1. Fluid Analysis

2. 幾種常見要判讀的體液 Ascites Pleural effusion Synovial fluid
CSF (cerebrospinal fluid)

3. Ascites Analysis Routine tests: Optional tests Unusual tests
Cell count and differential : 1 PMN for 250 red cells/mm3
Albumin
Total protein
Culture in blood culture bottle
Optional tests
Glucose
LDH
Gram stain
Amylase
Unusual tests
TB smear/culture
Cytology
Triglyceride
Bilirubin

4. Ascites Analysis
10~20mL fluid in 100mL blood culture  increase culture positive rate.
Several mL of fluid in red-top tube for biochemistry: albumin, total protein, glucose, LDH, amylase, Bilirubin.
1 mL in puple-top tube for cell count
Gram stain

5. Ascites Analysis SBP(spontaneous bacterial peritonitis)
Ascites PMN ≧ 250 cell counts/mm3
Positive ascites bacterial culture
Serum-ascites albumin gradient
High SAAG (≧1.1 g/dL)
Cirrhosis
Alcoholic hepatitis
Congestive heart failure
Massive hepatic metastasis
Constrictive pericarditis
Budd-Chiari syndrome
Low SAAG (< 1.1 g/dL)
Peritoneal carcinomatosis
Peritoneal tuberculosis
Pancreatitis
serositis
Nephrotic syndrome

6. Ascites Analysis Secondary bacterial peritonitis
Ascites PMN ≧ 250 cell counts/mm3
Positive ascites bacterial culture
A surgically treatable intraabdominal infection
Total protein >1 g/dL
Glucose < 50 mg/dL
LDH > upper limit of normal serum level
Amylase increases in pancreatitis or gut perforation
Bilirubin level should be checked when ascites reveals brown or dark orange color(>serum level/>6mg/dL)

7. Ascites Analysis
The importance between SBP and 2nd bacterial peritonitis:
The mortality of 2nd bacterial peritonitis approaches 100% if treatment consists only antibiotics with no surgical intervention.
The mortality is approximately 80 % if a patient with SBP receives an unnecessary exploratory laparotomy.

9. Pleural effusion Transudate or Exudate Light’s Criteria:
Pleural effusion protein/serum protein ratio > 0.5
Pleural effusion LDH/serum LDH > 0.6
Pleural effusion LDH > 2/3 upper limit of normal LDH level.
Two-test rule
Pleural effusion cholesterol > 45 mg/dL
Pleural effusion LDH > 0.45 times the upper limit of serum level
Three-test rule
Pleural effusion protein > 2.9 g/L
Pleural effusion LDH > 0.45 times the upper limit of serum LDH level

10. Pleural effusion Complicated pleural effusion tubal thoracotomy?
Complicated parapneumonic effusion
pH < 7.20
LDH > 1000
Glucose < 40 mg/dL

12. Synovial fluid Number of joints Possible problem 1 = monoarthritis
Trauma-induced arthritis
Septic arthritis
Crystal induced arthritis
Osteoarthritis (acute)
Lyme disease
Avascular necrosis
tumor
2~3 = oligoarthritis
Reiter’s syndrome
Ankylosing spondilitis
Gonococcal arthritis
Acute rheumatic fever
> 3 = polyarthritis
SLE RA
Viral arthritis
Chronic osteoarthritis

13. Measure
Normal
Noninflamm-atory
Inflammatory
Septic
Hemorrhagic
Volume, mL (knee)
<3.5
Often > 3.5
Often >3.5
Usually >3.5
clarity
Transpar-
ent
Transparent
Translucent-opaque
Opaque
bloody
Color
Clear
Yellow
Yellow to opalescent
Yellow to green
Viscosity
high
low
Variable
WBC
<200
200~2000
2000~10000
>100000
PMN(%)
<25
≧ 50
≧ 75
50~75
Culture
Negative
Often positive
negative
Total protein
1~2
1~3
3~5
4~6
LDH
Very low
High
similar
glucose
Equal
>25 lower
<25 much lower
equal