SEROUS FLUID Quick summary for MLT Body fluid lecture

Function of serous fluid is to provide lubrication and eases movement between surfaces

Formation an ultra-filtrate of plasma

o Reflects the contents of plasma w/ no material contributed by the cells of the

membrane

o Production = reabsorption rate

o Hydrostatic pressure of systemic circulation (capillaries) normally drive the

system

o Effusion (escape of fluid into a part) consists of 4 types

Heart pericardial 10-15 ml

Lungs pleural 1-15 ml (<10)

Abdominal peritoneal - <100 ml (30-50)

Peritoneal lavage saline to wash out

o Needle aspiration is needed to diagnose

Effusions can be classified based on the cause of the effusion

o Transudate secondary involvement of membranes, non-inflammatory or

mechanical injury; trans- through or across

Increase in hydrostatic pressure (congestive heart failure)

Decrease in oncotic pressure (hypoproteinemia)

o Exudate primary involvement of membranes; inflammatory or local disease;

ex- away from or out

Increase in capillary permeability

Infection, malignancy, lymphatic obstruction, infarction, rheumatoid

diseases, tumors that cause trauma
 o The differences for patient diagnosis and treatment

Color / Fluid: Total Fluid: WBC / Clot or no

clarity serum protein serum uL clot?
LD Protein
ratio ratio
Transudate Pale < 0.6 < 3.0 < 0.5 < 1,000 No
yellow / g/dL
clear
Exudate Yellow > 0.6 > 3.0 > 0.5 > 1,000 Yes,
to red / g/dL fibrinogen
reduced present
clarity

Effusions can become chylous (milky) due to chylomicrons (lipoprotein particles that
consist of triglycerides, phospholipids, cholesterol, and proteins. They transport dietary
lipids from the intestines to other locations in the body)

o Stains positive for fat globules

o Trauma to thoracic duct or lymphatic obstruction

o PSEUDOCHYLOUS obstructions necrosis

o Triglycerides > 110 mg/dl or over 2X plasma levels can also make it chylous

Specimen collection needle aspiration, EDTA tube for cell counts and diff, can
heparinize, also need a blood sample (because it is an ultra-filtrate)

Appearances and causes

 Pleural fluid Peritoneal fluid Pericardial fluid
(ascites)
Turbidity WBC infection, WBC peritonitis WBC infection
TB, RA or cirrhosis or malignancy
Bloody Traumatic aspiration Trauma, ruptured Trauma, TB,
(run HCT will = liver, spleen malignancy,
CBC) or TB, pericarditis, misuse
pneumonia of anticoagulants
Milky Chylous (lymph Chylous or Lymphatic duct
fluid) or pseudochylous damage, no drain
** Sudan Black pseudochylous (TB,
stain to differentiate RA)
chylous and
pseudochylous
Green Bile
Hematology side

o Cell count hematocytometer

o Differential cytospin w/ Wright stain

o The cells you may see

PMN Lymphs Mesos Malignant Others

Incr due to Incr due to TB o Lines cavities o Defined o Eos think of
infection or malignancy o Fried eggs community SHUNTS
o Can be multi- border o Plasma cells
nuclear o Fused edges o Lipophage
o Windows o 3D shape o Macrophage
present when o Erythrophage
when in grouped (vs
groups flat look of
o N:C ratio mesos)
good/normal o Signet ring
o Nucleus are cells pushes
normal the nucleus
o Grouped cells to the side
have o Cytology
scalloped usually will
edges ID
o Vacuoles may
be present
 but will
overlap the
nucleus (see
malignant
signet rings)

Chemistry

o Pleural fluid chemistry

Significance in Pleural
Glucose (<serum) means TB, RA, malignancy, purulent infection
pH >7.4 malignancies
<7.2 pneumonia
<6 gastric acid (esophageal rupture)
Amylase in pancreatitis, esophageal rupture, malignancy
Lactate in bacterial infection
Triglycerides in chylous effusions
ADA in TB and malignancy
o Peritoneal fluid effusion between peritoneal membranes is called ascites

Significance in Peritoneal
Amylase in pancreatitis, GI perforation
PO4 alkaline in intestinal perforation
BUN, creatinine in ruptured or punctured bladder
Glucose in TB, pregnancy
Transudate Is of hepatic origin
Exudate From bacterial peritonitis from intestinal perforation, ruptured appendix, and
malignancy

o Pericardial fluid

Significance in Pericardial fluid

Clear, pale yellow Normal, transudate
Blood-streaked Infection, malignancy
Grossly bloody Cardiac puncture, anticoagulants
Milky Chylous and pseudochylous
Differential
Increased Neutros Bacterial endocarditis
Malignant cells Metastatic carcinoma
CEA Metastatic carcinoma
(carcinoembryonic
antigen)
Gram stain/ culture Bacterial endocarditis
AFB Tubercular effusion
Adenosine Tubular effusion
deaminase