TRANSUDATES AND EXUDATES

• a mesothelial tissue which lines certain internal cavities of the body, forming a smooth, transparent, two-layered membrane lubricated by a fluid derived from serum.

  Serous membrane
• The peritoneum, pericardium, and pleura are serous membranes
• Fluids that are formed between the serous membrane:

  SEROUS FLUID
• lines the cavity wall,/outer layer

  parietal membrane
• covers the organ within cavity/inner

  visceral membrane
• closed cavities of the body: pleural, peritoneal, pericardial

  visceral membrane
• are formed as ultrafiltrate of plasma

  visceral membrane
• provide lubrication as the surfaces move against each other

  visceral membrane
• increased in serous fluid amount between the membranes, could either be transudates and/or exudates

  EFFUSION
• effusion -accumulation of fluid in an anatomic space
• -Serous effusions that results from disturbance of the fluid production and the regulation between

  serous membranes.

  TRANSUDATES
• TRANSUDATES -Causes :

  hypoproteinemia, nephritic syndrome, congestive heart failure
• -Are purulent (pus) fluids that form in any body cavity as a result of an inflammatory process

  EXUDATES
• (infections, malignancies)

  EXUDATES
• Specimen Collection and Handling of Effusions

  1. >100 ml is usually collected

  2. EDTA tube – for cell counts and differential

  3. heparin tube – chemical, serologic, microbiologic and cytologic analysis

  4. testing of transudates usually is not necessary

  5. most reliable differentiation between a transudate and exudates is obtained by determining the fluid

  to blood ratios for protein and lactic/lactate dehydrogenase (tissue damage)

  6. collected by needle aspiration (Fine Needle Apiration Biopsy)
• Differentiates transudates from exudates

  RIVALTA’S TEST / SEROSA MUCIN CLOT TEST
• RIVALTA’S TEST / SEROSA MUCIN CLOT TEST

  Acetic acid + water + unknown fluid
• RIVALTA’S TEST / SEROSA MUCIN CLOT TEST

  (+) result : heavy precipitation indicates that it is an

  exudates
• Collection method; thoracentesis

  PLEURAL FLUID
• Appearance: normal – clear / pale yellow

  PLEURAL FLUID
• -turbid – usually related to WBCs (infections)

  -bloody – hemothorax (traumatic injury) – pleural fluid Hct is more than 50% of WB Hct.
• -brown – rupture of amoebic liver abscess

  -black – aspergillosis

  -viscous – malignant mesothelioma (increased hyaluronic acid)

  -milky – maybe due to chylous (↑ Triglycerides) or pseudochylous effusions (↑ cholesterol)
• PLEURAL FLUID CHEMISTRY

  Glucose – parallel the plasma levels

  -Decreased in rheumatoid inflammation

  -Decreased in purulent infection
• increased in bacterial infection

  Lactate
• decreased in pneumonia (not responding to antibiotics)

  pH
• markedly decreased with esophageal rupture

  pH
• increased in tuberculosis and malignancy

  ADA (adenosine deaminase)
• increased in pancreatitis, esophageal rupture and malignancy

  Amylase
• *Pancreatitis

  *Pulmonary infarction

  Neutrophils
• *Tuberculosis

  *Viral infection

  * Autoimmune disorders

  * Malignancy

  Lymphocytes
• * Normal and reactive forms have

  no clinical significance

  * Decreased mesothelial cells are

  associated with tuberculosis

  Mesothelial cells
• Tuberculosis

  Plasma cells
• * Primary adenocarcinoma and

  small-cell carcinoma

  *Metastatic carcinoma

  Malignant cells
• termed as the mesothelium, is to provide a slippery, non-adhesive and protective surface

  Mesothelial cells
• plasma cells make antibodies to fight bacteria and viruses, to stop infection and disease.

  Mesothelial cells
• cancerous cells,has the ability to spread to other sites in the body (metastasize) or to

  invade nearby (locally) and destroy tissues., fast growing.

  Malignant cells
• PERICARDIAL FLUID Collection: pericardiocentesis (10-50 ml)
• A liquid that acts as a lubricant for the movement of the heart

  PERICARDIAL FLUID
• Found in small quantities between two layers of the pericardium

  PERICARDIAL FLUID
• Pericardial fluid is produced by mesothelial cells in the membranes and acts to reduce friction as the heart pumps blood.