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Cell count
Cell count
1 mm 1 mm 1 mm
WBC count
Vol 3x3x0.1 mm3 = 0.9 mm3 Cell count a cell/0.9 mm3 1mm3 = (a x 10)/9 Practical (A+B+C+D) (a x 10)/ 4
Cell count
Example
1 mm 1 mm 1 mm
WBC count
A+B+C+D = 200 cell Cell count = (200 x 10)/4
AA
BB
D D
Synovial fluid
Type Appearance Viscosity (string sign) Clot (5%acetic acid) Microscopic WBC, PMN Disease Normal Clear, translucent High >5 cm No lysis <200 50% none Non-inflam Inflam Infect Purulent No viscosity Easy to lysis >50,000 >90% Septic, Crystal induced Minimal turbid Cloudy turbid Low <5 cm Difficult to lysis 200-2,000 50-75% OA AVN Charcots jt Low <5 cm Easy to lysis 2,000-20,000 >75% RA, SLE, SpA, crystal induce
CSF examination
Gross : consistency, color, turbidity Microscopic examination
Cell count Centrifuge
Wrights stain : WBC, RBC, abnormal cell Gram stain AFB mAFB
Normal CSF
clear cell < 5 cells/mm3 ( lymph 100%) open pressure < 200 mm.H2O protein:lumbar < 40, ventricle 5-10mg/dl. glucose : lumbar 50-80% plasma glucose
Trauma??
Three-tube test
Trauma??
1. Normal ratio = RBC/WBC = 500-1000/1
eg. report RBC 140000 WBC 500 cells/mm3 corrected RBC = 140000/500 140000/1000 =140 280 cells/mm3 corrected WBC = 220-360 cells/mm3
Trauma??
correct protein
RBC 1000 cells/mm3 = protein 1 mg/dl.
Test OP
bacterial elevated
viral normal
fungal vary
TB Vary
WBC
protein
low
low
India ink+ve
AFB+ve rare
SAH Test
OP
abscess
Normal to elevation
GBS
normal
early
late
MS
normal
CA
Normal to elevation
elevated
WBC
Few-10 Mono*
5-10
20-300
protein
Normal to elevated
Mono*
Malig cell
CSF/serum sugar
normal
Normal
normal
Normal
others
bloody
Xantho chrome
Cytology +ve
Pleural Effusion
transudate exudate Malignancy Infection GI : pancreatitis CNT :RA, SLE Drug Others eg. asbestos, ARDS, RT
Exudate vs Transudate
At least 1 = exudate 1. Pleural fluid protein / serum protein > 0.5 2. Pleural fluid LDH / serum LDH > 0.6 3. Pleural fluid LDH > 2/3 UNL for serum
Lights criteria
Early empyema ?
Need ICD At least 1 of the followings : 1. Loculated pleural effusion 2. Pleural fluid pH < 7.2 3. Pleural fluid glucose < 60 mg/dl 4. Positive G/S or C/S of fluid
Note
Eo > 10% = eosinophilic pleural effusion
PPEAG :plasma - pleural alb. >1.2
Cause
RA
Exudate/ transudate
exudate
Cell
elevated WBC Mo*
Others
sugar<10 RF-positive unilat (common) moderate effusion low/normal sugar bilat (common) mild effusion ANA-positive low/normal sugar high amylase>160 Somogy unit or >2x serum level** low/normal sugar high amylase>160 Somogy unit or >2x serum level**
SLE
exudate
Esophageal rupture
exudate
Pancreatitis
exudate
Ascites examination
Gross : consistency, color, turbidity Microscopic examination
Cell count Centrifuge
Wrights stain : WBC, RBC, Abnormal cell, LE cell Gram stain AFB mAFB
Ascites Analysis
cause Cirrhosis Neoplasm 2 bac peritonitis SBP TB CHF Pancreatitis Clear, blood, Chylous Straw Turbid, bloody, chylous
0
Cell count RBC WBC L <250 H L L Occ a. H L Vary >1000 >50%=L >10000 >250 =PMN >1000 70%=L <1000 vary
Other
amylase