SEROUS FLUID

 Function
o Lubrication for the movable joints
o Nutrients for articular cartilage: osteoarthritis
o Lessens shock of joint compression
 Formation
o Ultafiltrate of plasma across synovial membrane
o Mo high weight molecules
o Synoviocytes in
 Classification and Pathologic Significance
o Non-inflammatory: degenerative joint disorders, osteoarthritis
o Inflammatory: immunologic disorders, rheumatoid arthritis, sle, scleroderma,
polymyositis, ankylosing spondylitis, rheumatic fever, and Lyme arthritis
o Crystal-induced: gout and pseudogout
o Septic: microbial infection
o Hemorrhagic: traumatic injury, tumors, hemophilia, coagulation disorders, anticoagulant
overdose
 Specimen Collection
o Needle aspiratiom
o Arthrocentesis
o Normal knee fluid: 3.5mL
o Normal fluid does not clot; diseased fluid clot
o Collect in sterile heparinized for micro and liquid EDTA for hema
o Centrifuge non-anticoagulated tubes and separate
o Sodium fluoride for glucose
o Test ASAP to avoid cellular yeis and changes in crystals
 Appearance
o Clear and plae yellow
o Deeper yellow: noninflamm/inflamm
o Green tinge: infection
o Hemorrhagic or traumatic tap: red
o Traumatic tap: look for decreasing blood in
o Crystal induced: milky
 Viscosity
o Hyaluronic acid: essential for joint movement
o Arthritis decresases polymerization of HA
o 4-6cm string from aspirating needle = OK
o Ropes: Mucin clot test
 Add 2-5% acetic acid to form clot
 Rate as good if solid, clear if fair, soft if low, and friable if poor
 Cell Counts
o Cannot use acetic acid because it will form clots
o Use NSS
o May have to treat viscous fluid with hyaluronidase
o Perform in same manner as csf fluid counts
o Normal: < 200 WBCs/uL
 Differential Count
o Incubate with hyaluronidase then cytocentri
o Normal: mono, macro, and synovial tissue cells
o Neutro: <25%
o Lympho: <5%
o All cells may appear more vacuolated
o Other cells:
 LE cells
 Eos
 Reiter cells
 Crystal Indentification
o Imprtant diagnostic test
o Frequently performed
 Type of Crystals
o Monosodium Urate: primary in gout
o CPPD: pseudogout
o MSU: Impaired urine metabolism seen in foods with high purine, leukemia chemo,
decreased renal excretion of uric a
o CPPD: degenerative arthritis, elevated calcium levels
o Hydroxyapatite: cartilage degeneration seen in electron micro
o Cholesterol: SLE and RA appear similar to urine
o Corticosteroid: due to injections
o CaOx: renal dialysis
o Artofacts: starch, powdered anticoagulants, dust and scratches
 Slide Examination
o Examine ASAP
 Because they are found intracellularly and cells disintegrate
o Initial examination is wet preps unstained under low and high power
o Crystals may be seen
o Done under polarized micro
o MSU crystals: needle-shaped, seen in the intra/extracellular cytoplasm
o CPPD crystals: seen in vacuoles of neutro
 Crystal Polarization
o Both MSU and CPPD crystal polarize light
o Compensated Crystal Polarization
 Msu: parallel long axis