy Infection and inflammation
Thoracic duct injury

SPECIMEN COLLECTION AND HANDLING

- Thoracentesis: Pleural
- Pericardiocentesis: Pericardial
- Paracentesis: Peritoneal
- >100ml
- EDTA: Hematology
- Heparin or SPS: Microbiology or Cytology
- Plain: Clinical Chemistry
- Ice:ph

TRANSUDATES VS EXUDATES

TRANSUDATES EXUDATES
Appearance Clear Cloudy
Fluid:serum protein <0.5 >0.5
Fluid: serum LD <0.6 >0.6
WCC <1000/ul >1000/ul
Spontaneous clotting No No/Yes
PF Cholesterol <45 to 60 mg/dl >45 to 60 mg/dl
PF:serum Cholesterol <0.3 >0.3
PF:serum Bilirubin <0.6 >0.6
Serum-ascites albumin gradient >1.1 <1.1

PLEURAL FLUID

APPEARANCE DISORDER
Clear, pale yellow Normal
Turbid, white Microbial infection
Bloody Hemothorax (>50%=Hct)
Hemorrhagic effusion, pulmonary embolus,
tuberculosis, malignancy
Milky Chylous material from thoracic duct leakage
Seudochylous material from chronic inflammation
Brown Rupture of amoebic liver abscess
Black Aspergillus
Viscous Malignant mesothelioma

CHYLOUS EFFUSION PSEUDOCHYLOUS EFFUSION

Cause Thoracic duct damage Chronic inflammation
Lymphatic obstruction
Appearance Milky/white Milky/green tinge
Leukocytes Predominantly lymphocytes Mixed cells
Cholesterol crystals Absent Present
 TAG >110mg/dl <50mg/dl
Sudan III Strongly positive Negative/weakly positive

CELLS SIGNIFICANCE
Neutrophils Pancreatitis
Pulmonary infarction
Lymphocytes Tuberculosis
Viral infection
Autoimmune disorders
Malignancy
Mesothelial cells Decreased: Tuberculosis
Plasma cells Tuberculosis
Malignant cells Primary adenocarcinoma and small-cell carcinoma
Metastatic carcinoma
Eosinophils Trauma
Allergic reactions
Parasitic infection

MALIGNANT CELLS
Increased N:C ratio. The higher the ratio, the poorer the cells are differentiated.
Irregularly distributed nuclear chromatin
Variation in size and shape of nuclei
Increased number and size of nucleoli
Hyperchromatic nucleoli
Giant cells and multinucleation
Nuclear molding
Cytoplasmic molding
Vacuolated cytoplasm, mucin production
Cellular crowding, phagocytosis

TEST SIGNIFICANCE
Glucose Decreased (<60mg/dl) in rheumatoid inflammation
Decreased (<60mg/dl) in purulent infection
Lactate Elevated in bacterial infection
TAG Elevated in chylous effusions
Ph (N=.30 less than blood) Decreased in pneumonia not responding to antibiotics
Markedly decreased (6.0) with esophageal rupture
ADA Elevated (>40U/L)in TB and malignancy
Amylase Elevated in pancreatitis, esophageal rupture, and
malignancy

MICROBIOLOGY SEROLOGY
GS/CS ANA: antinuclear antibody
AFB RF: rheumatoid factor
CEA: carcinoembryonic antigen
CA 125: metastatic uterine cancer
CA15-3: breast cancer
CA 549: breast cancer
CYFRA 21-1: lung cancer

PERICARDIAL FLUID
- 10-15ml

APPEARANCE DISORDER
Clear, pale yellow Normal, transudate
Blood-streaked Infection, malignancy
Grossly bloody Cardiac puncture, anticoagulant medications
Milky Chylous and pseudochylous material

TEST SIGNIFICANCE
 Increased neutrophils Bacterial endocarditis
Malignant cells Metastatic carcinoma
CEA Metastatic carcinoma
GS/CS Bacterial endocarditis
AFB Tubercular effusion
Adenosine deaminase Tubercular effusion

PERITONEAL FLUID
- Ascites: accumulation of ascetic fluid
- Peritoneal lavage: detect intra-abdominal bleeding
- RCC >100000/ul: indicative of blunt trauma injuries

APPEARANCE DISORDER
Clear, pale yellow Normal
Turbid Microbial infection
Green/Dark Brown Bile, gallbladder, pancreatic disorders
Blood streaked Trauma, infection, or malignancy
Milky Lymphatic trauma and blockage

TEST SIGNIFICANCE
<300WBC/ul Normal
>300WBC/ul Bacterial peritonitis, cirrhosis
>50% Neutrophils Bacterial peritonitis, cirrhosis
CEA Malignancy of gastrointestinal origin
CA 125 Malignancy of ovarian origin
Glucose Decreased in tubercular peritonitis, malignancy
Amylase Increased in pancreatitis, gastrointestinal perforation
ALP Increased in gastrointestinal perforation
BUN/Creatinine Ruptured or punctured bladder
GS/CS Bacterial peritonitis
AFB Tubercular peritonitis
Adenosine deaminase Tubercular peritonitis