Examination of Body Fluids - Pathology - MLT, ATOT, RDT

Topic: Examination of body fluids, Synovial fluid, Gastric analysis, Sputum examination
Faculty: Pathology
Course: MLT 1st year, ATOT, RDT

1. Examination of Body Fluids Dr. Salman Ansari(MBBS) Tutor, Dept. of Pathology Kanachur Institute of Medical Sciences

2. Examination of body fluids Body fluids - Definition, specimen collection, different types of examination Synovial fluid Gastric analysis Sputum examination

3. Body fluids - definition Definition : “Lubricating fluids present within the body cavities” They include: Pleural - lungs Peritoneal - abdomen Pericardial - heart Synovial - joints Increase in the volume of fluids in these cavities - called “effusion”

4. How to collect the specimen of body fluid? Clean dry container, under aseptic conditions and atraumatically to avoid mixing with blood Test tubes used : For chemical examination: fluoride tube Microscopic examination: EDTA tube Bacteriological examination: plain tube(no anticoagulant)

5. Examination of body fluids Physical examination Chemical examination Microbiological examination Microscopic examination

6. Physical examination Volume Colour: usually clear or straw-yellow Blood-stained: malignancy Turbid/cloudy: due to high cell count or high protein content Chylous: milky appearance - due to high lipid content due to lymphatic obstruction

7. Whether the fluid is transudate or exudate Transudate: non-inflammatory, seen in heart failure, nephrotic syndrome Exudate: inflammatory - in infection/malignancy

8. 2. Chemical examination Protein estimation Helps to differentiate transudate(low protein) from exudate(high protein) Glucose estimation Low glucose suggests bacterial infection, malignancy Amylase levels in ascitic fluid Useful in patients with pancreatic lesions

9. 3. Microscopic examination Differential count : using Neubauer’s chamber and staining with Leishman’s stain or Gram’s stain Cytological examination Smear examination

10. 4. Microbiological examination Culture to identify the organism in case of effusion due to infections

11. Synovial fluid examination

12. Uses To diagnose joint disorders, like: Infective arthritis(septic arthritis, rheumatic) Gouty arthritis Rheumatoid arthritis Degenerative arthritis

13. Sample collection B y needle aspiration from the joint - called arthrocentesis

14. Examination of synovial fluid Physical examination Chemical examination Microbiological examination Microscopic examination

15. Physical examination Appearance Condition Normal Clear, straw coloured, viscous, does not clot Turbid Infection, inflammation, crystals Purulent Septic arthritis Red/brown Hemarthrosis, “traumatic tap”

16. (...cont.)Physical examination Viscosity test: “ String test ” Viscosity is due to hyaluronic acid Decreases in inflammatory joint disorders

17. (...cont.)Physical examination Mucin clot test: If normal synovial fluid is mixed with 20 ml of 5% acetic acid, it forms a firm clot But when hyaluronic acid concentration is low, it fails to form a good clot Poorly formed clot is seen in inflammatory disorders of joint(like tuberculous arthritis)

18. 2. Chemical examination Glucose estimation: Usually 0-10% lower than serum glucose levels Reduced in inflammatory conditions Protein estimation: Usually lower than plasma concentration Increased in: rheumatoid arthritis , septic arthritis

19. 3. Microscopic examination DLC : Neutrophils more than 70% → bacterial infection More lymphocytes and macrophages → osteoarthritis Wet smear examination : Smear is prepared and examined with reduced light under low power objective and then high power objective Urate crystals - seen in gouty arthritis Rhomboid calcium pyrophosphate crystals Cholesterol crystals in rheumatoid arthritis

20. Cholesterol crystals

21. 4. Microbiological examination Synovial fluid culture - in suspected cases of pyogenic/tubercular arthritis

22. Gastric analysis

23. Gastric analysis Lab tests to measure gastric secretions and serum gastrin

24. When to do gastric analysis? Indications : To investigate recurrent peptic ulcer disease To detect Zollinger-Ellison syndrome To find out the cause of raised fasting serum gastrin levels To differentiate between benign and malignant ulcer

25. Zollinger-Ellison syndrome or Gastrinoma

26. When to NOT do gastric analysis? Contraindications : Esophageal stricture/varices Recent history of severe gastric bleed Hypertension malignancy

27. Collection of sample Patient should be fasting overnight - no eating or drinking after midnight Withhold any drugs which affect gastric acid secretion(such as antacids, H2 blockers) Collected using oral or nasogastric tube

28. Gastric analysis Tests for gastric acid secretions Test for intrinsic factor Cytological examination for malignant cells Test for gastrin

29. Gastric acid secretion tests 3 things are measured: BAO(Basal Acid output) : amount of HCl secreted without any stimulation MAO(Maximum Acid output) : amount secreted after stimulation - patient i njected with a drug to stimulate gastric acid secretion - e.g: pentagastrin(peptavlon), histalog(betazole) PAO(Peak Acid Output)

30. For BAO : sample collected every 15 minutes for 1 hour - total of 4 samples For MAO : patient given an injection of pentagastrin s.c/i.m and then sample collected every 15 minutes for 1 hour - total of 4 samples PAO : calculated from 2 consecutive samples showing the highest acid secretion

31. Interpretation High values seen in: Duodenal ulcer Zollinger-Ellison syndrome(gastrinoma) Anastomotic ulcer Low values(achlorhydria) in: Atrophic gastritis(pernicious anemia) Malignant ulcer of stomach

32. 2. Test for intrinsic factor IF is needed for absorption of Vit. B12 from small intestine Schilling test : to detect pernicious anemia

33. 3. Tests for gastrin Serum gastrin levels : by radioimmunoassay High levels seen in: atrophic gastritis, ZE syndrome Gastrin provocation test Done for diagnosing gastrinoma

34. 4. Cytological examination for malignant cells By brushing, lavage, aspirate or biopsy material through endoscopy Smear is prepared and stained and examined for malignant cells

35. Sputum examination

36. Sputum examination Sputum: highly specialised watery, colourless and odorless product of the respiratory tract Saliva + mucus(of airways ) = sputum

37. Sample collection Sputum collection : Early morning sputum sample : best First rinse mouth with water for 10-15 seconds Coughing into a wide mouthed, sterile glass/plastic container with screw cap If unable to get sample by coughing, nebulisation to promote sputum production

38. For TB: 3 samples on 3 consecutive days

39. Sputum examination Physical examination Microscopic examination Microbiological( Culture study)

40. Physical examination Quantity Appearance Colour

41. Physical examination Quantity : Increased and purulent: in bronchiectasis Increased and watery, pinkish colour: in pulmonary oedema Appearance : Normally clear Odour : Foul smelling - in bronchiectasis, lung abscess

42. Different colours of sputum and their causes White, viscid, mucoid Asthma Serous, pinkish, watery Pulmonary oedema Clear/ gray, sticky Chronic bronchitis Yellow(pus) Lower respiratory tract infection Green Long standing infection(Bronchiectasis, lung abscess) Rusty Pneumonia Bright red Pulmonary TB, lung tumours Black(coal dust) Coal workers pneumoconiosis, heavy smokers Anchovy sauce(chocolate brown) Rupture of amoebic liver abscess into lung Blood tinged sputum Lung tumours, TB

43. 2. Microscopic examination “ Sputum smear microscopy ” Procedure : 2-3 smears are prepared on glass slide and stained with Leishman stain Other stains like: - Gram’s stain for microorganisms Ziehl-Neelson stain for acid fast tubercle bacilli Special stains for fungi Papanicolaou stain for malignant cells

44. Cells : Normal sputum consists of few neutrophils, lymphocytes, red cells rarely

45. Cells seen in sputum and their significance Pus cells(neutrophils) Pyogenic infection of respiratory tract Eosinophils Asthma, parasitic infection of lungs Lymphocytes Early pulmonary tuberculosis RBCs Hemorrhage into lungs Heart failure cells(macrophages containing hemosiderin) CVC(chronic venous congestion) lung Anthracotic pigment-laden cells Coal workers’ pneumoconiosis, smoky areas

46. 3. Culture study To identify causative organism

47. For notes, scan: References: Ramadas Nayak - Textbook of Pathology for Allied Health Sciences Questions: [email protected] For PPT, scan: