AUBF BY SHAH SUNIL KUMAR

1. BODY FLUIDS
BOND KING (SUNIL)

2. TRANSUDATES
 Decrease plasma albumin
 Increase venous pressure
 Increase venous obstruction
 Cardiac failure
 Disturbance of circulation with passive
EXUDATES
 Damage of mesothelial linings
 Cause malignancy and infection.

3. CLINICAL CONDITION
1.TRANSUDATES
 Hypoproteinemia
 Congestive heart failure (weakness of heart)
 Liver cirrhosis
2.EXUDATES
 Fluid in lungs

4. DIFFERENT PARAMETERS TRANSUDATES EXUDATES
Origin Non- inflammatory Inflammatory
PH Alkaline Acidic
Sp. gravity < 1.018 > 1.018
Coagulation No clot formation clot formation( due to the
presence of fibrinogen)
Protein < 3 gm > 3 gm
Glucose Same with blood glucose Lower than blood glucose
LDH 200 IU/L > 200 IU/L
Chloride Lower than blood chloride Higher than blood chloride
Cells Less ( usually lymphocyte) Many ( neutrophils /
polymorphonuclear cells
(PMN))
Crystals Absent Present

5. Types of Exudates
1. Serous – pale yellow and contains few cells
2. Fibrinous – Dark yellow and contain fibrinogen
3. Serofibrinous – pale to dark yellow ; contains few
cells and fibrinogen.
4. Purulent – many pus cells (WBC) ; yellow green/
light brown.
5. Hemorrhagic – blood
6. Putrid – many pus cells; seen in Gangrene (death
of tissue)
7. Chylous – milky appearance ; contains fat
globules, pseudo globulin and lecithin ; associated
with thoracic duct destruction and brugia malayi
8. Serosanguinopurulent – combination of serous to
chylous ( bacterial infection , pus and blood
hemorrhage)

6. CEREBROSPINAL FLUID (CSF)
• Third major body fluid in the body
• Clear colorless fluid produced by highly vascular
chloride plexus of ventricles of the brain.
• 500 ml/day or 20 ml/hour

7. HISTORY
 Cotungo in 1764
 3rd major body fluid .
THE FLOW OF CSF
 70% CSF is derived by ultrafiltration and
secretions through choroid plexus.
 30% from ependymal lining of ventricle and
cerebral subarachnoid spaces.

8. Importance
 Act as a mechanical receptor (which prevents
the brain and skull from coming into contact).
 Serves as excretory channel(collect waste and
excrete out in the form of sweat , urine and
feces).
 Serves as nutrient to brain.
 Cushions to brain and lubricate the central
nervous system.

9. Importance of CSF Analysis
 To detect infection and to differentiate
meningitis( particularly bacterial meningitis).
 To detect CNS disorder
 To detect sub-arachnoid block. (Froin’s
syndrome) flow of CSF is abnormal.
METHOD OF COLLECTION
1. Lumbar puncture (to measure intercranial
pressure)
 Safe and simplest method for puncture
 Puncture in shrimp position.
 Lumbar 3 & 4 (adults)
 Lumbar 4 & 5 (children)

10. 2. Cisternal (occipital)
 Recommended in cases of paralysis and
meningitis.
3. Ventricular puncture (lateral cervical)
 Neck
 For infants
 Ventricular cannula.
* The length of syringe used for CSF collection
is 18 cm.

11. TUBES ( DISPOSABLE)
 1st tube – chemistry and serology (Red / yellow
top ; frozen)
 2nd tube – Microbiology section (black top ;
refrigerated not allowed)
 3rd tube – Hematology section (purple, EDTA,
Light blue, Green)
 4th tube – additional test (blue top; cytology)
Note:-
• If malignancy is suspect then only 4 th tube is used.
• Avoid glass tube becoz cell adhere to glass affecting
cell count.
• Perform immediately becoz of cell degradation.

12. Macroscopic Examination
 Volume – (90 - 170 ml)
 pH – (7.3 – 7.45) 7.31
 Specific gravity – 1.006 to 1.008
 Pressure – 50 – 200 mm H2O (90 to 180 mm
H2O) (adult)
 10 – 100 mm H20 (children)
 Clear; colorless
 Coagulation – normal CSF doesn’t clot
(transudate)
 Viscous as water

13. Clinical condition of fibrinogen in CSF
 Traumatic tap
 Froin’s syndrome
 Tubular meningitis/ sub acute meningitis
Symptoms of Meningitis
 Cob- web like clot
 Pellicle like clot (12- 24 hours after
refrigeration)
 Pine tree like clot.

14. Variation in color (clinical significance of CSF
Appearance)
1. Turbid (Tyndall effect)
 WBC ‘s - 200 cell/UL (associated with
meningitis)
 RBC ‘s – over 400/UL ( associated with
hemorrhage, traumatic tap)
 Microorganism – meningitis (viral, bacterial
etc.)
 Protein – Disorder of production of IgG in CSF
(blood brain barrier)

15. 2. Bloody (hemorrhage , lyses RBC’s , traumatic tap)
3. Xanthochromic (pale pink to orange yellow)
 Hemoglobin – old hemorrhage , lyses RBC in CSF.
 Bilirubin in CSF – RBC breakdown , increase serum
level
 Protein (150 mg/dl)
- RBC breakdown , increase serum level
- disorder affect blood brain barrier
 Melanin (Brownish color)
- meningeal melanosarcoma

16. Grayish / Greenish color of CSF
 Causes are acute meningitis, increase pus
cells.
Differentiate sub-arachnoid block from
traumatic Taps
Sub- Arachnoid Traumatic Tap
1. Even distribution of blood 1.Uneven distribution of blood
tubes 1-4
2. Clot formation(presence of 2. No clot
fibrinogen)
3.Presence of siderophage 3. Absence of siderophage
4.Quekensted test (+Ve) 4. D-dimer (-ve)

17. * Siderophage – macrophage with phagocyte
erythrocyte
# Quekensted Test
 Most useful method to detect sub-arachnoid
block.
 Done by comprising external jugular vein.
# Chemical examination of CSF
 Protein – over 80% from plasma
 Normal value – (15 – 45) mg/dl
 Increase CSF may found in Infection , meningitis
, multiple sclerosis and hemorrhage

18. QUALITATIVE TEST
1. Ross Jones ( excess of globulin in CSF)
2. Nonne apelt
 Reagent :- ammonium sulfate
 Presence of white ring of ppt give positive test
(both 1 & 2 )
3. Pandy’s test
 Reagent :- phenol
 Presence of bluish white cloud give positive test
4. Noguchi’s test
 10% of butyric acid
 Presence of ppt is positive test

19. QUANTITAIVE TEST
1. Turbidimetric Test (ppt is positive test)
 Reagent :- SSA (Sulfosalicylic Acid) and TCA
(Tricarboxylic Acid)
2. Nephelometric Test
 Reagent:-Benzyl chromium chloride (ppt is
positive test)
3. Dye binding technique
 Reagent :- Coomassie brilliant blue G250
 Blue ppt give positive test
4. Biuret Method
 spectrophotometer

20. Glucose in CSF
 Normal value – 50 to 85 mg/dl(approx.65 mg/dl)
 Increased
- Diabetes mellitus
- Infectious encephalitis
 Decreased
- hypoglycemia
- pyogenic meningitis
- Fungal meningitis
- Toxoplasmosis
- Subarachnoid hemorrhage
- primary tumor of brain

21. Comparison
Bacterial meningitis Viral meningitis Tubercular
Glucose Decrease Normal Decrease
Cells PMN lymphocyte lymphocyte
Note:- In case of glucose only Exudates decrease
but Transudates remains Normal.
Chlorides
 Normal value :- 113 – 127 MEQ/L
 Test :- schales and schales ; cotlove
chloridometer

22. Lactate
 Normal value : 10 -22 mg/dl (Newborn)
- (9 – 26)mg/dl (adult)
 As to detect viral from bacterial mycoplasma, TB
and fungal meningitis.
 Method:- Automated Analysers.
 Lactate > 35 – bacterial meningitis
 Lactate < 25 – viral meningitis
 Antibiotic therapy fall lactate level rapidly.

23. GLUTAMINE
 Normal value :- 8 – 18mg/dl
 Over 35 mg/dl – hepatic encephalopathy
 Reflects brain ammonia(ammonia + a-
ketoglutarate)
 In case of coma of unknown origin
 Reye’s syndrome – acute brain damage and liver
function

24. CSF ENZYME
LACTATE DEHYDROGENASE(LDH)
 Adult – 40 U/L
 Child – 70 U/L
Isoenzyme
 LD1 and LD2 – produced by brain cells.
 LD2 and LD3 – produced by lymphocyte.
 LD4 and LD5 – produced by neutrophils.

25. CREATINE KINASE
 Normal value - < 5 U/L (adult)
< 17 U/L (infants)
 CK-BB – brain is the isoform.
 CK-MM – muscle is the isoform.
 CK-MB – brain and muscle both is isoform.
Serologic Examination
 CEA – metastatic carcinoma
 hCG – choriacarcinoma and germ cell tumors.
 CSF ferritin – CNS malignancy ; patient with
inflammatory disease.

26. Microbiological Exam
# Staining
 Gram stain – most important to differentiate
bacterial pathogens.
 India Ink – Cryptococcus neformans
 Acid fast stain – TB agent
 Auramine - Rhodamine – TB agent
 Acridine agent – Differential amoeba (brick
red) from leukocytes (bright green)

27. # culture
Immunologic tests
1. Counter immunoelectrophoresis
Limited for the detection and identification of
 H. influenza – 1month to 5 years
 S. pneumoniae – 29 yrs old and above
 N. meningitidis – 5 to 29 yrs old
 E. coli - all age group
 Group B streptococci – all age group

28. Agglutination Tests
1. Latex Agglutination Test
 For bacterial antigen test (BATs) for
C. neoformans
2. ELISA
* Litmus lysate assay
 For the detection of presence of endotoxin.
 Sp.test for bacterial meningitis.