SYNOVIAL FLUID DISEASE Degenerative joint disorders, osteoarthritis LAB FINDINGS = Clear, Yellow = Good Viscosity = <1000 uL (WBC)

= Neutrophils <30% = Normal glucose Immunologic = Cloudy, Yellow = Poor Viscosity = 2,000-75,000 uL (WBC) = Neutrophils >50% = Decreased glucose = Antibodies present Crystal-induced = Cloudy, Milky = Low Viscosity = 100,000 uL (WBC) = Neutrophils <70% = Decreased glucose = With crystals = Cloudy, Yellow-green = Variable Viscosity = 50,000 100,000 uL (WBC) = Neutrophils >75% = Decreased glucose = (+) Culture & Gram stain = Cloudy, red = Low Viscosity = Same with blood (WBC) = Same with blood = Normal glucose

Non-inflammatory

Inflammatory

Immunologic disorders, RA, LE, scleroderma, polymyositis, anklylosing spondylitis, RF, lyme arthritis, gout, pseudogout

Septic

Microbial infection

Hemorrhagic

Traumatic injury, tumor, hemophilia, other coag. disorders, anticoagulant overdose

Viscosity = polymerization of hyaluronic acid = Arthritis: affects production of hyaluronate & ability to polymerize = String test = Polymerization: by ropes/mucin clot test 2-5% Acetic acid Surrounding fluid: more turbid, more unable to polymerize Clot: firmness indicate polymerization Good (solid), Fair (soft), low (friable), poor (no clot) Mucin clot test: distinguish synovial fluid from other fluids Too viscous = Hyaluronidase to 0.5 mL = Drop of 0.05% hyaluronidase in phosphate buffer per mL (37oC) for 5 mins. WBC diluting fluid = not acetic acid form clot = NSS = hypotonic saline (0.3%) or saline w/ saponin to lyse RBCs = Methylene blue + saline for mixed specimen = Highly viscous in automation false elevate Microbiology = Staph, Strep, Haemophilus, N. gonorrheae

= incubation of fluid w/ hyaluronidase decrease specimen viscosity Diff count: = cytocentrifuged = incubation with hyaluronidase prior = mononuclear cells (mono, macro, synovial): primary cells = WBCs more vacuolated in synovial fluid than blood smear = lympho (<15%) if elevated (non septic inflammation) Crystals = Pseudogout: degenerative arthritis cartilage calcification & endocrine disorders producing elevated calcium levels = compensated polarized light: identification Chemistry test = Glucose: most frequent inflammatory & septic (decreased) = Simultaneous blood & synovial 8 hr fasting = within hour = Protein: inflammatory & hemorrhagic

FECALYSIS = bacteria, cellulose, GI secretions, bile pigments, cells from intestinal walls, electrolytes, water Serologic tests = CHO (Oligo) resistant to digestion (upper intestine) = Confirmatory = digestion alimentary tract = RA & LE: autoimmune diseases; detecting autoantibodies = trypsin, chymotrypsin, aminopeptidase, lipase = Arthritis: freq. Complication of Lyme disease (B. = Bile salts: aid digestion of fats burgdorferi) = 9,000mL 500-1500mL 150mL = Inflammation: acute phase reactants --- fibrinogen & C= Water & electrolytes: absorbed by small & large reactive protein = large intestine absorb water (3000mL) Excess: diarrhea Prolonged: constipation