Thread by @iamklubsybear

#Klubsycakes
SYNOVIAL FLUID
1. Synovial fluid or joint fluid is found in movable joints
(diarthroses)

2. Synovial fluid is formed as a non-selective ultrafiltrate of plasma across synovial membrane except for the exclusion of high molecular weight protein

3. Type B Synoviocytes = these are fibroblast-like cells with prominent endoplasmic reticulum located in a deeper layer of the synovial membrane and produces hyaluronic acid, fibronectin, and collagen to produce synovial fluid

4.Hyaluronic acid= a mucopolysaccharide protein that is major responsible for viscosity of synovial fluid. Polymerization of hyaluronate (hyaluronic acid) causes viscosity.

5. Type A synovioctes = are macrophage-like cells located in the superficial layer of the synovial membrane and play an important role in phagocytosis

6.Arthrocentesis = collection of synovial fluid by needle aspiration

NOTE!!!!!!
Yung pang collect = syringe moistened with heparin
Yung lalagyan = Evacuated tubes

7. Synovial fluid volume
Normal= less than3.5 ml or 0.1 to 3.5ml
Inflammation = >25ml

8. Normal synovial fluid does not clot when NO acetic acid is added

Normal synovial fluid will produce a good clot when acetic acid is added

9. SYNOVIAL FLUID TUBES (Strasinger, 7th edition)
TANDAAN IBA PO ITO SA CSF

Ito ang pang synovial fluid:
CHEM OR SERO —> MICROSCOPIC ANALYSIS, CELL COUNTING, & CRYSTAL IDENTIFICATION—> MICRO

#9

*Chem and glucose testing
= NO anticoagulant such as RED top
=Sodium fluoride (Gray) for glucose analysis

*HEMA /MICROSCOPIC EXAMINATION/CRYSTAL
IDENTIFICATION = Sodium heparin or LIQUID EDTA

*MICROBIOLOGY = Sterile red tap, Sodium heparin, or
SPS

10. Powdered anticoagulants should not be used
because they may produce artifacts that interfere with
crystal analysis.

11. Specimens for synovial fluid crystal analysis should
not be refrigerated because refrigeration can cause
them to produce additional crystals that can interfere
with the identification of significant crystals.

12. Normal synovial fluid appears colorless to pale
yellow

20.NORMAL WBC count in Synovial fluid?
ans: <200cells/ul

21. Synovial fluid differential count should be
performed on cytocentrifuged preparations or on thinly
smeared slides

22.Normal differential count (synovial fluid)
Monocyte and macrophages= 60 to 65%
Neutrophils = <25%
Lymphocytes= <15%

NOTE:
Mononuclear cells, including monocytes, macrophages,
and synovial tissue cells, are the primary cells seen in
normal synovial fluid

23. Ochronotic shards = ground pepper appearance
associated with Joint prosthesis and ochronosis

24. Rice bodies
*They are fragments of degenerating proliferative
synovial cells or microinfarcted synovium
*Resembles polished rice macroscopically
*Shows collagen and fibrin microscopically

25. RA cell (Ragocyte) = Neutrophil with dark
cytoplasmic granules containing immune complexes

26. Reiter cell = Vacuolated macrophage with ingested
neutrophils

27. LE cell = Neutrophil containing characteristic
ingested “Round homogenous body”. Found in SLE

28.Synovial lining cell= Similar to macrophage, but may
be multinucleated resembling a mesothelial cell

29. Hemosiderin = associated with Pigmented
villonodular synovitis

30. Yellow= parallel = (negative) Birefringence

31. Blue = perpendicular = (positive) Birefringence

32. Compensated polarizing microscope = it confirms
the type of birefringence (positive or negative). A red
compensator is used

33 . A control slide for the polarization properties of
MSU can be prepared using betamethasone acetate
corticosteroid.

34. Pseudogout = associated with degenerative arthritis,
producing cartilage calcification and endocrine
disorders that produce elevated serum calcium levels.

36.NORMAL SYNOVIAL FLUID GLUCOSE =
the difference is less than10mg/dl compared to blood glucose

FORMULA: Blood glucose – Synovial fluid glucose

36. SYNOVIAL FLUID GLUCOSE

NOTE!!
*Requires fasting for 8 hours
* Specimens should be analyzed within 1 hour or
preserved with sodium fluoride
*Marked decrease synovial fluid glucose is associated
with TYPE 2 AND SEPTIC ARTHRITIS
SYNOVIAL GLUCOSE LEVELS AND ASSOCIATED
CONDITIONS

36. SYNOVIAL FLUID GLUCOSE
*10 and 20 mg/dl less than plasma level =
noninflammatory arthritis, osteoarthritis, pigmented
villonodular synovitis, trauma, or hemangioma, or
hemorrhagic arthritis

36. SYNOVIAL FLUID GLUCOSE

*0 to 40 mg/dL less than plasma level = inflammation

*20 to 100mg/dl less than plasma level = infection

*0 to 80 mg/dl less than plasma level = crystal induced

37. Synovial LACTATE AND ACP = Maybe requested to
monitor the severity and prognosis of Rheumatoid
arthritis

38. Synovial Lactate Normal values = <250 mg/dl
*Levels greater than 9 mmol/L (81 mg/dL) indicate
bacterial arthritis – Strasinger, 7th edition.
*Increased in infections

39. NUMBER OF WBCS sa lahat ng types ng
joint disorders

#OF WBCs
<200= normal
200- 999 with <30% neutrophil =Non inflammatory
1000 and above with 50-70% neutrophil= inflammatory
50,000 to 10,000 with >75% neutrophil = Septic arthritis

40. An eosinophil of greater than 2 %is associated with
allergic disease with arthritis, hemorrhagic joint
effusion, Lyme disease, parasitic arthritis, RA, and
tubercular arthritis

41. Tests to positively identify a synovial fluid
ANS: Ropes test and Toluidine blue test

42. Synovial fluid total protein value = less than 3mg/dl

43, Organisms associated with joint infection
Staphylococcus aureus = most common
Streptococcus
Haemophilus
Neisseria gonorrheae = venereal arthritis
Chlamydia trachomatis = venereal arthritis
Borrelia burgdorferi = lyme disease
M.tuberculosis= osteoarticular tuberculosis

13. Normal viscous synovial fluid resembles egg white.

14.COLOR AND CLARITY
Turbid = WBC, Synovial cell debris, and fibrin
Deeper yellow= Inflammation
Greenish = bacterial infection
Red = traumatic tap or hemorrhagic arthritis
Milky= crystals

14. Normal synovial fluid viscosity
= string measuring 4 to 6 cm

15.Hyaluronate Polymerization test/Ropes/Mucin clot
test
Reagent: 2 to 5% acetic acid
Normal: synovial fluid forms a clot

Grading
Good = solid clot
Fair = soft clot
Low= friable clot
poor= no clot

16. WHAT TO DO IN VERY VISCOUS SYNOVIAL FLUID?
A. Pretreated by adding a pinch of hyaluronidase to
0.5ml fluid

B. Add 1 drop of 0.05% hyaluronidase in phosphate
buffer per ml of fluid and incubate at 37’C for 5 minute

17. What are the Diluting fluid used for cell counting in a
synovial fluid specimen?
ANS: NSS with methylene blue, Hypotonic saline 0.3%,
or Saline with saponin

18. Purpose of adding methylene blue in NSS for cell
counting?

Ans: stains the WBC nuclei, permitting separation of the
RBCs and WBCs during counts performed on mixed
specimens

19. In cell counting, do not use fluids that contain acetic acid to dilute synovial fluids because the acetic acid can cause mucin clot formation and cell clumping