Fluid Dr 6th Sem

FLUID D/R

NUDRAT JAWEDBSMT 3rd YEAR 5th

SEMLNH

CONTENTS

• Introduction• Types of fluids• Collection & transport of fluid• Analysis of fluid

• Physical Appearance• Specific Gravity• Protein• Glucose• Cell Count (RBCs, WBCs, Mono & poly’s %.

INTRODUCTION

Fluids are tested instead of blood because they can give more direct answers to what may be going on in a particular part of the body or in diagnosis of many pathological conditions. These fluids are;• CSF• Pleural fluid• Pericardial fluid• Peritoneal fluid• Synovial fluid

CEREBROSPINAL FLUID (CSF)

• CSF is produced by the choroid plexus, present within the brain & around the brain & the surface of the spinal chord.

• It protects & provide cushion to the brain.

• It is clear & colorless.• Its level in adults is about 150 ml &

in neonates is about 60 ml.• It is collected by lumber puncture.

PURPOSE

The purpose of a CSF analysis is to diagnose medical disorders that affect the central nervous system. Some of these conditions are as follows:

• Meningitis & encephalitis • Metastatic tumors (e.g., leukemia) • Syphilis • Guillain-Barré syndrome• Multiple sclerosis

LUMBER PUNCTURE

PLEURAL FLUID

• The pleura is thin double layered lining which separates the lung from the chest wall. There is space in between two layers which is called pleura space & it contains pleural fluid.

• It is straw yellow & clear.• Normally < 20 ml is present in the

body.• It is collected by the process

called thoracentesis.

THORACENTESIS

PERICARDIAL FLUID• Surrounding the heart is a sac

known as the pericardium. It is the serous visceral pericardium that secretes the pericardial fluid into the pericardial cavity, (the space between the two pericardial layers).

• It reduces the friction by lubricating the pericardium.

• It is clear & straw colored.• Normally 15-50 ml fluid is present.• It is collected by pericardiocentesis.

MRI OF PERICARDIAL EFFUSION

PERICARDIOCENTESIS

PERITONEAL FLUID• A liquid that is made in the abdominal

cavity to lubricate the surface of the tissue that lines the abdominal wall and pelvic cavity and covers most of the organs in the abdomen.

• Also called ascitic fluid.• It is clear & pale yellow.• It is about 10 ml present in the peritoneal

cavity.• It is collected by the process called paracentesis.

PARACENTESIS

PURPOSESerous effusions are of two types;• TRANSUDATES

End stage of liver diseases, nephrotic syndrome, protein losing enteropathy, hypoproteinemia of any cause & glomerulonephritis, etc.

• EXUDATES

Pneumonia, malignancy, pancreatitis, pulmonary tuberculosis, ovarian neoplasm, etc.

SYNOVIAL FLUID

• The joints are lined by synovial membrane & synovial cells. The cavity in between the membrane is called synovial cavity which contains synovial fluid.

• It lubricates the joints space & provide nutrient to the articular cartilage.

• It is straw colored, clear & viscous.• Normally it is about 0.15-3.5 ml present.• Method of collection is called arthocentesis.

PURPOSE

Synovial fluid is collected for the diagnosis of;• Arthritis• SLE• Gout• Inflammation of synovial linings

ARTHOCENTESIS

COLLECTION & TRANSPORT OF FLUID

• CSF = not < 1.5 ml• SEROUS FLUID = not < 2 ml• SYNOVIAL FLUID= not <1 ml

• TRANSPORT :• Usually fluid is received in syringes

or without anticoagulant tubes.• If received in anticoagulant , it

should be in sodium heparin or liquid EDTA.

ANALYSIS OF FLUIDS

PHYSICAL APPEARENCE

• VOLUME• If sample in syringe, read the marking• If in tube, make an estimation• Report in ml

• COLOR• May be light yellowish, yellowish,

brownish, reddish or colorless.

• TURBIDITY• May be slightly turbid, turbid or clear.

SPECIFIC GRAVITY

Specific gravity denotes the dissolved substances in fluid. Refractometer is used for measuring specific gravity. • Pour 50μl sample on the screen of

refractometer & close the roof.• Read the value of scale which is marked

on eye piece.

PROTEIN & GLUCOSE

Concentration of protein & glucose in fluids are analyzed

by means of analyzer in biochemistry department.

CELL COUNT (RBCs & WBCs)

• EQUIPMENT & REAGENTS• Capillary tube • Neubauer chamber & cover glass• Microscope• For RBC dilution = Formal citrate• For WBC dilution = Turk’s solution

HOW TO DECIDE FOR DILUTION

• To decide for dilution, always charge the neubauer chamber with undiluted sample.

• Focus the one large square (1 WBC) area under microscope.

• See whether cells are overlapping or not I.e.dilution required or not.

• Never make an idea for dilution by physical appearance of fluid.

DILUTION FOR RBC

RATIO

QUANTITY OF REAGENTS M.FACTOR

1:2 0.1 FLUID + 0.1 FORMAL CITRATE

20

1:10 0.1 FLUID + 0.9 FORMAL CITRATE

100

1:20 0.05 FLUID + 0.95 FORMAL CITRATE

200

1:40 0.05 FLUID + 1.95 FORMAL CITRATE

400FORMULA = no. of counted RBCs x multiplying factor

DILUTION FOR WBCs

RATIO QUANTITY OF REAGENTS M.FACTOR

1:2 0.1 FLUID + 0.1 TURK’S SOLUTION

05

1:10 0.1 FLUID + 0.9 TURK’S SOLUTION

25

1:20 0.01 FLUID + 1.9 TURK’S SOLUTION

50

1:40 0.1 FLUID + 3.9 TURK’S SOLUTION

100

FORMULA = no. of counted WBCs ( L1 + L2 + L3 + L4) x multiplying factor

HOW TO USE NEUBAUER CHAMBER

• WBCs are counted in 4 corner squares.

• RBCs are counted in middle area which has 25 small squares.

SLIDE PREPARATION

• Make a smear of fluid on slide• After the smear dried, fix it in 70 %

ethanol.• Stained with H&E.• Examine the slide under microscope

(mono’s & Poly's %).