Page 614 - Clinical Hematology_ Theory _ Procedures ( PDFDrive )

598 PART 8 ■ Fundamentals of Hematological Analysis

laparotomy. I the test results are equivocal, another lavage
Variations in Peritoneal
TABLE 29.8 may be indicated in 1 to 2 hours.
(Abdominal) Fluid Appearance
otal WBC counts are o limited value in di erential diag-

9
Examples f Conditions nosis, but a total WBC count higher than 0.3 × 10 /L is consid-
o
ered to be abnormal. More than hal o patients with in ected

Color ascites have a total WBC count higher than 0.3 × 10 /L, with
9

Pale yellow Normal more than 25% PMNs on the leukocyte di erential smear.
9
Straw colored Normal Leukocyte counts greater than 0.5 × 10 /L are considered to

Congestive heart failure be use ul presumptive evidence in distinguishing between
Cirrhosis bacterial peritonitis and cirrhosis. In bacterial peritonitis,

9
Neoplasm the total WBC count is higher than 0.5 × 10 /L, with more
than 50% PMNs.
Reddish brown Neoplasm

or bloody Pancreatitis A wide variation in the peritoneal WBC count is seen in

Pulmonary infarct patients with chronic liver disease because o extracellular

Trauma shi s in f uid associated with ascites ormation or resolu-

Traumatic thoracentesis tion. During diuresis, the total leukocyte concentration may

Tuberculous peritonitis increase dramatically, but the concentration o PMNs usu-
ally remains low. T ere ore, the variance o the total WBC
Appearance count usually does not lead to con usion between cirrhosis

Clear Normal and bacterial peritonitis.

Tuberculous peritonitis otal WBC counts may occasionally be elevated in peri-

Turbid (cloudy) Bacterial peritonitis toneal f uid independently o the RBC count. T is is partic-

Pancreatitis ularly true in patients with penetrating abdominal trauma
Conditions with increased cellular with visceral injury. I lavage is per ormed immediately a er

components the injury occurs, the WBC count may not yet be elevated
( able 29.10).
Mucinous Neoplasm

Chylous Obstruction of lymphatic duct (e.g.,
*
(milky) lymphoma) Cellular Differential Exam ination

Tuberculous peritonitis Following preparation o the sediment, the smears should be

Trauma properly stained with Wright’s or Wright-Giemsa stain or

Pancreatitis di erential leukocyte evaluation or with Papanicolaou’s stain

or cytological evaluation.
Purulent Bacterial peritonitis
A di erential cell count should be per ormed on the
* Supernatant is white because of chylomicrons. Wright-Giemsa–stained smear. I a cytocentri uge is used

or sediment preparation, arti acts may be encountered (see

“Pleural Fluid” or a discussion o the arti act induced by

accuracy in the diagnosis o penetrating trauma (gunshot cytocentri uge preparation).

and stab wounds) o the abdomen than in other conditions Although the quantities o some cells in peritoneal

( able 29.9). A positive result by lavage is indicative o fuid compared with pleural f uid may vary in some

Criteria for Diagnosing Blunt and Penetrating Trauma by Analysis of Peritoneal
TABLE 29.9
Lavage Fluid

Diagnosis Gross Findings Laboratory Analysis

Positive Blood in aspirate or lavage RBC count >0.1 × 10 /L; >0.05 × 10 /L in cases of
12
12
Lavage uid retrieved via Foley catheter or chest tube penetrating trauma

Evidence of food, foreign particle, or bile WBC count >0.5 × 10 /L
9
Amylase level >2 × serum amylase level

Indeterminate Small amount of bloody uid noted in dialysis catheter RBC count 0.05–0.1 × 10 /L; 0.01–0.05 × 10 /L in
12
12
on insertion cases of penetrating trauma

WBC count 0.001–0.005 × 10 /L
9
Amylase levels slightly higher than serum amy-

lase levels

Negative RBC count <0.025 × 10 /L
12
WBC count <0.001 × 10 /L
9
Amylase level lower than serum amylase level