1. SEROUS BODY FLUIDS (Pleural fluid)

2. Serous Fluid The fluid between two membranes of the closed cavity of the body Two membranes: Visceral membrane – covers the organ Parietal membrane – lines the body wall Provides lubrication & free movement Production and resorption of fluid is constant: 1 to 10 ml per cavity

3. Serous Fluid Formation & composition: Composition is similar to plasma Formation is controlled by: Permeability of the capillaries in the parietal membrane Hydrostatic pressure in these capillaries Oncotic pressure / colloid osmotic pressure

4. Origin & Anatomic relationships Pericardium Heart Pericardial fluid Pleural cavity Lungs Pleural fluid Peritoneum abdominal organs

5. Pleural fluid Pleural fluid is the fluid that is found between the layers of the pleura, the membranes that line the thoracic cavity and surround the lungspleura

6. Specimen collection PARACENTESIS – percutaneous puncture to obtain specimen Thoracentesis Minimum of 50 mL.

7. Method of Collection Needle Aspiration Anticoagulated specimen: cell count (4% sodium citrates) Sterile tube: culture Heparinized tube: chemistry Non-anticoagulated specimen: clotting determination

8. Abnormalities EFFUSION – accumulation of fluid in body cavity Transudates Filtration of blood serum across a physically intact vascular wall because of systemic disease Exudates Active accumulation associated w/ inflammation & vascular wall damage Inflammations, malignancies & infections

9. TransudateExudate AppearanceClear, serum- like Cloudy, Y-G-P-R Sp.Gr.< 1.015 > 1.015 LDH< 200 IU> 200 IU Total Protein< 3.0 g/dL> 3.0 g/dL Fluid serum protein ratio < 0.5> 0.5 Transudates and Exudates

10. TransudateExudate WBC ctUsu < 1,000/uLUsu > 1,000/uL OriginNon-inflammatoryInflammatory ColorLight yellow / strawDarker/ orange red GlucoseHigher: 80-100mg%Lower (bacteria) CellsFew: lymphocytesMany: PMNs CultureNegativeUsually Positive Transudates and Exudates

11. Pleural Fluid Pleural effusion. A, Blood-stained pleural aspirate. This patient had pleural metastases from carcinoma of the breast. B, Chylous pleural effusion. This patient had bronchial carcinoma that had invaded and obstructed the thoracic duct. C, Pleural transudate. This pale effusion is typically found in patients with heart failure or other causes of generalized edema.

12. Pleural Fluid Causes of Pleural effusions 1. Transudates 1.a. Congestive heart failure 1.b. Hepatic cirrhosis 1.c. Hypoproteinemia (e.g. Nephrotic syndrome)

13. Pleural Fluid Serological Tests 1. ANA tests 2. Quantitation of Igs 3. Complement components Microbiological studies 1. Staphylococcus aureus and coliform species 2. AFB

14. Prepared by Mohammed al zhrani Khalid Mubarak Sanad alharthi