pleuralfluid-210317131800 (1).pdf 123456

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1. Ms AnkitaR Bhatiya
Assistant Professor
Shree P.M.PatelCOLLEGE OF
PARAMEDICAL SCIENCE N
TECHNOLOGY

2. It include:
1.What is Pleural fluid?
2.Function of Pleural fluid.
3.Collection of Pleural fluid.
4. Examination of Pleural fluid.

3. Introduction:
It is fluid which is present in the pleural cavity of
lungs b/w parietal pleura n visceral pleura.
The pleural cavity is a potential space lined by
mesotheliumof the visceral n parietal pleura.
Pleural fluid Formation:
Pleural fluid is a selective ultrafiltrateof plasma.
Small amount of the Pleural fluid is also formed
from the cells lining the pleura and other by capillaries.
There is about 60-70 ml of pleural fluid at any one time
and about 125 ml is generated every day.

4. Composition of Pleural fluid:
oVolume: 60-70 ml
oCell/mm
3
:1000-3000
Mesothelialcell :60%
Monocyte:30 %
Lymphocyte: 5%
Neutrophil: 5%
oProtein: up to 3 gm/dl
oGlucose: Same as plasma
oLDH:70-140 U/L

5. Function of Pleural fluid:
Protection: It helps to protect the lungs from the
sudden injury n damaged.
Also acts as a medium for the transfer of
substances from the lung tissue to blood .
Nutrition :
Removal of waste :
Lubrication :

6. Collection of Pleural fluid:
Throracentesisis a process by
which pleural fluid is collected.
A needle is placed through the
skin and muscles of the chest wall into
thepleuralspace.

7. Indication of Pleural fluid:
1.Infections: Tuberculosis, Pneumonia (Bacterial,viral,fungal)
2. Neoplasm: Bronchogeniccarcinoma, Metastatic carcinoma,
Lymphoma, Mesothelioma
3. Pulmonary infract
4.Non infections non inflammatory disease:
Rheumatoid disease
Systemic lupus erythreomatous
5. Extra pleural sources:
Pancreatitis
Ruptured esophagus
Urinithrorax

8. Procedure:
1.Take consent of a patient.
2.Position of patient: The patient is sitting in an upright
position with arms & head extended to over bed table.
3.Proper aseptic precautions are taken
with the help of spirit –iodine-spirit.
4.Before puncture give injection of atrophin
intramuscularly to prevent vasovagalshock.
5.Give xylocaneinjection as local anesthesia before puncture.

9. 6.Then insert the needle b/w intercostalspace & allow the fluid to flow
in container.
7. Pleural fluid is collected in 3 tubes:
1. EDTA Bulb: Cell count n differential count.
2. FlourideBulb: For glucose examination.
3. Plain Bulb: Chemical n immunology study

10. Examination of Pleural fluid:
1.Physical examination:
2.Chemical examination:
3.Microscopic examination:

11. Physical examination of Pleural fluid:
1.Volume:
Normally: 60 to 70 ml
Transudates–100 to 150 ml
Condition: Increase hydrostatic pressure
Decrease plasma oncoticpressure
Congestive heart failure
Hepatic cirrhosis
Hypoproteinemia
Exudates–More than 150 ml
Condition: Pneumonia( Bacterial, Viral,Fungal)
Tuberculosis
Bronchogeniccarcinoma, Metastatic carcinoma,
Lymphoma, Mesothelioma
Pulmonary infract
Rheumatoid disease
Systemic lupus erythreomatous
Pancreatitis, Ruptured esophagus,Urinithrorax

12. 2. color:
Normally: colorless
Transudates: Pale yellow or straw clr
Exudates:
Reddish: Presence of blood (Bacterial
pneumonia, Cancer, Pancreatitis.)
Green; Pseudochlyouseffusion.

13. 3.Appreance:
Normally: Clear or transparent
Transudate: Clear or transparent
Exudate:
Turbid: Bacterial n viral Pneumonia,
Tuberculosis, Pancreatitis
Cloudy: Bacterial n fungal pneumonia
Purulent: Bacterial Pneumonia
Milky :Chylouseffusion

14. 4. Clot:
Normally: absent
Transudate: absent
Exudate: Present
TuberculousPeunomia
5,Specific gravity:
Transudate: below 1.010
Exudate: above 1.010
Pneumonia( Bacterial, Viral, Fungal)
Cancer
Pancreatitis
Rheumatoid pleuritis

15. Chemical examination of Pleural fluid:
1.Glucose:
Normal range: same as blood glucose
Transudate: same as blood glucose
Exudate: slightly reduce
Method:
1.Visualised method
Benedict test
2.Colorimetric method
GOD-POD
Condition for decrease glucose:
Bacterial pneumonia
Viral pneumonia
Fungal pneumonia
Pancreatitis
Tuberculosis
Rheumatoid pleuritis
Esophagausrupture
Cancer

16. 2. Protein:
Normal range: 6-8gm/dl
Transudate: below 3 gm/dl
Exudate: Above 3 gm/dl
Method:
1.Turbidometric method method
SSA
Heat n acetic acid
2.Colorimetric method
Biuret
Condition for Increase protein:
Pneumonia(Bacterial, fungal,viral)
Tuberculosis

17. 3. Lactate:
Normal range: 140-280U/L
Transudate: NORMAL
Exudate: Above 280U/L
Method:
1.Colorimetric method
2. U.V.Kineticmethod
Condition for Increase protein:
Pleuritis(Bacterial, fungal,viral)
Tuberculosis
Melingancy

18. 4. Amylase:
Normal range: 30-110 U/L
Transudate: Normal
Exudate: Above 110U/L
Method:
1.Colorimetric method
2. U.V.Kineticmethod
Condition for Increase protein:
Pancreatitis
Melingancy
Esophageal rupture

19. 5. Lipid: (Tg)
Normal range: 50-110 mg/dl
Transudate: Normal
Exudate: Above 110U/L
Method:
1.Colorimetric method
Condition for Increase protein:
Chylouseffusion

20. 6.Tumor marker:
CEA: Carcinoembryogenicantigen
Transudate: Absent
Exudate: Positive
Condition for present tumor marker:
Lung carcinoma
Brest carcinoma

21. Microscopic examination of pleural fluid:
1.TLC (Total leukocyte count):
Normally: 0-50 cell/cumm
Transudate: 0-50 cell/cumm
Exudate: 50-500 cell
Method: Same as Blood
Condition in increase TLC count:
Bacterial Pneumonia
Viral Pneumonia
Fungal Pneumonia
Parasitic Infection
Pancreatitis
Tuberculosis
Malignancy
SLE
Congestive heart failure
Hypersensitivity reaction

22. 2. DC:
Method: Same as Blood
Neutrophilia:
Bacterial Peumonia
Pulmonary infraction
TuberculousPeumonia
Pancreatitis
Metastatic Tumor
Lymphocytosis:
Viral Peumonia
Tuberculosis
Malignancy
Rheumatoid pleuritis
SLE
Leukemia
Eosinophilia:
Parasitic Infection
Air in pleural space
Leukemia
Hypersensitivity reaction
Congestive heart failure

23. 3.Gram’s Stain:
Normally: Bacteria absent
Transudate: Bacteria absent
Exudates: Bacteria present
Clinical Condition: Bacterial Pneumonia,pancreatitis
Bacteria: Diplococci
Streptococcus
Pseudomonas
Neisseria
Homophiles influenza
4.AFB Stain:
Normally: Bacteria absent
Transudate: Bacteria present
Exudates: Bacteria present
Clinical Condition: TuberculousPeumonia
Bacteria: Mycobacterium Tuberculosis