Synovial-Fluid.pdf

SYNOVIAL FLUID Presented by : POWER TOP BRATZY NG BSMLS 2B DRAG RACE BRATZY Synovial Fluid Alternative names: Joint fluid analysis; Joint fluid aspiration Synovial fluid is viscous colorless liquid that found in the joint cavities. FUNCTION Lubricate the joint space; as a lubri...

SYNOVIAL FLUID Presented by : POWER TOP BRATZY NG BSMLS 2B DRAG RACE BRATZY Synovial Fluid Alternative names: Joint fluid analysis; Joint fluid aspiration Synovial fluid is viscous colorless liquid that found in the joint cavities. FUNCTION Lubricate the joint space; as a lubricant to the surfaces of the frequently moving joints. Supplies nutrients to particular cartilage; as nutrition must be provided by moving synovial fluid in and out of the cartilage, it may be clear that joint movement is essential to cartilage nutrition and maintenance. Shock absorber ; our cartilage, immersed in the synovial fluid, protects our bones from the tremendous impact they would receive when we walk, run, jump, etc.  JOINTS DISORDERS 1. Non-inflammatory Degenerative joint disorders (osteoarthritis) 2. Inflammatory Rheumatoid arthritis Lupus erythematosus Rheumatic fever Crystal-induced gout JOINTS DISORDERS 3. Septic Microbial infection 4. Hemorrhagic Traumatic injury Tumors Hemophilia and other coagulation disorders  COLOR AND TRANPARENCY Color : Normal SF is pale yellow Deeper yellow or Green tinge: Bacterial infection. Abnormal colors: Dark red or dark brown Chronic rheumatoid arthritis. (bloody) {hemarthrosis} due to: Xanthochromia Fracture through the joint surface which is difficult to be evaluated Tumor involving the joint owing to the yellow color of synovial Traumatic arthritis fluid, hence any color is usually due Hemophilic arthritis to hemarthrosis. May present in septic or rheumatoid arthritis. COLOR AND TRANPARENCY 2. Transparency: Milky : Normal = crystal clear Gouty arthritis Turbid : leukocytosis (more than 200 cell/µl). Tuberculousarthritis Cloudy Milky, fatty: Calcium Cholesterol crystals. hydroxyapatite Fibrin. crystals Degenerative synovial cells which gives free floating tissue aggregates.  MICROSCOPIC EXAMINATION TEST NAME What it measures WBC count and Presence and type of WBCs differential Gram Stain Presence and type of Bacterial Culture microbes CELL COUNT REAGENT AND PROCEDURE The white cell counting technique is used, but isotonic saline solution is substituted the usual acetic acid The count should be completed without delay to prevent spontaneous clumping of leukocytes. Degeneration of leukocytes begin one hour after sample collection If the fluid is highly viscous it must be incubate at 37 c with hyaluronidase enzyme 0.05% for 5 mins. RBCs usually present in very low numbers but may be present because of trauma of aspiration NEUTROPHIL MONOCYTE indicate septic inflammation >80% Large mononuclear cells 1. bacterial arthritis leukocyte, may be 2. gouty arthritis vacuolated 3. rheumatoid 1. normal arthritis seen in 2. viral infection synovial fluid EOSINOPHIL LYMPHOCYTE indicate non septic indicate no. of eosinophils inflammation >2% 1. viral infection 1. metastatic carcinoma 2. rheumatoid in in synovium which lymphocytes 2. acute rheumatic fever may be found 3. rheumatoid arthritis  crystals that may be found crystals indicate the presence of crystal induced arthritis tets must be performed at the collection time because crystals are affected by pH, temperature, as refrigeration of sample will increase MSU  2 types may be ENDOGENOUS CRYSTALS found monosodium urate (uric acid) MSU, needle like seen in gout calcium pyrophosphate dehydrate EXOGENOUS CRYSTALS (CPPD) gloves powder cholesterol, flat rectangular corticosteroids notched plate calcium oxalate  chemical analysis of synovial fluid glucose Protein 1.07-2.13g/dl (nearly 1/3-1/2 that of plasma) Normal value: 0-10% lower than Normal plasma protein also enter synovial fluid by passive diffusion glucose plasma level because In aspirates (normal knee) equilibration is slow, hence test must - total protein: 1.3g/dl performed after at least 6hrs of - >3.0g/dl due to increased permeability and fasting immunoglobulin synthesis cases  chemical analysis of synovial fluid Uric acid Alkaline phosphate Normal value: 10mg/dl Acute > 90mg/dl  Serological test of autoimmune disease RF (rheumatoid factor) - found in SF about 60% RA patients usually at a titer to slightly lower than that of serum. ANA (antinuclear antibody) - test is used as a primary test to help evaluate a person for autoimmune disorder that affect many tissues and organs throughout the body SALAMUCH