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610 PART 8 ■ Fundamentals of Hematological Analysis
CHAPTER HIGHLIGHTS Seminal Fluid
■ Seminal f uid is examined physically, chemically, and
Cerebrospinal Fluid microscopically.
■ CSF acts as a shock absorber or the brain and spinal cord, ■ Procedures are per ormed to determine the physical and
circulates nutrients, lubricates the CNS, and may also con- chemical properties, to quantitate the number o sperm
tribute to the nourishment o brain tissue. cells, and to examine cellular motility and morphology.
■ Clinically, the examination o spinal f uid is use ul in ■ Fresh specimens should be examined or color, pH, vol-
diagnosing a variety o disorders including subarachnoid ume, and viscosity.
hemorrhage, meningeal in ection (meningitis), multiple ■ Seminal f uid can be analyzed or a variety o reasons,
sclerosis, and neoplasms. including in ertility studies, arti cial insemination proto-
■ Normal CSF is crystal clear and colorless. A yellow color- cols, postvasectomy assessment, and evaluation o prob-
ing o a specimen is re erred to as xanthochromia. able sexual assault.
■ Normal CSF has the viscosity o water.
■ otal WBC counts are use ul in developing a di erential Synovial Fluid
diagnosis. Very ew leukocytes should be seen in normal ■ Synovial f uid is a transparent, viscous f uid secreted by the
CSF. Elevated WBC counts can be observed in acute, synovial membrane.
untreated, bacterial meningitis. Very high WBC counts ■ Tis f uid is ound in joint cavities, bursae, and tendon
are unusual and suggest intraventricular rupture o a brain sheaths.
abscess. ■ T e unction o the f uid is to lubricate the joint space and
■ Normal CSF contains a ew mononuclear cells and rare transport nutrients to the articular cartilage.
ependymal cells. ■ Analysis o synovial f uid plays a major role in the diagno-
■ Cells that may be encountered in CSF include granulo- sis o joint diseases.
cytic leukocytes, mature lymphocytes or reactive lympho- ■ Synovial f uid analysis can also support a diagnosis o dis-
cytes, mononuclear phagocytes, plasma cells, ependymal eases as disparate as amyloidosis, hypothyroidism, ochrono-
cells and choroidal cells, leukemic blasts, and malignant sis, hemochromatosis, and even simple edema. In addition,
cells. Other types o cells can include immature, nucleated arthrocentesis may alleviate elevated intra-articular pressure.
erythrocytes, or intracellular bacteria.
■ A decreased glucose level in the CSF in the presence o a Body Fluid Slide Preparation
normal blood glucose level indicates bacterial utilization
o glucose. ■ A di erential cell count on a body f uid should be per-
■ An elevated total protein concentration is suggestive o an ormed on stained smears prepared rom a concentrated
inf ammatory reaction or a bacterial in ection. preparation—not in a hemacytometer.
■ A viral in ection will not have a dramatic e ect on CSF ■ Ordinary centri ugation can be used to concentrate cel-
glucose levels and may not a ect the total protein level lular elements in the sediment, and slides can be prepared
signi cantly. with the traditional push method.
■ Te Wright-Giemsa stain is basically a cytoplasmic stain
with moderate nuclear staining ability. In contrast, the
Pleural, Peritoneal, and Pericardial Fluids Papanicolaou’s stain is predominantly a nuclear stain with
■ An e usion is an abnormal accumulation o f uid in a par- a modest ability or cytoplasmic di erentiation.
ticular space o the body. E usions in the plural, pericar- Amniotic Fluid
dial, and peritoneal cavities are divided into transudates
or exudates. ■ Amniotic f uid is the nourishing and protecting liquid
■ ransudates generally indicate that f uid has accumulated consisting o mostly water but also contains proteins, car-
because o the presence o a systemic disease. bohydrates, lipids and phospholipids, urea, and electro-
■ Exudates are usually associated with disorders such as lytes, all o which aid in the growth o the etus.
inf ammation, in ection, and malignant conditions involv- ■ In the late stages o gestation, most o the amniotic f uid
ing the cells that line the sur aces o organs (e.g., lung or consists o etal urine.
abdominal organs). ■ It is essential that the amniotic f uid be breathed into the
■ ransudates and exudates requently di er in characteris- lungs by the etus in order or the lungs to develop normally.
tics such as color and clarity and total leukocyte cell count. ■ T e analysis o amniotic f uid, tapped rom the mother’s
■ A hemorrhagic e usion in the absence o trauma almost abdomen, is called amniocentesis.
always suggests malignancy or occasionally pulmonary ■ Te f uid contains etal cells that can be examined or
in arct. genetic de ects, and chemical analysis, or example, bro-
■ Extremely elevated total WBC counts in pleural f uids are nectin, and other assays can determine etal lung maturity.
consistent with a diagnosis o empyema. ■ LBCs are associated with the risk o developing respiratory
■ Pericardial f uid is relatively acellular. stress syndrome in a premature in ant.
