Body Fluid Analysis

Front 1

Amniotic sac

Back 1

- cushioning medium for developing fetus
- matrix for influx & efflux of materials

Front 2

Amniocentesis

Back 2

- Hemolytic disease
- Fetal lung maturity

Front 3

Obtaining Amniotic fluid

Back 3

- at 14-20 wk gestation obtain fluid & harvest cells of fetal origin
- chromosome abnormalities: Down’s syndrome
- neural tube defects

Front 4

Decrease in serum maternal alpha-Fetoprotein

Back 4

Down syndrome

Front 5

Increase in serum maternal alpha-Fetoprotein

Back 5

neural tube defects

Front 6

Fetal lung maturity (FLM)

Back 6

- Phospholipid quantitation: as aleoveolar cells mature they differentiate
- Type I: gas exchange
- Type II: produce surfactant: Indicated by marked by increases in phospholipid content: Lecithin (phosphatidylcholine, PC)
Phosphatitylglycerol (PG)
- Sphingomyelin (SP): concentration relatively constant
- SP present in amniotic fluid is not derived from the lung

Front 7

Atelectasis

Back 7

- alveolar collapse due to immature lungs
- respiratory distress syndrome (RDS), hyaline membrane disease
- > 1500 infant deaths in U.S./yr
- Treat: mechanical ventilation, O2, and intratracheal surfactant administration
- FLM testing assists in perinatal survival: in utero and nursery

Front 8

Fetal lung maturity testing

Back 8

1.) Phosthatidylglycerol (PG)
2.) S/A ratio: surfactant/albumin
3.) L/S ratio: Lecithin/spingomyelin
4.) Lammelar body counts

Front 9

Phosthatidylglycerol (PG)

Back 9

- most common qualitative, agglutination method
1) TLC
2) rapid slide method: PG agglutinates particles coated with a PG binder
- Agglutination = mature
50% of negative results are also mature
- No useful info.
- Need for quantitation

Front 10

S/A ratio: surfactant/albumin

Back 10

- Performed by fluorescence polarization
- Fl labeled PC reagent dye: Dye binds to surfactant, producing low polarization and dye binds to albumin producing high polarization
- Meconium and blood (> .5%) can interfere with testing
- Diabetes does not affect interpretation
- >50 mg/g high risk pregnancy: Higher cutoff when not high risk

Front 11

L/S ratio: Lecithin/spingomyelin

Back 11

- Lecithin = phosphatidyl chloline
- TLC
- > 2.0 = mature
- > 3.0 if mother is a diabetic: Diabetic mothers with a ratio of 2.0, more likely to deliver a baby with RDS
- Fluid contamination with blood (L/S ~ 1.5-2.0)
- High L/S can be reported
- Very low L/S may also be reported

Front 12

Lammelar body counts

Back 12

- Platelet channel of a hematology cell counter
- 2-20 fL
- Requires non-contaminated uncentrifuged specimen
- surfactant phopholipid packets

Front 13

Cerebrospinal fluid: CSF

Back 13

- Normally 150 ml of CSF bathes the ventricles of the brain and spinal cord
- Lumbar puncture: L3-L4
- Tubes numbered 1-3 or 1-4
- Order of draw: 3, 4 least contaminated by cells if intervening tissue
- Perform analysis immediately
- Analyzed for: CNS Infection (meningitis), hemorrhage, and demyelinating disease
- Tube distribution
1) chemistry
2) microbiology
3) hematology

Front 14

Visual exam of CSF

Back 14

- Normally clear, colorless
- Presence of blood: 1) traumatic tap where decrease in quantity in each tube: 1 to 3
2) hemmhorage: homogenous when drawing tube
- Hemoglobin pigments: Xanthochromia (yellow) and Subarachnoid hemmorrhage at least 2 hr earlier:(r/o hyperbilirubinemia > 20 mg/dL)

Front 15

CSF Glucose

Back 15

- > 45 mg/dl, ~2/3 of plasma [glucose]
- decreased “hypoglycorrhachia”
- glucose consumption: organisms (meningitis)
bacterial,amebic,fungal, trichinotic
- CNS tumor
- glucose and lactate determinations: increased lactate with decreased or normal glucose indicates bacterial (vs viral) meningitis

Front 16

CSF Protein

Back 16

- 0.5% of [plasma]
- decrease: (most common) tear in dura, otorrhea, rhinorrhea
- leached fluid contains protein

Front 17

Causes of increased protein in CSF

Back 17

- traumatic tap (blood)
- bacterial, fungal infections
- cerebral hemmorrhage
- local synthesis (intrathecal) production of IgG
- herniated disc
- increased permeability of blood brain barrier due to high intracranial pressure

Front 18

Permeability of the Blood Brain Barrier

Back 18

- CSF albumin/serum albumin index
- < 9, intact barrier
- Increased permeability: 9-14, slightly impaired
: 14-30, moderately impaired
: >100, complete breakdown

Front 19

Intrathecal IgG production

Back 19

1) CSF IgG, CSF albumin ratio
- > 0.27; indicates increased synthesis
- 70% of MS cases
2) CSF IgG Index: 0.30-0.70
- Above upper limit in ~80% MS cases
3) IgG Synthesis rate: –9.9 to +3.3 mg/D, with values > 8 considered increased
- Most cases MS have a result > 8 mg/D
- Utilizes Tourtellotte’s formula

Front 20

Oligoclonal banding

Back 20

- CSF electrophoresis
- look for bands in gama region
- support diagnosis of multiple sclerosis

Front 21

CSF test to support diagnosis of multiple sclerosis

Back 21

1.) Increased CSF IgG
2.) Oligoclonal banding electrophoresis

Front 22

Multiple sclerosis disease exacerbations

Back 22

- Myelin basic protein
- < 4 ng/mL: remission
- 6-16 ng/mL: mild
- 17-100 ng/mL: active

Front 23

Cystic Fibrosis (CF) Screen

Back 23

- Sweat test: Cystic fibrosis screen
- CF: autosomal recessive exocrine gland disorder
: electrolyte and mucous secretory defects
- Chloride impaired reabsorption by body tissues
- Method: collect sweat by pilocarpine nitrate iontophoresis
- Cl > 60 mmol/L = positive

Front 24

Synovial Fluid

Back 24

- Normal: pale yellow, viscous, nonclotting
- Glucose: synovial fluid/plasma 0.9/1
- decreased in gout, rheumatoid arthritis, SLE, and infection
- Microscopic: Uric acid vs CPPD crystals
- Gout vs Pseudogout: Compensated polarization

Front 25

Qualitative tests of hyaluronic acid content

Back 25

1) Mucin clot formation, “rope test”
2) Viscosity
- Both decreased infection and inflammatory conditions

Front 26

Serous fluids

Back 26

1.) Pleural
2.) Peritoneal
3.) Pericardial

Front 27

Effusion

Back 27

- an increase in fluid volume

Front 28

Pleural Fluid

Back 28

thoracentesis

Front 29

Peritoneal Fluid

Back 29

- paracentesis
- Effusion: >50ml
- ascites: too much peritoneal fluid

Front 30

Transudate

Back 30

- fluid which has passed through a membrane which possesses normal permeability
- low cell count, low protein content (albumin), low specific gravity, <1.012

Front 31

Exudate

Back 31

- a consequence of altered permeability of small blood vessels
- high cell count, high [protein]
- may be purulent (inflammatory process)
- SpGr. > 1.020
- F/P ratios: total protein >0.5, LD >0.6
- pH < 7.2: supports diagnosis of infection
- pH >7.4: supports a diagnosis of malignancy

Front 32

Laboratory testing for assessment of fetal lung maturity is base on:
A.) differentiation products of type I pneumocytes
B.) production of acetylcholinesterase
C.) production of AFP
D.) products of type II pneumocytes
E.) presence of meconium

Back 32

D.) products of type II pneumocytes

Front 33

Amniotic fluid:
A.) provides a cushion for the fetus
B.) is a mixture of maternal and fetal fluids
C.) is assessed by umbilical catheterization
D.) A and B
E.) A, B, and C

Back 33

D.) A and B

Front 34

Lamellar body counts reflect:
A.) platelet count of the fetus
B.) platelet count of the mother
C.) meconium count of the fetus
D.) surfactant phospholipid packets
E.) all of the above

Back 34

D.) surfactant phospholipid packets

Front 35

Blood in CSF is commonly observed after:
A.) administration of indocyanine green
B.) traumatic tap
C.) hemolytic anemia
D.) lumbar puncture
E.) low pH

Back 35

B.) traumatic tap

Front 36

CSF glucose is measured to access:
A.) transport efficiency
B.) diabetes
C.) traumatic tap
D.) hemochromatosis
E.) infection

Back 36

E.) infection

Front 37

Increased CSF protein is pathognomonic for:
A.) multiple sclerosis
B.) collagen vascular disease
C.) fungal infection
D.) all of the above
E.) none of the above

Back 37

D.) all of the above along w/ CNS tumor presence, bacterial infection, and traumatic tap

Front 38

CF is characterized by:
A.) elevated sweat chloride levels
B.) homozygous expression of an autosomal recessive trait
C.) pancreatic insufficiency
D.) all of the above
E.) A and C only

Back 38

D.) all of the above

Front 39

Synovial fluid:
A.) is formed by plasma ultrafiltration
B.) lubricates the pnemocytes
C.) is rich in hyaluronic acid
D.) all of the above
E.) A and C only

Back 39

E.) formed by plasma ultrafiltration and rich in hyaluronic acid

Front 40

Serous fluids:
A.) are derived from serum
B.) provide lubrication and protection
C.) fill the potential space
D.) all of the above
E.) A and B only

Back 40

D.) all of the above

Front 41

Analysis of paracentesis fluid is performed to:
A.) determine cause of fluid presence
B.) assess infection risk
C.) determine lung involvement
D.) all of the above
E.) A and B

Back 41

E.) determine cause of fluid presence and assess infection risk

Front 42

The most common cause of ascites is:
A.) portal hypertension
B.) venous return
C.) parietal cell differentiation
D.) eccrine infection
E.) type A cell leakage

Back 42

A.) portal hypertension