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Official Journals By StatPerson Publication

Table of Content-Volume 12 Issue 2 - November 2019


 

 

Evaluation of serous effusions based on different routine parameters available in our set-up for serous fluid examination at a tertiary care hospital in Konkan region of Maharashtra, India

 

Shweta Joshi-Warpe1, Bhushan M. Warpe2*, Suvarna N. Patil3, Shraddha S. Desai4, Sujata Pawar5

 

1Assistant Professor (Pathology), 2*Associate Professor (Pathology), 3Medical Director, 4PG-DMLT (Technician),  5Associate Professor (Paediatric Nursing)  at Department of Pathology, B.K.L. Walawalkar Rural Medical College, Shree-Kshetra Dervan, Taluka– Chiplun,               District- Ratnagiri- 415606, State- Maharashtra, INDIA.

Email:shwetajoshi4422@yahoo.com, bhushan.warpe@gmail.com

 

Abstract               Background: The findings of Serous fluid study on routine examination vary at different regions of the country.                                            Aims and objectives were: 1) To study the spectrum of various disorders diagnosed on routine fluid examination.                                   2) To identify the utility of different parameters (like Proteins, Glucose, ADA, TLC, DLC, others) used while conducting routine fluid examination. 3) To type the serous effusions whether, transudate or exudate in routine fluid examination. Methods: Inclusion criteria- All serous effusion fluids like ascitic or peritoneal, pleural, pericardial fluids included in this study which came to our Pathology Department for routine fluid examination. Results: Total cases of serous effusion observed during the study were 177 in two years. Out of which, 91 cases were of pleural effusion (51.47%), 83 cases were of ascites (46.89%) and 3 cases with (1.69%) were of pericardial effusion. Pleural effusions were mostly seen in this study. Male cases were 59.3% while female cases were 40.6%, in this study. M:F ratio was 1.45:1. Maximum patients of pleural effusion were in an age group of 61-70 years. Maximum patient of ascites were in an age group of 51-60 years. Total 81 cases of exudative pleural fluid were noted with 56.25% of cases. 62 cases of exudative ascitic fluids were noted with 63.63% of cases. Exudates were more in number than transudates in this study. Conclusion: Body fluids are one of the unique specimens received in the laboratory that require multi-disciplinary testing. Complete fluid analysis can be done with nucleated cell counts with differential diagnosis, biochemistry, culture, cytology and flow cytometry. Accumulation of fluid in body cavities is a common manifestation of a wide range of diseases that frequently present to physicians. Combined analysis of laboratory data of serous fluid samples, clinical and pathological data is essential for establishing a differential diagnosis. Malignancy and tuberculosis having serous effusions were more commonly seen in our Konkan belt.

Key Words: Serous effusions, routine

 

INTRODUCTION

The serous body cavities are mesothelial-lined potential spaces that surround the lungs (pleura), heart (pericardium), and the abdomen and pelvis (peritoneum).1

The pleural space normally contains 0.1–0.2 ml/kg body weight of fluid, filtered from systemic capillaries down a small pressure gradient.2 The heart is located within a protective membrane called the pericardium. The fluid between the pericardial membranes is called serous pericardial fluid. Normally, only a small amount of fluid is present because the rates of fluid production and absorption are about the same.3

Diseases which disrupt this balance or damage the membrane, cause an effusion or accumulation of fluid. A peritoneal effusion is sometimes referred to as ascites or ascitic fluid.3 Effusions may be classified as transudates, exudates, chylous, or pseudo-chylous.1Serous effusions are classified as transudates or exudates on the basis of the fluid protein level. Classically, fluid protein level >3g/dl is an exudate and <3g/dl is a transudate, in the context of a normal serum protein level.2 In clinical practice, exudative effusions can be separated effectively from transudative effusions by using Light’s criteria on pleural fluids.4 This criteria classifies an effusion as exudate if one or more of the following are present: (1) the ratio of fluid protein to serum protein is greater than 0.5, (2) the ratio of fluid lactate dehydrogenase (LDH) to serum LDH is greater than 0.6, or (3) the fluid LDH level is greater than two thirds of the upper limit of normal for serum LDH.4

 

AIMS AND OBJECTIVES

  1. To study the spectrum of various disorders diagnosed on routine ‘serous’ fluid examination at our set-up of Konkan belt.
  2. To identify the utility of different parameters (like Proteins, Glucose, ADA, TLC, DLC, etc) used while reporting routine serous fluid examination.
  3. To type the serous effusions whether, transudate or exudate in routine serous fluid examination.

 

 

MATERIALS AND METHODS

The present study was hospital based, prospective observational study of two years duration from 01/07/2017 to 31/06/2019. The total number of cases obtained in the present study was 177.

Inclusion criteria: All serous effusion fluids like ascitic or peritoneal, pleural, pericardial fluids were included in this study which came to our pathology department for routine fluid examination.

Exclusion criteria: Fluids other than serous effusions like CSF, synovial fluid, fluids from cystic lesions, pus, broncho-alveolar lavage (BAL) were excluded from this study.

Serous fluid sample was received to Central clinical laboratory (CCL) from different Indoor patient department sections. As soon as fluid sample was received, it was labelled by comparing the sample with requisition form for Patient identification number, Name, Age, Sex, Lab number. After registration of sample, it was sent to clinical pathology section, where it was grossly examined for quantity, colour, appearance, deposit, coagulum, presence of blood. Half quantity of sample was then taken in a test tube, centrifuged at 2000rpm for 1 min. The supernatant was discarded and sediment was used for smear preparation i.e. Gram, ZN stains for bacteriological examination and Field stain for cellularity and differential count. Wet Films of sample were examined.

For Mounting of Neubauer’s chamber, 1:10 dilution of fluid (1drop of fluid + 9 drops of Turk’s fluid) was done. Waiting for 10 min for the cells to settle down, the Neubauer’s chamber was loaded with prepared solution. Wet film field smear and Neubauer’s chamber was checked under microscope for cell morphology, RBCs, atypical cells and TLC and DLC of given fluid. Then fluid was sent to biochemistry section for chemical examination, where protein, glucose and ADA of fluid were done. Reporting of fluid sample was done by pathologist.

Sample was preserved for 48 hrs after its receiving. Volume-1 to 2 mL of serous fluid is collected in Lavender-top (EDTA) tube or green-top (heparin) tube. Fluid should be examined within 2 hours of collection, if there is any delay, refrigerate fluid at 2°C to 8°C; it remains stable for 48 hours.5 The routine pleural fluid (PF) evaluation usually includes the following: cell count and differential; tests for protein, LDH, glucose, adenosine deaminase (ADA), cytology and, if infection is a concern, pH and bacterial and mycobacterial cultures.6 ADA measurement is cheaper, easier and quicker to perform than interferon gamma levels for diagnosing tuberculosis. ADA levels are increased in TB cases due to activated lymphocytes.4All types of peripheral blood cells may be seen in the various body fluids. Additionally, there are cell types that are seen only in specific types of fluid or have clinical significance when seen in that fluid.3 Total leukocyte and RBC counts are of limited value in body fluid analysis except in peritoneal fluid examination when diagnostic peritoneal lavage is performed.1 The differential cell count in pleural aspirates can aid in narrowing the differential diagnosis.2

Although other methods are available for detecting and differentiating WBCs in body fluids, manual microscopy is still considered the gold standard, despite its many limitations.6 For completely clotted serous fluid specimens, actual cell counts will not be performed. Morphology will still be assessed by cyto-centrifuged, stained slides. Routine cytological evaluations would be indicated to confirm or rule out suspected neoplastic or tumour cells, malignancy.5

 

OBSERVATIONS AND RESULTS

  • Total cases of serous effusion observed during the study were 177.
  • Out of these, 91 cases were of pleural effusion (51.47%), 83 cases were of ascites (46.89%) and       3 cases (1.69%) were of pericardial effusion.
  • Pleural effusions were maximum no in this study. 105 cases were males with 59.3 % and 72 cases were females with 40.6% in this study. M:F ratio was 1.45:1 in this study.
  • Maximum patients of pleural effusion were in an age group of 61-70 years.
  • Maximum patient of ascites were in an age group of 51-60 years.
  • Total 81 cases of exudative pleural fluid were noted with 56.25%. 62 cases of exudative ascitic fluid were noted with 63.63%. Exudates were more in number than transudates in this study.
  • 90.90% of transudative effusions were having protein levels <2.5 g/dL.
  • 93.75% of exudative effusion had >3.5 g/dL of protein level.
  • 87 % of transudates had > 110 mg/dL of glucose levels while 44.44% of exudates had glucose < 70 mg/dL.
  • 96% of transudates had TLC of <350/cumm.
  • 90.27% of exudates had TLC of >550/cumm.
  • ADA was performed in all 177 cases of serous effusions in this study. Maximum cases were having normal ADA levels. 38 cases of tuberculosis observed in this study were showing exudative effusions, 24 TB cases were showing suspicious of tuberculosis (30 to 60U/L), and 9 cases were of frank tuberculosis positivity (>60UL). 4 cases were having effusion under evaluation which had levels of ADA in a group of suspicious for TB (30-60U/L). Only one case of transudate was seen with frank TB and positive ADA levels.
  • Out of 177 cases of serous effusion, (71 cases), maximum number of cases were having malignancy with 40.11% followed by tuberculosis (21.46% with 38 cases) later, followed by 23 cases (12.99%) of liver pathology, based on clinical impression, in this study.
  • Exudates were more common than transudate effusions in malignancy followed by tuberculosis (40.11% & 17.5% respectively).
  • Transudate were more observed in cases with liver pathology (10.73%) followed by cardiovascular system pathology or heart failure (5%).
  • Amongst the pathological diagnosis of serous effusions, inflammatory smears were more in number, that is, 106 cases with 59.88%.
  • Among inflammatory smears, lymphocyte rich smears were frequent (45 cases with 59.88%).
  • Among the malignant cases (71 cases), serous effusions with impression as negative for malignant cells (50 cases with 28.24%) were more in number.
  • In bacteriological examination, Gram and Zn stains for AFB reported as negative were more common in this study.
  • Only 10 cases with 5.6% were Gram stain positive bacteria and 14 cases with 7.9% were Zn stain positive for AFB, in this study.
  • Analyse the following representative tables and charts for detailed knowledge of the above narration.

 Table 1: Site of serous effusions

Site of effusions

Total No of cases

Percentage

Pleural

91

51.47%

Ascitic

83

46.89%

Pericardial

03

1.69%

Total

177

100%

 

 

Table2: Gender wise distribution of serous effusions

Site of effusions

Gender

Percentage %

Male

Female

Male

Female

Pleural

51

40

28.81%

22.5%

Ascitic

53

30

29.94%

16.94%

Pericardial

1

2

0.56%

1.1%

Total

177

177

100%

100%

 

 

 

 

 

 

Table 3: Age wise distribution of serous effusions

Age group

Site of effusion

Pleural

Ascitic

Pericardial

11-20 years

3

0

0

21-30 years

15

8

0

31-40 years

11

9

1

41-50 years

16

18

1

51-60 years

14

21

1

61-70 years

17

17

0

71-80 years

9

8

0

81-90 years

6

2

0

Total

91

83

3

Table 4: Type of serous effusions

Site of effusion

Type of fluid

Percentage %

Transudate

Exudate

Transudate

Exudate

Pleural

10

81

30.30%

56.25%

Ascitic

21

62

63.63%

43.05%

Pericardial

2

1

6%

0.6%

Total

33

144

100%

100%

 

 

 

 

 

 

 

Table 5: Parameters analysed to type the serous effusion

Site of effusion

Protein (g/dl)

Total

Glucose (mg/dl)

Total

TLC ( /cumm)

Total

 

<2.5

2.5-3.5

>3.5

 

<70

70-110

>110

 

<350

350-550

>550

 

Transudate

30

01

02

33

02

02

29

33

32

01

00

33

Exudate

05

04

135

144

64

70

10

144

03

11

130

144

 

 

Table 6: ADA levels analysed in serous effusions

Type of effusion

 ADA levels (U/L)

Total

 Percentage %

<30

30-60

>60

<30

>60

Transudate

32

00

01

33

96%

3.03%

Exudate

102

33

09

144

70.83%

6.25%

 

 

 

 

 

 

Table 7: Cases of serous effusions with clinical diagnosis

Clinical Diagnosis

No of clinical cases.

Percentage %

1)Tuberculosis(TB)

38

21.46%

A)Pulmonary TB

31

17.51%

B)Abdominal TB

07

3.9%

2)CVS Pathology

09

5.0%

3)Respiratory Pathology

10

5.6%

4)Liver Pathology

23

12.99%

5)GIT Pathology

07

3.9%

6)Malignancy

71

40.11%

7)Effusion ↓ Evaluation

13

7.3%

8)Renal Pathology

05

2.8%

9) Others (pregnancy)

01

0.5%

Total

177

100%

 

Table 8: Clinical impression associated with type of effusions

Clinical Diagnosis

Type of effusion (Number)

Type of effusion (Percentage)

1)TB

Transudate

Exudate

Transudate

Exudate

A)Pulmonary TB

0

31

0

17.51%

B) Abdominal TB

0

7

0

3.9%

2)CVS Pathology

9

0

5%

0

3)Respiratory Pathology

0

10

0

5.6%

4)Liver Pathology

19

4

10.73%

2.25%

5)GIT Pathology

0

7

0

3.9%

6)Malignancy

0

71

0

40.11%

7)Effusion ↓ Evaluation

0

13

0

7.3%

8)Renal Pathology

5

0

2.8%

0

9)Others ( Pregnancy)

0

1

0

0.5%

 

 

Table 9: Pathological impression on routine examination of effusions

Pathological impression

Total No. of cases

Percentage

1) Inflammatory smears

  1. Neutrophils rich smears (NRS)

31

17.51%

  1. Lymphocyte rich smears (LRS)

51

28.81%

  1. Mixed inflammatory cell smears (MICS)

21

11.86%

  1. Florid mesothelial reaction (FMCR)

03

1.69%

Total Inflammatory cases

106

59.88%

2) Malignancy

 

 

 a)Negative for malignancy (NMC)

50

28.81%

 b)Suspicious of malignancy (SMC)

04

2.25%

 c)Positive for malignancy (PMC)

16

9.03%

Total Malignant cases

71

40.11%

Total

177

100%

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Table 10: Bacteriological examination of serous effusions

Site of Fluid

Gram stain

Zn stain

 

Positive

Negative

positive

Negative

Pleural

06

85

10

81

Ascitic

04

79

04

79

Pericardial

00

03

00

03

Total

10

137

14

163

Percentage

5.6%

77.40%

7.9%

92.09%

 

 

1

Pie chart 1: Bacteriological examination of serous effusion

 

DISCUSSION

The serous body cavities are mesothelial-lined           potential spaces that surround the lungs (pleura), heart (pericardium), and the abdomen and pelvis (peritoneum).1

Normally, movement of these organs is facilitated by a small amount of fluid, an ultra-filtrate of plasma. When production and resorption of this plasma ultra-filtrate are not properly balanced, fluid may accumulate within one or more serous cavities, resulting in a true fluid-filled cavity (effusion).1

Normally, there is just enough fluid between the two membranes to provide lubrication. The normal adult has just 5-15 mL of pleural fluid and less than 50 mL of peritoneal fluid.3 Serous fluids include pleural, pericardial and peritoneal fluids.3

Fluid may accumulate in the serous cavity space by a number of mechanisms: increased capillary pressure, decreased (more negative) intra-cavity pressure (e.g. atelectasis), decreased plasma oncotic pressure (e.g. hypoalbuminaemia), increased membrane permeability and obstructed lymphatic flow (e.g. malignancy or infection).7

Effusions may be classified as transudates, exudates, chylous or pseudochylous.1

Transudates are effusions that form as a result of a systemic disorder that disrupts the regulation of fluid balance, such as suspected perforation.

 

Transudate-Common causes •Left ventricular failure •Cirrhotic liver disease •Hypoalbuminaemia •Atelectasis •Peritoneal dialysis; Less common transudative causes: •Pulmonary embolus (10–20% are transudates)                           •Malignancy (5% are transudates) •Hypothyroidism •Mitral stenosis •Constrictive pericarditis •Urinothorax •Ovarian hyperstimulation •Meig’s syndrome.

 

Exudates are caused by conditions involving the tissue of the membrane itself, such as an infection or malignancy.3

Exudate-Common causes •Malignancy – primary / secondary / mesothelioma •Para-pneumonic effusion and empyema •Pulmonary embolus (with infarction) •Tuberculosis (TB); Less common exudative causes: •Rheumatoid arthritis •SLE •Other connective tissue disease •Benign Asbestos Pleural Effusion (BAPE) •Pancreatitis •Oesophageal rupture •After coronary artery bypass surgery  •Yellow nail syndrome  • Drugs • Fungal infections 

 

Chylothorax/pseudochylothorax:                                Cause: •Hydatid disease (ruptured cyst). Chylous effusions originate as a result of leakage from the thoracic duct, often secondary to obstruction or trauma. Pseudochylous effusions are caused by breakdown of cellular lipids in long standing effusions.


 

Characteristic

Transudate

Exudate

Appearance

Clear to pale yellow

Cloudy, bloody, or turbid

Specific gravity

Less than 1.015

Greater than 1.015

Total protein

Less than 2.5 g/dL

Greater than 3 g/dL

Fluid protein–to–serum protein ratio

Less than 0.5

Greater than 0.5

Lactate dehydrogenase (LDH)

 

Less than 2/3 the upper limit of normal serum LDH

Greater than 2/3 the upper limit of normal serum LDH

Fluid LDH–to–serum LDH ratio

Less than 0.6

Greater than 0.6

Fluid cholesterol

Less than 55 mg/dL

Greater than 55 mg/dL

WBC count

Less than 100 cells/microL

Greater than 1,000 cells/microL

Fluid/serum cholesterol ratio

<0.3

>0.3

Serum-fluid albumin gradient

>1.2g/dl

1.2g/dl or less.

 


If the patient has a transudative effusion, therapy should be directed toward the underlying heart failure or cirrhosis. If the patient has an exudative effusion, attempts should be made to define the etiology.4 The concept of transudate versus exudate, as determined by total protein measurements, is outdated and the use of serum-fluid albumin gradient as an indicator of portal hypertension is more accurate, not done currently at our set-up.

Pleural fluid is commonly straw-coloured; this appearance is typical of transudates but also frequently occurs with exudative effusions. Blood-stained fluid is suggestive of malignancy, pulmonary infarction, trauma, benign asbestos pleural effusion (BAPE) or effusions occurring after coronary artery bypass surgery.1 A pleural fluid haematocrit >50% of the individual’s peripheral blood haematocrit is diagnostic of a haemothorax. Aspiration of frank pus is diagnostic of empyema, and a putrid odour suggests anaerobic infection. Turbid pleural fluid may suggest empyema, although chylothorax may give rise to this appearance; the presence of a milky supernatant after centrifuging the sample implies chylothorax, whereas a clear supernatant (with clearance of cell debris) suggests empyema.4

Ascites is defined as pathological fluid accumulation within the abdominal cavity. The word ascites is derived from the Greek word ‘askos’, which means a bag or sack. Ascites usually carries an unfavourable prognosis.8 As many diseases can cause ascites, particularly cirrhosis, samples of ascitic fluid are commonly analysed in order to develop a differential diagnosis.8 Clinically, ascites is a consequence or complication of a number of diseases; including hepatic, cardiac, renal diseases, infection and malignancy.8 Mixed ascites occurs when cirrhosis is combined with a malignant or infectious process, which occurs in 5% of patients with ascites. Peritoneal carcinomatosis with or without liver metastases and tuberculous peritonitis are the most common causes of mixed ascites.1

 Cardiac-related ascites, for example, is a transudative process with a total protein level typically in the exudate range. The serum ascites–albumin gradient (SAAG), determined as the serum albumin concentration minus the ascitic fluid albumin concentration, is a more physiologically appropriate test.1

The heart is located within a protective membrane called the pericardium. The fluid between the pericardial membranes is called serous pericardial fluid. Normally, only a small amount of fluid is present because the rates of fluid production and absorption are about the same.3

 

Pericardial Fluid

Reference Value

Appearance

Clear

Colour

Pale yellow

Glucose

Parallels serum values

Red blood cell (RBC) count

None seen

White blood cell (WBC) count

Less than 300 cells/microL

Culture

No growth

Gram stain

No organisms seen

Cytology

No abnormal cells seen

 

 

 

 

 

 

 

 

 

 

 

 

 

Volume-1 to 2 mL of serous fluid is collected in Lavender-top (EDTA) tube or green-top (heparin) tube, ideally. If there is any delay in examination, refrigerate the fluid at 2°C to 8°C; it remains stable for 48 hours.5 When specimen volume is not limited, the specimen should be divided into heparin (7-10 mL) for lactate dehydrogenase, total protein, and glucose; heparin (7-10 mL) for Gram stain and/or acid-fast stain; EDTA (5-7 mL) for cell counts and differential; and 25 mL for cytologic examination.1

Gross examination can play a vital role in determining the pathogenesis of the effusion. Transudates are usually clear and pale yellow and do not clot.5 Cloudy or purulent fluid is most often associated with an inflammatory process. Hemorrhagic fluid might indicate a traumatic tap, malignant neoplasm, infarction, or trauma. A chylous fluid will appear turbid or milky, even after centrifugation. Pseudochylous effusions may be milky or greenish and have a sparkly sheen from the accumulation of cholesterol crystals.1 When the fluid is clear to straw-coloured, further workup is unnecessary unless chemical examinations indicate an exudative process.1

RBC count is of limited value in body fluids other than CSF. CSF is not a serous effusion. RBC counts should not be routinely performed on all serous and synovial fluids. If a haemorrhagic condition is suspected, a hematocrit may be used for confirmation. A hematocrit greater than 1 percent in pleural fluid is typically associated with malignancy. When the hematocrit is greater than 50 percent of the peripheral blood hematocrit, a true haemorrhagic condition is indicated.3

The nucleated cell count or WBC, is diagnostically important in CSF and synovial fluid, but has limited value in serous fluids. The type of cells seen in serous fluids has greater significance than the count itself. The total leukocyte count may be useful in distinguishing between peritoneal transudates (eg, in uncomplicated cirrhosis) from spontaneous bacterial peritonitis (SBP) caused by passage of bacteria from blood to ascitic fluid. 5 In some diseases, such as peritonitis, the total WBC and differential count has high sensitivity; whereas, in differentiating pleural effusions, it lacks the sensitivity required to be clinically useful.5

Lymphocytes are seen in variable numbers in most serous effusions. Plasma cells may be seen in fluid specimens of patients with rheumatoid arthritis, malignant disorders, tuberculosis, and other conditions associated with lymphocytosis.5 A lymphocytic pleural effusion is most often the result of viral infections, tuberculosis or malignancy. However, up to 10% of tuberculosis effusions are polymorph predominant and lymphocyte-rich exudates may also be caused by sarcoidosis, rheumatoid pleuritis, nonspecific inflammatory diseases and chylothorax.2

Neutrophils may vary in number, but predominance suggests a bacterial pneumonia, pulmonary infarction, pancreatitis or bacterial peritonitis.5 A predominance of polymorphonuclear cells reflects an acute process.2

Eosinophils can be seen in a wide variety of disorders, including pneumothorax, idiopathic effusions, infections, neoplasms, chronic peritoneal dialysis, congestive heart failure, vasculitis, and malignant lymphomas. Basophils are unusual in serous fluid, but usually accompany eosinophils.5 Seldom it is impossible to differentiate mesothelial cells from malignant cells. Mesothelial cells are seen in variable numbers in most effusions and are increased in sterile inflammations caused by conditions such as pneumonia, pulmonary infarction, and malignant disorders.5

In many inflammatory diseases, the cellular components in body fluids [cerebrospinal fluid (CSF), serous fluids] are increased, rendering essential diagnostic information. The diagnostic value of the total white blood cell count (WBC) and differential count has been evaluated extensively over the years and a remarkable amount of knowledge has been gained; yet, there is a great deal of clinical uncertainty whether the diagnosis should be based solely on these variables. When malignancy is suspected, the addition of tumour markers to the results of cytological analysis increases the rate of detection. Other biochemical markers are useful in specific circumstances involving serous effusion, such as amylase in effusions due to pancreatitis, or oesophageal rupture and triglycerides in chylothorax.

To diagnose tuberculous pleuritis among exudates, Pleural fluid adenosine deaminase (ADA) and Pleural fluid interferon-gamma exhibit high diagnostic accuracy. ADA is an enzyme that plays an important role in lymphoid cell differentiation and produced in increasing quantities by activated T-lymphocytes in response to pathogenic tuberculous bacteria. A pleural fluid ADA level greater than 40 U/L has a sensitivity of 90 to 100 percent and a specificity of 85 to 95 percent for the diagnosis of tuberculous pleurisy.4 Following were our findings for discussion with respect to other studies:

  • In study of our institute, we routinely examined serous effusions on the basis of physical examination, biochemical examination (protein, glucose, ADA), microscopic examination (TLC, DLC), cytology. Similar study was done by Najib M Rahman, et al. in pleural effusion: a structured approach to care in Churchill Hospital, Oxford, UK 2.

  • In our study, ADA levels were high in effusions with tuberculosis cases having exudative type fluid. Similar observations were obtained in study done by Jose M. Porcel, et al. in Diagnostic approach to pleural effusion in adults, Saint Thomas Hospital, Nashville, Tennessee.4

  • In our study, in TB cases, serous effusions showing decreased Glucose and raised ADA were observed. Similar findings were observed in study done by Lin-Lin Huang, et al. in Ascitic fluid analysis in the differential diagnosis of ascites: Focus on cirrhotic ascites.8

In our study, clinical diagnosis with Tuberculosis, Malignancy, GIT pathology, Respiratory and liver infections were seen. The maximum serous effusions were exudate.

    • Cardiac pathology, liver cirrhosis and alcoholic liver disease cases were having transudative type of effusions. Similar observations were observed in study done by Jose M. Porcel, et al. in Diagnostic approach to pleural effusion in adults at Saint Thomas Hospital, Nashville,Tennessee.4 Similar observations were also seen in study done by Kristin E. Baer, et al. in serous body cavity fluid examination.1

    CONCLUSION

    • Body fluids are one of the unique specimens received in the lab that require multidisciplinary testing. Complete fluid analysis can be done with nucleated cell counts with differential diagnosis, biochemistry, culture, cytology and flow cytology.

    • Accumulation of fluid in body cavities is a common manifestation of a wide range of diseases and frequently presents to physicians.

    • Combined analysis of laboratory data of serous fluid samples, clinical and pathological data is essential for establishing a differential diagnosis.

    • Malignancy and tuberculosis having serous effusions were more commonly seen in our institute.

     

     

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    • Rahman NM, Chapman SJ, Davies RJ. Pleural effusion : a structured approach to case. Br Med Bull. 2005;72:31-47.

    • Walters J. Hematology and the analysis of body fluids. 1996 Apr 29;2:4-29.

    • Porcel JM, Light RW. Diagnostic approach to pleural effusion in adults. Am Fam Physician 2006;73(7):1211-20. 

    • Fleming C, Russcher H, Lindemans J, de Jonge R. Clinical relevance and contemporary methods for counting blood cells in body fluids suspected of inflammatory disease. Clin Chem Lab Med. 2015;53;(11):1689-7060.

    • Porcel JM. Pearls and myths in pleural fluid analysis. Respirology 2011;16(1):44-52.

    • Jalal R, Aftab K, Hasan SH, Pervez S. Diagnostic value of clot examination for malignant cells in serous effusions. Cytopathology 2009;20(4):231-4.

    • Lin-Lin Huang, Harry Hua-Xiang Xia, Sen-Lin Zhu. Ascitic fluid analysis in the differential diagnosis of ascites : Focus on cirrhotic ascites. J Clin Transl Hepatol. 2014;2(1):58-64.