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Joint Fluid

UABF By;Strasinger et.,al.

UABF By;Strasinger et.,al.

Ultrafiltrate of plasma Similar concentration of plasma Nutrition for vascular deficient cartilage Hyaluronic acid

UABF By;Strasinger et.,al.

Damage of the articular membrane

UABF By;Strasinger et.,al.

UABF By;Strasinger et.,al.

UABF By;Strasinger et.,al.

UABF By;Strasinger et.,al.

UABF By;Strasinger et.,al.

NORMAL SYNOVIAL FLUIDS


VOLUME Color Clarity Viscosity Leukocyte count Neutrophils Crystals Glucose:plasma difference Less than 3.5 mL Colorless to pale yellow Clear Able to form a string 4-6 cm long 200 cells/uL Less than 25% of the differential None present

Less than 10 mg/dL lower than the blood glucose Less than3 g/dL UABF By;Strasinger et.,al.

Total protein

COLORLESS TO PALE YELLOW

UABF By;Strasinger et.,al.

2% - 5% ACETIC ACID REPORTING Good Fair Low Poor VISCOSITY SOLID CLOT Soft clot Friable clot No clot

UABF By;Strasinger et.,al.

Lupus erythematosus (LE) cells- present in patient with lupus arthritis

Neutrophils-20% of SF 50%-urate gout, pseudogout and RA 75%-acute bacterial rthritis

Henrys 22nd ed.

Lymphocytes-15% of SF cell Prominent in early RA Chronic infection

Eosinophilia-2% RA, RF, parasitic and infection.

Monocyte and Macrophage- 65% of all cell count Most common


Henrys 22nd ed.

Synovial Cells-no pathologic significance

Lipid bodies- trauma,and RA

Henrys 22nd ed.

CRYSTAL IDENTIFICATION

Crystal identification
To evaluate arthritis, microscopic examination of synovial fluid for the presence of crystals is an important diagnostic test. Crystal formation is caused by metabolic disorders and decreased renal excretion that produce elevated blood levels of crystallizing chemicals, degeneration of cartilage and bone, and injection of medications, such as corticosteroids into a joint.

Sources: Henrys 22nd edition, Analysis of urine and other body fluids by: Susan Stratsinger

Types of Crystals
Monosodium urates
- needle-shaped rods 520 m long, 12 m in L

- appear as rounded spherolites


- characteristic of acute urate gout -occasionally observed as a result of inflammation in septic arthritis

Sources: Henrys 22nd edition

Cholesterol
-appear as irregular birefringent

plates, with notched corners


-needle or rhomboid-shaped crystals

may be present similar to MSU or CPPD in


chronic effusions

- ethanol and ether soluble

Sources: Henrys 22nd edition

Calcium pyrophosphate dihydrate


-these crystals appear as rhomboids, rods, or
rectangles 120 m in length -weakly birefringent with positive elongation -too small to polarize the light, making them difficult to detect without phase-contrast microscopy

Sources: Henrys 22nd edition

Calcium oxalate
-5- to 30-m bipyramidal octahedral envelopes with variable birefringence and positive elongation -seen in arthropathy associated with chronic renal dialysis and primary oxalosis, a rare inborn error of metabolism - monohydrate form is birefringent but nondescript in shape

Sources: Henrys 22nd edition

Other crystals:
Lipid crystals
1- to 20-m spheres with a Maltese cross appearance and positive birefringence; implicated as a cause of acute arthritis

Calcium hydroxyapatite
small and nonbirefringent (isotropic) ,they are clumped into 1to 50-m spherical microaggregates

Crystalline corticosteroids
blunt, jagged edges without clear crystal structure

Sources: Henrys 22nd edition

Slide Preparation
Fluid is examined as an unstained wet preparation, slide and

coverslip must be cleaned and carefully dried ,the coverslip edges are sealed
with nail polish, and crystals may be observed in Wright stained smears.

Crystal Polarization
Polarization of crystals is used to differentiate the linear structures

of their molecules, and to identify them through the color they produced.

Sources: Henrys 22nd edition, Analysis of urine and other body fluids by: Susan Stratsinger

Chemistry Test/ Chemical Analysis


Glucose Protein Lactate dehydrogenase Uric acid

Sources: Henrys 22nd edition

Reference Intervals for Synovial Fluid Constituents


Constituent Total protein Albumin 1-Globulin 2-Globulin -Globulin -Globulin Hyaluronic acid Glucose Uric acid Lactate Synovial fluid 13 g/dL 55%70% 6%8% 5%7% 8%10% 10%14% 0.30.4 g/dL 70110 mg/dL 28 mg/dL 929 mg/dL Plasma 68 g/dL 50%65% 3%5% 7%13% 8%14% 12%22% 70110 mg/dL 28 mg/dL 929 mg/dL

Sources: Henrys 22nd edition

Microbiologic Tests
An infection may occur as a secondary complication of

inflammation caused by trauma or through dissemination of a


systemic infection. Gram stains and cultures are two of the most important

tests performed on synovial fluid.

Serologic Tests
Through measurement of the concentration of acute phase reactants such as fibrinogen and C- reactive protein the

extent of inflammation can be determined.


Sources: Henrys 22nd edition

COMMON FECAL TEST FOR DIARRHEA

Secretory diarrhea

Osmotic diarrhea Altered motility Steatorrhea

Macroscopic Screening
Color

Appearance

Microscopic Examination of Feces

Leukocytes

associated with microbial diarrhea Muscle fiber Fats associated with steatorrhea

affects intestinal mucosa) -ulcerative - colitis- bacterial desyntery

Neutophils ( conditions that

Specimen can be examined:

Wet preparation -methylene blue Dried smears - Wright's or gram stain

PROCEDURE

MATERIALS, INSTRUMENTATION

Sudan III Steatocrit and acid steatocrit Fecal elastase-I

Sudan stain, microscopy Hematocrit centrifuge, gravimetric assay Immunoassay ELISA technique

Near-infrared reflectance spectroscopy (NIRA)

Van de Kamer

NIRA spectrophotometer. wavelengths range 1400-2600 nM. computer software for processing spectra Fecal fat extraction and titration of long chain fatty acid by sodium hydroxide.