¾ lymphoma

¾ Carcinoma

¾ Tuberculosis

¾ Parasitic infestations

¾ Adhesions

¾ Hepatic cirrhosis

¾ Nephrotic syndrome.

(If surgical treatment is not indicated, elimination of

dietary long-chain fatty acids will decrease accumulation

of chylous fluid in abdomen, pericardium or pleural cavity).

Microscopic Examination

In peritoneal fluid TLC > 500/cu mm or RBC count >

100,000/cu mm are considered abnormal. Increased

TLC, chiefly neutrophils, typically occur with acute

peritonitis from any cause and may be the only evidence of

intestinal rupture due to blunt trauma. A high incidence of

lymphocytes should suggest the possibility of tuberculous

peritonitis, but may also be found with chylous ascites.

Cytology examination with Papanicolaou stained films

should be done. Sometimes, differentiation between

reactive shed mesothelial cells and true neoplastic cells

may be difficult.

Microbiologic Examination

Gram’s stain and AFB stain should be done as usual.

Cultures should also be done to know the actual pathogenic

organism and its sensitivity.

ChemicalExamination

Ascitic transudate is seen in:

¾ Congestive heart failure

¾ Constrictive pericarditis

¾ Hepatic vein obstruction

¾ Cirrhosis

¾ Nephrotic syndrome.

Contd...

394 Concise Book of Medical Laboratory Technology: Methods and Interpretations An acid pH of the peritoneal fluid should suggest

perforated peptic ulcer.

With pancreatitis, the fluid amylase level is raised.

Elevated ammonia levels in peritoneal fluid above

3 g/mL are not found in pancreatitis and suggest intestinal

necrosis, perforation, or urinary extravasation.

Jejunal and ileal fluids have very high alkaline

phosphatase (100–10,000 times serum level).

Ascitic fluid LDH is raised in:

¾ Malignancy of peritoneum

¾ Hemorrhagic peritoneal fluid of any etiology.

Differential diagnosis of peritoneal transudate vs.

aspirated urine

Simultaneous measurements of creatinine and urea

nitrogen on blood and peritoneal fluid are helpful. High

levels of peritoneal fluid urea and creatinine with normal

serum levels suggest inadvertent aspiration from the

urinary bladder. High levels of peritoneal fluid urea and

creatinine with elevated urea but normal creatinine in

peripheral blood suggest rupture of the urinary bladder,

since urea diffuses more rapidly than creatinine across the

peritoneal surface.

AMNIOCENTESIS AND AMNIOTIC FLUID

ANALYSIS, DIAGNOSTIC

Normal Value

Routine Analysis (Table 12.8)

Color: Colorless, straw-colored, or clear to milky.

TABLE 12.8: Presence of amniocentesis and amniotic fluid

Parameter Observation SI unit

Acetylcholinesterase Negative

Alpha1-Fetoprotein

12 weeks’ gestation <42 µg/mL

14 weeks’ gestation <35 µg/mL

16 weeks’ gestation <29 µg/mL

18 weeks’ gestation <20 µg/mL

20 weeks’ gestation <18 µg/mL

22 weeks’ gestation <14 µg/mL

30 weeks’ gestation <3 µg/mL

35 weeks’ gestation <2 µg/mL

40 weeks’ gestation <1 µg/mL

Normal values may also be reported in multiples of the median

(MOM) or 0.5–3.0 MOM.

Bilirubin

Trimester 1, 2 < 0.074 mg/dL < 1.2 µmol/L

40 weeks’ gestation < 0.024 mg/dL <0.4 µmol/L

Parameter Observation SI unit

Calcium 4 mEq/L 4 mmol/L

Carbon dioxide 16 mEq/L, 16 mmol/L

Chloride 102 mEq/L 102 mmol/L

Creatinine

< 27 weeks’ 0.8–1.1 mg/dL 72–99 µmol/L

gestation

30–34 weeks’ 1.1–1.8 mg/dL 99–162 µmol/L

gestation

35–40 weeks’ 1.8–4.0 mg/dL 162–360 µmol/L

gestation

Oestriol

Trimester 1, 2 < 9 µg/dL <309 µmol/L

Term <59 ng/dL <2023 µmol/L

Glucose 30 mg/dL 2 mmol/L

Lecithin

< 35 weeks’ 6–9 mg/dL

gestation

> 35 weeks’ 15–20 mg/dL

gestation

Lecithin/sphingomyelin

(L/S)

Ratio

Immaturity < 1.5

Borderline maturity 1.5–1.5

Maturity 2.0–4.0

Postmaturity >4.1

Meconium Negative

pH

Trimester 1, 2 7.12–7.38 7.12–7.38

Term 6.91–7.43 6.91–7.43

Potassium 4.9 mEq/L 4.9 mmol/L

Sodium 133 mEq/L 133 mmol/L

Sphingomyelin 4–6 mg/dL

Total protein 2.5 g/dL 25 g/L

Urea

Trimester 1, 2 12–24 mg/dL

Term 19–42 mg/dL

Uric acid

Trimester 1, 2 2.76–4.68 mg/dL 0.17–2.8 mmol/L

Term 7.67–12.13 mg/dL 0.46–0.72 mmol/L

Contd...

Contd...

Cerebrospinal and Other Body Fluids 395

Abnormalities that may be Found Upon

Routine Analysis

Abnormal Possible Cause

color

Yellow Due to fetal bilirubin, erythroblastosis

fetalis

Green Due to meconium, breech presentation,

fetal death, defecation, distress, hypoxia,

intrauterine growth retardation, postmaturity, vagal stimulation

Red Due to presence of blood, intrauterine

hemorrhage

Port wine Acute fetal distress, abruptio placentae

Brown Oxidized hemoglobin, maternal tissue

trauma, fetal death, fetal maceration

Abnormal Bilirubin SI Units

Fetal involvement 0.10–0.28 mg/dL = 1+ 1.6–4.5 µmol/L

Later fetal 0.29–0.36 mg/dL = 2+ 4.7–5.8 µmol/L

involvement

Fetal distress 0.47–0.95 mg/dL = 3+7.6–15.4 µmol/L

Fetal death >0.95 mg/dL = 4+ > 15.4 µmol/L

Abnormal Creatinine

35–40 weeks’ gestation: Large

muscle mass, possible diabetes > 2 mg/dL > 180 µmol/L

Low birthweight <2 mg/dL < 180 µmol/L

Increased alpha1-fetoprotein: Anencephaly, cystic fibrosis,

duodenal atresia, esophageal atresia, fetal bladder neck

obstruction with hydronephrosis, fetal death, meningomyelocele, multiple pregnancy, nephrosis (congenital),

neural tube defects, spina bifida, omphalocele, and

Turner’s syndrome.

Increased bilirubin: Anencephaly, erythroblastosis

fetalis, hemolytic disease of the newborn, hydrops fetalis,

intestinal obstruction, and Rh sensitization.

Positive acetylcholinesterase: Neural tube abnormalities that allow cerebrospinal fluid (which contains

acetylcholinesterase) to leak into the amniotic sac.

Positive meconium: Fetal distress.

Decreased alpha1-fetoprotein: Not applicable.

Decreased bilirubin: Not clinically significant.

Decreased creatinine: Fetal lung immaturity.

Chromosome analysis: Interpretation required.

Description

Detection of fetal jeopardy or genetic disease and

determination of fetal maturity. Amniocentesis is a 20–30

minute procedure in which an aspiration of amniotic

fluid is taken transabdominally and usually performed

after week 12 of gestation. In routine analysis, amniotic

fluid is examined for levels of calcium, chloride, carbon

dioxide, creatinine, estriol, glucose, pH, potassium,

sodium, protein, urea, uric acid, culture, and or genetic

defects, chromosomal studies, detection of fetal jeopardy

or distress (via color, bilirubin) and to measure lung

maturity (via L/S ratio) and age (via creatinine) of the

fetus. Alpha1-alpha-fetoprotein is a globulin protein

secreted by the yolk sac and by fetal liver cells during

hepatic cell multiplication. Highest amounts are found

during pregnancy and in hepatic cancer. Measurement

is usually performed from week 16 to 20 to help identify

fetal neural abnormalities, gastroesophageal atresia, and

nephrosis. Chromosome analysis of amniotic fluid cells

is performed by examining karyotyped cells for genetic

abnormalities such as Down syndrome, Tay-Sachs

disease, and other inborn errors of metabolism. Amniotic

fluid is examined for color and bilirubin level for purposes

of detecting fetal jeopardy or distress due to hemolysis

of fetal red blood cells. Erythroblastosis fetalis occurs

when maternal antibodies attack fetal RBCs, causing fetal

anemia. This occurs when the mother’s blood contains

the Rh factor that reacts with fetal erythrocyte antigens.

The test is usually performed at gestation week 24 or later

and can help determine the need for intrauterine fetal

blood transfusion.

Risks

Bleeding, intrauterine death, premature labor, spontaneous

abortion.

Contraindications

Abruptio placentae, incompetent cervix, placenta previa,