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Fluid Analysis:- Part 2 – Fluid Analysis Parameters, Therapeutic Fluid Aspiration

November 15, 2022Fluid analysisLab Tests

Table of Contents

  • Fluid Analysis
      • Sample for Fluid Analysis
      • Indications for Fluid Analysis
      • Precautions for Fluid Analysis
    • Pathophysiology of Fluids 
      • Various Procedures to get fluids are:
      • The fluid analysis includes:
      • Therapeutic advantages of Fluid Analysis:
        • Difference between various fluids:
        • Comparison of Transudate and Exudate:

Fluid Analysis

Sample for Fluid Analysis

  • The fluid for the analysis  are:
    1. Ascitic fluid.
    2. Pleural fluid.
    3. Pericardial fluid.
    4. Amniotic fluid.
    5. Cerebrospinal fluid.
    6. Semen analysis.
    7. Cervical mucus test.
    8. Joint fluid (synovial fluid).
    9. Sweat chloride test.
    10. Urine analysis.

Indications for Fluid Analysis

  1. To diagnose the cause of the fluids.
  2. This could be therapeutic.
  3. To diagnose the diseases.

Precautions for Fluid Analysis

  • The fluid analysis should be done immediately to prevent false results due to cellular or chemical deterioration.
  • Follow precautions if there is a delay in the testing of fluid.

Pathophysiology of Fluids 

  1. Effusions from the abdomen, pleura, pericardium, and joints are classified into exudate and transudate.
    1. Exudates are caused by inflammatory, infectious, or neoplastic diseases.
    2. Transudates are caused by venous congestion, hypoproteinemia, and fluid overload.
  2. Some of the fluids are analyzed to diagnose the disease, like sweat for cystic fibrosis.

Various Procedures to get fluids are:

  1. Lumbar puncture for CSF.
  2. Amniocentesis to get fluid from the uterus.
  3. Pericardiocentesis for pericardial fluid.
  4. Thoracentesis for pleural fluid.
  5. Paracentesis for the peritoneal fluid.
  6. Arthrocentesis for the fluid from the joints.

The fluid analysis includes:

  1. Gross appearance.
  2. Specific gravity
  3. Total protein
  4. LDH level.
  5. Total cell count.
  6. Microscopic examination for the differential count.
  7. Cytospin For the cytological examination.
  8. In the case of CSF, the glucose level is estimated.
  9. In some cases, AFB or Gram stain is done.
  10. Fluid analysis is to diagnose the etiology of fluid formation, or sometimes it may be therapeutic.

Therapeutic advantages of Fluid Analysis:

  1. Fluid aspirated from the pleural improves ventilation and oxygenation.
  2. Fluid from the Peritoneum relieves the pressure and ease of breathing and eating.
  3. Fluid aspirated from the joint relieves the pain and function.
  4. Fluid aspirated from the pericardial cavity improves diastolic filling and cardiac output.

Difference between various fluids:

Test Exudate Transudate Chylous
Appearance cloudy clear cloudy to milky
Color variable pale yellow pale yellow to milky
Cell count >1000 <1000 >1000
DLC poly → MN cell lympho poly → MN cells
Triglycerides <60 mg/dL <60 mg/dL >110 mg/dL
Total protein >3.0g/dL <3.0g/dL >3.0g/dL
Fluid protein/serum TP >0.5 <0.5 >o.5
Fluid LDH/serum LDH >0.6 <0.6 >0.6

TP = Total protein

MN = Mononuclear cells.

Comparison of Transudate and Exudate:

Parameter (Characteristic features)        Transudate                        Exudate            
Appearance Pale yellow

Yellow (inflammatory) Red (hemorrhage)

Brown (bilirubin)  or cloudy

Protein <3 g/dL >3 g/dL
Fluid: serum protein ratio <0.5 >0.5
Fluid: LD ratio <0.6 >0.6
Specific gravity <1.016 >1.016
WBC Absent Increased
LDH Normal  <200 IU/L Increased >200 IU/L
Glucose Normal (equal to serum level) Less or equal to serum
Pleural fluid cholesterol <60 mg/dL >60 mg/dL
Pleural fluid: serum cholesterol  ratio <0.3 >0.3
Pleural fluid: bilirubin ratio <0.6 >0.6
Fibrinogen No clot Clots are seen
Spontaneous clotting Negative May see clot formation
Cell count 300 to 1000 /cmm >1000 /cmm
WBCs Few lymphocytes Many polys >25%
RBCs Few Variable
Differential Mononuclear cells predominate
<25% neutrophils
>25% neutrophils
Fluid analysis: Fluid exudate/transudate difference

Fluid analysis:: Fluid exudate/transudate difference

  • Please see more details in fluid part 3.

Possible References Used
Go Back to Fluid analysis

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