pleural fluid analysis
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Indications
- evaluation of pleural effusion
Clinical significance
- pleural fluid erythrocytes > 5000/uL
- bloody appearance
- associated with cancer, pulmonary infarction, asbestosis, trauma[3]
- hemothorax if pleural fluid hematocrit > 50% peripheral blood hematocrit[3]
- pleural fluid leukocytes > 50,000/uL
- parapneumonic effusions, emphyema[3]
- pleural fluid leukocytes > 10,000/uL
- pleural fluid leukocytes < 5000/uL
- chronic exudates, tuberculous pleurisy, cancer[3]
- pleural fluid lymphocytes > 80%
- tuberculosis, lymphoma chronic rheumatoid pleurisy, sarcoidosis, late post CABG effusion
- pleural biospy indicated in the absence of diagnosis[3]
- pleural fluid lymphocytes > 10%
- non-specific finding
- air or blood in pleural space
- parapneumonic effusion, drug-induced pleurisy, asbestosis, Churg-Strauss syndrome, lymphoma, pulmonary infarction, mycosis (coccidioidomysosis, crytococcosis, histplasmosis), parasitic infection[3]
- pleural fluid eosinophils >10%
- suggestive of air or blood in pleural space,
- parapneumonic effusion, drug-induced pleurisy, asbestosis, Churg-Strass syndrome, lymphoma, pulmonary infarction
- mycosis: coccidioidomycosis, cryptococcosis, histoplasmosis
- parasitic infection[3]
- pleural fluid glucose < 60 mg/dL
- pleural fluid lactate dehydrogenase (LDH)
- pleural fluid LDH > 0.6 x serum LDH &/or > 2/3 upper limit of normal for serum LDH is an exudate
- pleural fluid protein
- pleural fluid protein > 0.5 x serum protwein is an exudate
- pleural fluid adenosine deaminase for tuberculosis
- 60-70 U/L highly specific for Mycobacterium tuberculosis (tuberculous pleural effusion)
- value < 40 U/L virtually excludes tuberculosis[3]
Procedure
- pleural fluid Gram's stain
- pleural fluid cell count & differential
- pleural fluid amylase
- pleural fluid triglycerides (for chylothorax)
- pleural fluid microbiologic stains
- pleural fluid cultures
- pleural fluid cytology
- pleural fluid LDH (compared to serum LDH)
- pleural fluid glucose
- pleural fluid protein (compared to serum protein)
- 10) pleural fluid adenosin deaminase (for tuberculosis)
More general terms
References
- ↑ Manual of Medical Therapeutics, 28th edition, Ewald & McKenzie (eds) Little, Brown & Co, 1995, pg 259
- ↑ Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 771
- ↑ 3.00 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 3.10 Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 15, 16, 17. American College of Physicians, Philadelphia 1998, 2006, 2009, 2012, 2015
- ↑ Harrison's Principles of Internal Medicine, 13th ed. Isselbacher et al (eds), McGraw-Hill Inc. NY, 1994, pg 1146
- ↑ Rahman NM, Mishra EK, Davies HE, Davies RJ, Lee YC. Clinically important factors influencing the diagnostic measurement of pleural fluid pH and glucose. Am J Respir Crit Care Med. 2008 Sep 1;178(5):483-90. PMID: https://www.ncbi.nlm.nih.gov/pubmed/18556632 Free PMC Article