Chapter 7 Examination of cerebrospinal fluid and serous membrane fluid n examination of cerebrospinal fluid (CSF) General property: normal CSF is colorless and transparent watery fluid. In abnormal status, the general property of CSF is changed as follows: yellow CSF: obsolete intracranial hemorrhage purulent CSF: pyogenic meningitis reddish or bloody CSF : intracranial hemorrhage or subarachnoid hemorrhage

Chemical examination : Protein : Pandy test: (-) or 0.2~0.4 g/ L elevated protein: purulent meningitis, tubercular meningitis, viral meningitis Glucose : 2.5~4.5 mmol / L increased glucose: purulent meningitis, tubercular meningitis Chloride: 119~129 mmol/ L Ddecreased chloride: tubercular meningitis, purulent meningitis

Microscopic test : Total cell count: 0~8 × 10 6 / L DC: lymphocyte, neutrophil granulocyte tubercular meningitis: < 500 × 10 6 /L (lymphocyte) purulent meningitis: > 1000 × 10 6 /L(neutrophil) viral menintitis: <100 × 10 6 /L (lymphocyte) meningeal leukemia :

Examination of serous membrane fluid(SMF) General property Chemical examination Microscopic test Bacteriology

The main differential points of transudate and exudate transudate exudate quality non-inflammatory inflammatory, tumorous general property color light yellowish dark yellow, bloody, purulency transparency transparent cloudy coagulability - + specific gravity chemical examination Rivalta test - +

protein 30 g/L glucose same as blood lower than blood cell count 500 × 10 6 /L DC lymphocyte neutrophil or lymphocyte tumor cell negative can be found bacteriological test negative positive ( infectious case)

Case analysis Case analysis n History and physical examination: A 28-year-old male was admitted to the hospital because of fever, cough, shortness of breathe and chest pain. After X-ray examination, he was found medium pleural effusion in his right thoracic cavity. In second day, pneumothorax puncture was operated and pleural effusion was examined. Laboratory data: Hb 110g/L, WBC 8 × 10 9 /L, PLT 120 × 10 9, the color of the effusion is yellow and cloudy, SG 1.025, rivalta test (+), protein 45g /L, glucose was apparently lower, cell count: 800 × 10 6 /L, DC lymphocyte. Laboratory data: Hb 110g/L, WBC 8 × 10 9 /L, PLT 120 × 10 9, the color of the effusion is yellow and cloudy, SG 1.025, rivalta test (+), protein 45g /L, glucose was apparently lower, cell count: 800 × 10 6 /L, DC lymphocyte.

Question n Please judge the quality of pleural effusion in this case. n What is probably diagnosis for this patient? n And why?