Serous fluids analysis

Serous fluids

Serous fluid is a small amount

of fluid (of plasma ultrafiltrate)
that lies between the
membranes lining the body
cavities (parietal) and those
covering the organs within the
cavities (visceral)
It is functions to keep the
membrane lining moist
(lubricant), provide nutrients, &
remove wastes
Effusion: accumulation of fluid in
a body cavity due to a
pathologic process

Factors controlling serous

fluids

Capillary permeability
Fluid absorption by the lymphatic
system
Hydrostatic pressure (i.e., blood
pressure) in capillaries
Oncotic (osmotic) pressure produced
by presence of plasma proteins in
capillaries

Types
& collection procedures

Serous fluids Types

Pericardial fluid around heart
Pleural fluid (thoracic fluid) lung cavity
Peritoneal (ascitic fluid) abdominal cavity

The serous fluid is normally collected from a

needle aspiration performed by a physician
Needle aspiration

Paracentesis is the term for the removal of the

peritoneal / abdominal fluid
Thoracentesis - is the removal of fluid from the thorax or
lung cavity and
Pericardiocentesis is removing fluid from around the
heart

Transdates

The Transudate is an effusion that is a result of a

systemic disorder that has disrupted the balance of
fluid production / fluid re-absorption

Increase in hydrostatic pressure or a decrease in plasma

oncotic pressure; fluid moves out of the vessel and into
the body cavity; serous fluid accumulates
Non-inflammatory processes; a protein-poor fluid is
produced
Associated disease states include: CHF, cirrhosis,
nephrotic syndrome (hypoproteinemia)
Finding:
WBCs
<1,000/l
In pretonial
<300/lWBC
Mononuclear cells predominate

Exudates

the effusion that is a result of a problem with the

membranes themselves

Increase in capillary permeability or decreased lymphatic

reabsorption; fluid moves out of the vessel and into the
body cavity; serous fluid accumulates
Inflammatory processes; a protein-rich fluid is produced
Associated disease states include: infection,
malignancy/neoplasm, Rheumatoid Arthritis, trauma
Findings
WBCs
>1,000/l
In pretonial
>500/lWBC
Early neutrophils/late mononuclear cells predominate
Glucose concentration less than serum

Lights Criteria
Fluid is exudative if it meets ANY criteria:
1. fluid LDH/serum LDH > 0.6
2. fluid protein/serum protein > 0.5
3. fluid LDH > 2/3 upper limit of normal serum LDH
LDH is increased in exudates from damaged tissue
and dead leukocytes (LDH is the ubiquitous enzyme
which catalyzes the last step in glycolysis and its
increased presence represents the liberation of
intracellular contents into surrounding fluid) LDH is
normal in transudates, except when a lymph duct
drains a tumor; the increased LDH results from
liberation from rapidly turning over neoplastic tissue
If all 3 negative, fluid is transudative

Serous fluid sample

Serous fluids should be collected in EDTA/sodium heparin

(CBC), & sodium heparin (microbiology/cytology, &
chemistry) tubes to be analyzed as soon as possible
after collection. In addition, a non-additive / clot tube

may also be collected to see if the specimen contains

enough fibrinogen to form a clot

Appearance: Pale yellow & clear

White, turbid: WBCs / infection
Bloody :RBCs/ hemorrhage
Milky: Chyle lymph & emulsified fats
Viscous: Increased hyaluronic acid / malignant
mesothelialoma

Serous fluid sample

Effusion does not normally contain

fibrinogen or red blood cells (RBCs).
Bloody or clotted specimens may be
the result of a traumatic puncture,
hemorrhagic effusion, or a ruptured
blood vessel (active bleeding)

Blood specimens usually collected at

same time and comparisons of test
results made

Testing overview

Variety of tests used to aid in determining the

cause of the effusion
Appearance
Evaluation of clotting ability whether or not it will form
a clot, etc
Cell counts
Protein level
Both fluid and current serum level to make comparison:
fluid protein / serum protein

LDH enzymes
Both fluid and current serum level to make comparison:
fluid LDH/ serum LDH

Cultures
Serology rarely done on serous fluids as blood testing
is adequate
Cytology / Pathology if malignancy is suspected

Chemistry tests

Chemistry tests ordered on serous fluids vary greatly depending

on the diagnosis or suspected problem

Total protein and the enzyme LDH are generally performed on both the
fluid and the patients serum

The information obtained from these test are then used to form a ratio
between the serum and fluid

Serous fluid Glucose levels compared to plasma

Amylase & Lipase. These enzymes provide information about pancreatic

disorders

Bilirubin test and alkaline phosphatase may be ordered on peritoneal fluid

when there suspicion of perforated intestine or gall bladder

Serous fluid pH & ammonia levels are occasionally ordered as well

Causes of pleural effusion

Transdate
Congestive heart failure
Hepatic cirrhosis
Nephrotic syndrome
Exudate
Infection
Malignancy/neoplasm
Systemic rheumatic disease
(SLE, RA)
Gastrointestinal disorders
Pancreatitis
Trauma/surgery

Causes of Pericardial
effusion

Transdate
Congestive heart failure
Hepatic cirrhosis
Exudate
Infection
Myocardial infarction
Systemic rheumatic disease
(SLE, RA)
Metastatic cancer/mesothelioma
Trauma/surgery

Causes of Peritoneal
effusion

Transdate
Congestive heart failure
Hepatic cirrhosis
Nephrotic syndrome
Exudate
Infection
Malignancy/neoplasm
Pancreatitis
Metabolic disease (e.g., uremia)
Tuberculosis
Trauma/surgery

Serum-ascites albumin
gradient (SAAG)

The serum-ascites albumin gradient or gap (SAAG) is

a calculation used to help determine the cause of ascites
SAAG = (albumin concentration of serum) - (albumin
concentration of ascitic fluid) N.R < 1.1
High SAAG ascites (> 11 g/L) include:
Low protein in ascitic fluid (< 25 g/L ): cirrhosis of the liver
High protein in ascitic fluid (> 25 g/L): heart failure, BuddChiari syndrome
A low gradient (< 11 g/L ) indicates causes of ascites not
associated with increased portal pressure. Examples
include peritoneal tuberculosis, pancreatitis, nephrotic
syndrome, serositis, and various types of peritoneal
cancer (peritoneal carcinomatosis