Body Fluids

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Jump to: Synovial Fluid | CSF | Semen | Amniotic Fluid | Serous Fluid

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Synovial Fluid

Purpose: lubricant—absorb shock

Classifications
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Synovial Crystals

Uric acid (monosodium urate)	Gout
Calcium pyrophosphate	Pseudogout
Cholesterol	Chronic arthritis conditions (RA)
Apatite	Mineral in cartilage – arthritis
Corticosteroid	From drug injection

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CSF

Purpose: supply nutrients, remove waste, and cushion

Produced in choroid plexus, flows between arachnoid and pia mater

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Indications

Hemorrhage, neurologic infections, malignancy, tumors

Counterindications

Septicemia, systemic infection, localized lumbar infection

Normal Reference Ranges

	Adult	Neonates
WBC	<5	<30
RBC	0	0
Lymphs	40-80%	5-35%
Macrophages	15-45%	50-90%
Neutrophils	0-6%	0-8%
Protein	15-45 mg/dL	15-45 mg/dL
Glucose	50-80 mg/dL*	50-80 mg/dL*

*Glucose is 60-70% plasma concentration

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CSF—Abnormal Findings

Abnormal Proteins

Oligoclonal bands in gamma region = MS

Myelin basic protein (from nerve sheath) : used to monitor MS

Normal Proteins

Albumin – most, Prealbumin, Tau Transferrin (unique to CSF), IgG – small amount

Electrolytes in CSF

Ca, Cl, Mg, K, Na, Lactate

Lactate is used to differentiate bacterial ↑ vs. viral ↓ meningitis

Glucose

↓ bacterial meningitis,↓ tubercular meningitis, Normal in viral meningitis

Microbiology
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Semen

Reference Ranges
                Volume         : >1.9 ml            2-5ml
             Viscosity       :                        drops
             Count           : >39 million        20-160
             Motility         : 50-100%
             Index           : >2
             Morphology   :                        <30% abnormal

Other Infertility Tests

Sperm viability: eosin-nigrosin stain

Dead stain red (unable to keep eosin out)

Fructose: ↓ means lack of support medium produced by seminal vesicles
Sperm agglutinins: Ab in male or female plasma causes agglutination of sperm
Varicocele: hardening of veins draining testes – most common cause of infertility

Amniotic Fluid

Formed from

Metabolism of fetal cells
Transfer of H2O across placental membrane
In 3rd trimester, fetal urine

Baby begins to swallow fluid at this point, so input & output are equal, therefor fluid does not build up

Bilirubin: test to check for RBC destruction due to maternal Rh Ab

Lecithin-sphingomyelin ratio

Lecithin: from alveolar lining, produced at a constant rate until 35th week
Sphingomyelin: produced at a constant rate after 26th week
L/S ratio ≥ 2.0 : preterm delivery safe

The Shake Test (foam test)
95% ethanol + amniotic fluid --> shake --> sit 15 min.
A thin line of bubbles lining outside edge = lung maturity
Creatinine: at 36 weeks urine appears in amniotic fluid, ~ concentration of >2 mg/dl
Phosphatidylglycerol: lipid not found in blood and it parallels lecithin (except in diabetic moms)

Serous Fluid

Pleural (thorasic), Pericardial, and Peritoneal (ascites)

Purpose: Lubrication of parietal and visceral membranes

Parietal membrane lines cavity wall
Visceral membrane covers organs

Production: an ultrafiltrate of plasma, maintained by pressure (osmotic and hydrostatic forces) and is reabsorbed into the lymphatic system

Exudate vs. Transudate

	Exudate	Transudate
Appearance	Cloudy – yellow, green, red May be clots Empyema = pus Bloody – malignancy, trauma, organ infarct Green – bile (liver or gall bladder hole) Chyle – white fluid, thoracic duct injury or malignancy	Clear – pale yellow (normal) No clots (do not contain fibrinogen)
Source	↑ Capillary permeability ↓Lymphatic absorption	↑Hydrostatic (blood) pressure ↓ Oncotic (plasma) pressure
Due to	Conditions involving membranes of cavity -infection & malignancy	Systemic disorders -disruption of fluid filtration and reabsorption
	Inflammatory Process Infection Neoplasm Trauma Systemic disorder	Noninflammatory Process Congestive heart failure Hepatic cirrhosis Nephrotic syndrome
	Requires further testing	No further testing needed
	> 1000 WBC (pleural) > 500 WBC (peritoneal) Neutrophils early, mononuclear late Glu ≤ serum TP > 50% serum LDH > 60% serum	< 1000 WBC (pleural) < 500 WBC (peritoneal) Mononuclear cells Glu = serum TP < 50% serum LDH < 60% serum