AMNIOTIC FLUID

HCG BUA

SYNCYTIOTROPHOBLAST CELLS

Composed of 2 subunits:

ALPHA = HVG, LH, FSH, TSH (identical to other hormones)

BETA = Confers specificity for HCG

Works by Enzyme immunoassay

With first morning urine as the preferred specimen

Anti-Hcg rabbit as source

25mL to 30 is collected from amniocentesis

25ml is needed for Hcg

Fetal urine is the major contributor to AF volume found in the amnion during the first trimester.
Collection of urine for pregnancy urine must be 1.015.

FP: HEMATURIA

FN: DILUTE URINE (low s.g)

Amniotic fluid is around 800-1200

>1200 increase || <800mL decrease (amniotic fluid)

Amniocentesis happens after 14th week of gestation with 30mL

2nd trimester amniocentesis is for assessing genetic defect, must be kept at body temp

And 3rd trimester amniocentesis is for assessing fetal lung maturity (must be kept refrigerated or frozen)
or HDN (must be kept away from light)

Fern like crystals in AF is due to protein and sodium Chloride

Glucose pos neg

Protein pos neg
Creatinine >10 >3.5
Urea >300 <30
 In maternal urine In amniotic fluid

L/S Ratio: <2.0 means mature fetal lungs

Foam stability: foam bubbles means mature fetal lungs

Microviscosity: measured by fluorescence polarization

Lamellar Body Count: >32,000 – ADEQUATE FLM

Testing fetal age, what’s being measured? Amniotic fluid creatinine

1.5 to 2.0: before 36 weeks

>2.0 36 weeks

Lamellar bodies: OD 650

Amniotic fluid

- Normal: 365
- HDN: 450

Anencephaly: missing part of brain

Spina bifida: incomplete closing of the back bone

Afp: increase neural tube and decrease for down syndrome: screening

Acetylcholesterase: confirmatory test

SPUTUM
Considered as acceptable sputum specimen? <10 SEC and > 25wbc

Sialic acid = most important single component of sputum viscosity.

First morning: most preferred sample

24 hour: for volume measurement

Throat swab: pediatric

Sputum induction: non-cooperative patients

Tracheal aspiration: debilitated or unconscious

Preservation involves redrigeration or 10 percent formalin

Currant jelly like color of sputum indicates? Klebsiella pneumonia

Colorless or transluscent is made of mucus only> normal

Rusty: lobar pneumonia

If lots of food particles, reject

Mistaken as balstomyces? Myelin globules

Dittrich’s plugs, fibers, curshman spirals, charcot leyden crystals and creole bodies: bronchial asthma

Stain for p.carini visualization? Grocott’s methnamine silver stain. Also for cyssts of jiroveci

BRONCHOALVEOLAR LAVAGE: millei of alveoli is collected by washing it with saline then drawing

ALVEOLAR MACROPHAES, MOST PREDOMINANT

EOSINOPHILS: HYPERSENSITIVITY REACTIONS

SWEAT

Used to induce sweat production?: Gibson and cooke pilocarpine iontophoresis

Sweat test: used to diagnose cystic fibrosis or mucoviscidosis

Sweat is tested for sodium and chloride

Sweat na and cl values (red)

<70: diagnosable

40: borderline

CSF

3 layers od meninges: dura meter, arachnoid meter, pia meter

Method of collection for csg: lumbar puncture

20ml/hour is collected by lumbar puncture but only if pressure . Choroid plexus also produces 20
mL/hour too
If 1 csf tube: micro hema cc

If 4 tubes: chem/sero – micro – hematology – micro/sero

If 3: cc is collected then micro then hema

CSF Total volume: 90-150mL

Neonates: 10-60mL

Pink- oxyhemoglobin

Yellow – oxyhemoglobin or bilirubin

Orange = heavy hemolysis

Bloody = red

Intracranial hemorrhage Traumatic tap

even uneven
neg Pos
xanthrochromic Clear
Pos Neg
pos neg
Pellicles in csf indicates? Tubercular meningitis

Adults: 0-5 wbcs

Neonates: 0-30 wbcs

Acetic acid and methylene blue diluting fluid for csf wbc count

CSF differential count is odne on stained smears. Must be mixed with 30 percent albumin to retain and
make clear

Most predominat cells: lymphocytes and monocytes

Occasional: neutrophils

Adults: 70)% lympho and 30 mono

Neonates: 80 percent mono

Limulus lysate test: gram negative endotoxin with clumping and clot formation as the positive result
Rbc count

- Done only in case of traumatic tap

- -1 wbc for every 700 rbc seen
- -8mg/dl total protein for every 10k rbcs
- -1mg/dl total protein for every 1.2k rbcs

Csf protein

- Adults: 15 to 45
- 150: infants
- 500: immature

Transthyrehrin 2nd most prvelt protein

Gammaglobulins are normally igg (multiple sclerosis when detected by csf electrophoresis) and iga

Ssa: only albumin

TCA: BOTH albumin and globulins

Csf/serum albumin index to asses BBB integrity, normal values is less than 9, abnormal when greater
than 9

Solved by: dividing csf albumin with serum albumin

< 0.70 is normal and greater is abnormal

Oligoclonal babding

- In csf and not in serum: MS NENG

- In serum and not in csf: LLV
- IN BOTH: HIV

Normal values for chemistry

- Glucose: 60-70 of blood glucose

- Glutamine: 8-18, increased amts means reye’s syndrome
- Lactate: 10-22, inversely proportional to glucose

CSF LDH
Normal: 1>2>3>4>5

Bacterial meningitis: 5>4>3>2>1

Serym ldh

- Normal: 2>1>3>4>5

SPERM

Sperm maturation

- Spermatogonium
- Spermatocyte 1
- Spermatocyte 2
- Spermatid

Spermatozoa (5%)

1. Vas deferens: project

2. Epididymis: sperm maturation, needs fructose, less fructose, less motile
3. Seminiferous tubules: spermatogenesis

60-70 percent seminal fluid

20-30 prostate fluid

Days of abstinence? 2 to 5 days not greater than 7 days (less motility and greater volume)

First portion is missing: less sperm count and increased pH (won’t liquify)

Last portion is missing: reverse of above (won’t clot)

Liquefaction is 30-60 minutes if it fails then deficiency in prostatic enzymes

pH 7.2 -8.0

2.5mL is the normal volume

Viscosity: pour in droplets, threads of over 2cm is abnormal

- 0=watery
- 4=gel-like

NV: 20 MILLION PER ML

 Round cell count: Number of sperm times S divided by 100

Glycoprotein p30: most specific method to detect semen.

Vasectomy: must be zero withi twelve weeks of the procedure

SYNOVIAL FLUID

METHOD OF COLLECTION: Arthrocentesis

Normal: <3.5ml

Inflammation: <25mL volume required to collect

GASTRIC FLUID

Pernicious anemia is caused from missing parietal cells. These cells produce hydrochloric acid.
Absence of hydrochloric acid is known as anacidity. Gastrin works with the cells to produce HCl
needed to make pepsin to break down proteins

ZES” Malignancy of the pancreas. Where gastrin is increased and therefore HCL is increased

Specimen collection wrok with gastric aspiration that has three tubes

- Leevin: nose
- Rehfus: mouth
- Sawyer: longest tube

Nvolume collected is 30-60Ml

Nv: 45-120

150

But when fasting

Nv: 20-50mL

Abnormal: >50mL

Diagnex tubeless test: can use urine

VAGINAL SECRETION

- IT’S mostly done for infection, second foresnice and pregnancies

- Collected during pelvic exam
 Synovial fluid viscosity: tested with mucin clot 4-6cm long is normal

Colorles to pale yellow is normal

Bacterial infection

Greenish tinge

Inflammation deeper yellow

Pathological groups

- Group 1: non-inflammatory
- Group IIA: inflammatory (immunologic)
- GROUP IIB: inflammatory (crystal induced)
- GROUP IV: septic
- GROUP V: hemorrhagic

Serous fluid

Exudate: involve memberanes and infections and malignancies

Transudate: congestive heart failure or hypoproteinemia associated with nephrotic syndrome

Laboratory differentiation

LD ratio: Exu – >0.6 || <0.6

Cholesterol: >45-60 || <45-60

Albumin gradient: <1.1 || >1.1

Brown: rupture of amoebic liver abscess

Hemorrhagic (even) vs hemothroax (even distribution)

Sialic acid = most important single component of sputum viscosity.

FECALYSIS

- 100-200g is exceted in a 24 hour period

- Bulky – bile duct obstruction or pancreatic disorders
- Goat dropping: constipation
- Fecal fats: indicates maladbsorption from a 3day sample stool
- FOBT: Indicates gastrointestinal bleeding
 In APT test, pink in fetal but brown in adults

Muslce fibers

- Abnormal >9 undigested muscle fibers

- PARTI DIGESTION SHOW STRIATIONS IN ONE DIRECTION ONLY

Fecal leykocytes

- >3 NEUTROPHILS PER HIGH POWER FIELD

Fobt: Most frequently perofmred fecal test.

- Sample collected is the center portion of the stool

RECALLS

Amniotic fluid: 800-1200

Csf: wbc count is most frequently done

Synovial: cell count is most frequently performed

Appears yellow and negative in brefringence: monosodium urate

METHOD OF COLLECTION: Arthrocentesis

Normal: <3.5ml

Inflammation: <25mL volume required to collect

Exudate: indicatie of infections, inflammation and etc.

Chylous: >110 trig

Pseudo: <50
CSF TUBES

- Hematology: refrigerated
- Microbiology: room temperature
- Chemistry and serology are frozen