Pathological Analysis of CSF & Analysis of Sputum,Urine and Sperm

Pathology and Laboratory Medicine

Cerebrospinal fluid analysis:

Cerebrospinal fluid (CSF) is a clear colourless watery fluid present within the subarachnoid space surrounding the brain & spinal cord.

Its main function is protecting the brain & spinal cord from the injury.

Pathological Analysis of CSF & Analysis of Sputum,Urine and Sperm

Formation & composition of CSF:

CSF is secreted continuously at a rate of about 2 to 0.7 ml per min. Or 600 to 700ml per day. The total volume of CFS in adult range from 140 to 270ml.

Composition:

Protein

Glucose

Urea

Uric acid

Creatinine

Ammonia

Sodium

Potassium

Characteristic of CSF:

Colour less fluid & clear

Ph – 28 to 7.32

Specific gravity 003 to 1.004

No clot formation

Po2 – 40 to 44mm of hg

Indication of CSF analysis:

Meningitis

Encephalitis

Neuro syphilis

Subarachnoid haemorrhage

Collection of CSF:

CSF is usually obtained by lumber puncture or “spinal tap”. The procedure is typically performed under local anaesthesia using a sterile technique. A hypodermic or spinal needle is used to access the subarachnoid space and fluid collected. Fluid may be sent for biochemical, microbiological, and cytological, analysis

Procedure:

Position:

The patient is placed on their side (left is more common than right) & head flex so the chin is close to the chest, hunches the back, and brings knee toward the chest. It’s like a foetal position as much as possible. May also sit on a stool and bend their head and shoulders forward.

Site:– spinal needle is inserted between the lumbar vertebrae l3/l4, l4/l5 or l5/s1

Local anaesthesia :- 10ml lidocaine,1%,

Puncture: after 10min after of anaesthesia administration and aspirate the insert needle is inserted and aspirates the CSF.

FINDINGS:-

Colour :

yellow, orange or pink: xanthochroid  csf protein > 100mg/dl

Red blood cell lysis

Red blood cell> 100,000/mm3 (subarachnoid haemorrhage)

brown to dark CSF  : meningeal melanomatosis

Green CSF : hyperbilirubinemia

Cloudy or turbid:

CSF leukocytes > 200wbc/mm3

Red blood cells. 400per mm3

Red: refampicin therapy.

Pleural Fluid Analysis:

The pleura are thin membranes that line the lungs and the inside of the chest cavity and act to lubricate and facilitate breathing.

Accumulation of pleural fluid in pleural space or water on lungs it is known as pleural effusion

Appearance, colour & normal amount:

Normal pleural fluid is pale colour

Normal value of pericardial fluid is 10 to 20ml and pericardial fluid is clear

What is pleural fluid analysis:

Pleural fluid analysis is a test that examines a sample of fluid that has collected in the pleural space. This is the space between the lining of the outside of the lungs (pleura) and the wall of the chest. When fluid collects in the pleural space, the condition is called pleural effusion.

Procedure:

A procedure called thoracentesisis used to get a sample of pleural fluid. The health care provider examines the sample to look for:

Cancerous (malignant) cells

Other types of cells (for example blood cells)

Levels of glucose, protein and other chemicals

Bacteria, fungi, viruses, and other germs that can cause infections

Inflammation

Preparation For Procedure:

No special preparation is needed before the test. An ultrasound, ct scan, or chest x-raywill be performed before and after the test.

Do not cough, breathe deeply, or move during the test to avoid injury to the lung.

Doctor prescribed medicines to thin the blood.

Position:

For thoracentesis, you sit on the edge of a chair or bed with your head and arms resting on a table.

Cleans the skin around the insertion site. Numbing medicine (anaesthetic) is injected into the skin.

A needle is placed through the skin and muscles of the chest wall into the pleural space. As fluid drains into a collection bottle, you may cough a bit. This is because your lung re-expands to fill the space where fluid had been. This sensation lasts for a few hours after the test.

During the test, tell your doctor if you have sharp chest pain or shortness of breath.

FINDINGS:

Increase the level of pericardial fluid suggests the congestive cardiac failure.

Milky pericardial fluid  suggest  the TB

Analysis Of Peritoneal Fluid :

Peritoneal fluid analysis is also known as paracentesis or an abdominal tap. It’s a procedure that tests the fluid collected from the peritoneal space. Ascites is the accumulation of fluid (usually serous fluid which is a pale yellow and clear fluid) that accumulates in the abdominal (peritoneal) cavity. The abdominal cavity is located below the chest cavity, separated from it by the diaphragm. Ascitic fluid can have many sources such as liver diseasecancerscongestive heart failure, or kidney failure.

Normal level of peritoneal fluid is 50ml and clear in appearance and colourless.

FINDINGS:

Yellow : cirrhosis of liver , hepatitis, congestive cardiac failure

Green : cholecystitis, appendicitis, duodenal ulcer

Milky : nephritis, lymphoma

Bloody fluid: pancreatitis, rupture of spleen.

Analysis Of Synovial Fluid

Synovial fluid, also called Synovia, is a viscous, non Newtonian fluid in the cavities of synovial joint or found around the joint such as knee , ankle, hip, elbow, wrist and shoulder

Typical Characteristics Of Synovial Fluid:

Clear and colourless

White blood cell(WBC ) count: less than 200cells/micro litre

Viscosity : high

Glucose level: similar to that of the patient’s serum glucose level.

Procedure:

Synovial fluid is collected via arthrocentesis (needle aspiration). Sample volume depends on the size of the joint and the necessary tests. Generally, the volume of the few millilitres, but it can significantly increase in the presence of

FINDINGS:

Cloudy, yellow-green, more viscous, positive culture suggests septic condition

cloudy/turbid, dense yellow with crystals suggests inflammatory disease of nonimmunologic origin

Cloudy reddish, low viscosity, with WBC count equal to the blood count suggests hemorrhagic conditions.

Milky/cloudy suggests high number of crystals are present

Sputum Analysis :

When you a respiratory tract infection or a lung related disorder, your lungs produce a thick substance known as sputum. This substance can make it hard to breathe, because coughing, and harbour bacteria. Often the most difficult part of a sputum culture is getting enough material in a sputum sample for analysis  

Sputum is colourless watery and odourless tracheal bronchial secretion which is altered in the variety of condition. Affecting the lung and the tranche, bronchial.

Composition :

plasma

Electrolytes and water of sputum is trancheobronchial tree

Sputum collection:

The patient is instructed clear his mouth with water before collecting the sample.

The sputum must be coughed up the lung or the bronchi and should be collected carefully in the wide amount

Sterile glass and plastic container of about 50ml and must be closed

In early morning for the routine examination.

24hr sample for their examination  of tuberculin  bacilli

Examination of sputum:

Quality: normal morning sputum 5 ml and 24hr sample about 10ml.

Findings:

Greenish: rupture of liver

Bright red: TB and pulmonary infraction

Black: inhalation of cold dust of smokers.

Yellow: pulmonary infection.

Odour: foul smelling lung abscess and bronchiectasis and bronchitis.

Cheesy odour: malignant tumour of lung and emphyema.

Semen Analysis : a semen analysis also called “ seminogram”  it’s done to help evaluate male fertility, whether for those seeking pregnancy or verifying the success of vasectomy

Problem with male semen a count for 40% of infertility

Composition And Production Of Semen:

Sperm

Fructose

Prostaglandins

Alkaline fluid

Seminal plasmin: an antibiotic capable of killing bacteria in both male and female systems

Relaxing hormone that activates sperm by motility

Water

Semen consist spermatozoa are produce in testicles and mature in epididymis and store in epididymis until the ejaculation.

Semen is acidic it contain acid phosphatise and proteolytic enzyme.

Semen Collection :

The person has to be obtains from intercourse period at least 3days but not more than 5days

The patient has to evacuate the bladder before the ejaculation the sample should be collected in the privacy room or at the home.

Within 1hr the sample should be transported in the laboratory.

FINDINGS:

Colour and appearance: the normal semen is thick whitish to slightly yellowish fluid.

Pink to brownish suggests that blood urine and feces present

White clumps indicate pus and the presence of an infection in the reproductive tract of the male.

Yellow: pyospermia means inflammatory process in reproductive system or condition in which a number of white blood cells present in semen.

Volume :

Normal volume  is 2 to 5 ml

Decrease the volume  of semen known as hypospermia

Increase the volume  of semen known as hyperspermia

No production of semen known as Aspermia.

Urine Analysis :

Examination of urine is basic procedure should be carefully perform  to obtain the maximum and best result for the renal disorder

Pathological Analysis of CSF & Analysis of Sputum,Urine and Sperm

Composition Of Normal Urine :

The main composition of urine is 95% of water and remaining 5% composed of 2%urea and 3% divided between organic and inorganic substance.

Inorganic substance :  chloride, phosphorus, sulphur , sodium, potassium, calcium, magnesium and iron

Organic substance: uric acid, creatinine, ammonia and bicarbonate.

Collection Of Urine :

Urine is collection in plastic disposable urine container, a fresh, voided, clean, midstream, specimen of urine is collected.

Types of sample:

Morning specimen

Random specimen

Timed specimen

A :- 24hr specimen : it’s used for estimation of protein, sugar and electrolytes

B: – 12hr specimen: it’s useful for quantitative cell and creatinine.

C: – 2hours specimen: it’s useful for estimation of glucose.

Preservation of urine :

Examination of urine should be done within 1 to 2 hr when, if the examination  is delay, the chemical  reaction is occur and to prevent  the multiplication  of the bacteria

Examination Of Urine:

Volume: normal volume of urine is 2liter per day

If the volume of urine is greater than 2liter it’s known as polyuria.

If the volume is less than 500ml it’s known as oliguria.

If there is difficulty in urination or any painful micturition it is known as dysuria

If there is totally absence  of urine its known as anuria

Increase the urination during night time it’s known as nocturia.

Colour:

The normal colour of urine is amber yellow

Presence of protein in urine known as proteinuria

Presence of glucose its known as glycosuria

Presence of ketones its known as ketonuria

Presence of blood in urine known as hematuria

Presence of bilirubin its known as bilirubinuria

STOOL ANALYSIS :    

Stool examination is very useful in evaluation  of disorder of GI system

Collection Of Stool: the sample is transferred from a clean bed pan in the toilet.

Preservation:

Preservation of sample can be done by using  of 25ml formalin

ANALYSIS:

Colour:

The normal colour of stool is depending on diet and health.

Brown: human feces ordinarily has light to dark brown, which results from  a combination of bile, and bilirubin derivatives from dead red blood cells.

Black: presence of black stool suggest  the infection  of upper GI tract

Red colour stool suggest the bleeding  from the GI Tract

Presence of blood in stool known as melena

Presence of mucus or blood it’s known as dysentery.

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